Ferda Kahveci

Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases

Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms.

Comparison of SPECT findings and neuropsychological sequelae in carbon monoxide and organophosphate poisoning

Abnormal regional cerebral blood flow in patients with acute carbon monoxide (CO) and organophosphate (OP) poisoning was examined using 99m Tc-hexamethylpropylene amine oxime (HMPAO) brain single photon emission computed tomography (SPECT) in fourteen patients. We evaluated the predictive significance of acute phase brain SPECT findings for long-term neuropsychological sequelae. Changes were found in the frontal, temporal, parietal lobes within the first week after both types of poisoning. The distribution of the hypoperfused cerebral areas as demonstrated by 99m Tc-HMPAO imaging was similar in the two groups during the acute phase. Neuropsychological sequelae developed in five patients poisoned with OP and six with CO. Patients who had SPECT findings heterogeneously or in the temporal or frontal lobes displayed disorientation. Those with fronto-parietal and frontal lobe changes displayed mental confusion. Parkinsonism also was observed in patients with parieto-occipital, parietal and frontal lobe lesions. The distribution of these lesions appears to predict the long term sequelae of these poisonings, though additional studies with larger numbers of patients are needed to confirm the role of SPECT imaging in both OP and CO poisonings.

Persistence of candiduria in ICU catheterized patients is not linked to adherence and proteolytic activities of Candida strains.

ObjectiveIn this study, the patients who developed asymptomatic candiduria in the intensive care unit were followed prospectively for the persistence of candiduria after the replacement of indwelling urethral catheter and the correlation between persistence and virulence factors (proteinase enzyme activity and epithelial adhesion) was assessed.DesignProspective study.SettingIntensive care unit and mycology laboratory at a university hospital.PatientsThirty-four patients with asymptomatic candiduria were included in the study.ResultsCandiduria persisted in 19 of 34 patients(56%; group 1) and cleared in 15 of 34 patients(44%; group 2) after urinary catheters were changed. When the virulence factors (epithelial adhesion and proteinase activity) and distribution of Candida spp. were compared between two groups, no statistically significant correlation was found.ConclusionThe host immune response might be more important than virulence factors of Candida spp. for persistence of candiduria.

Influences of alternate therapy protocol and continuous infectious disease consultation on antibiotic susceptibility in ICU.

Abstract In this study, the effects of alternate use of imipenem and cefoperazone/sulbactam(CFP/Sul) on antibiotic resistance in the intensive care unit (ICU) were investigated. Between 1 April 1993 and 1 April 1994, the infectious diseases consultant saw patients when required and there was no alternative therapy for antibiotics. For the following 2 years, the same consultant followed up each patient from admission to discharge by daily visits to the ICU and an alternative therapy protocol was initiated. The most common microorganisms were found to be Acinetobacter baumannii and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae, respectively, in the two periods. This study demonstrated that sensitivity rates of imipenem, ciprofloxacin and aminoglycosides were improved as a result of this protocol.

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

BackgroundThe prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey.MethodsA total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded.ResultsOf the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients.ConclusionsA high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.Trial registrationClinicalTrials.gov ID NCT03249246. Date: August 15, 2017. Retrospectively registered.

Persistent hypoxemia during extracorporeal membrane oxygenation in delayed diagnosed paraquat intoxication

Paraquat is a highly toxic herbicide used in agriculture worldwide that causes progressive pulmonary fibrosis (PF) due to selective accumulation in the lungs. Paraquat intoxication can result in death due to multi-organ failure within a few days or respiratory failure due to PF within a few weeks. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is currently a widely used therapeutic strategy for acute respiratory distress syndrome (ARDS). Presently described is case of a 46-year-old man who was hospitalized with ARDS and treated with V-V ECMO. Expected oxygenation levels could not be attained despite ECMO support. When excluding causes for hypoxia in this patient on ECMO, detailed medical history revealed exposure to paraquat 3 weeks previously. Severe hypoxemia persisted during V-V ECMO and the patient died on sixth day after admission. The aim of this study was to examine probable causes of persistent hypoxemia during V-V ECMO observed in this case.

A Rare Cause of a Pressure Ulcer: A Single Hair

Pressure ulcers are the loss of tissue and remain a common problem in critically ill patients. These patients are at high risk for developing pressure ulcers because of their hemodynamic instability, malnutrition, and strictly limited physical activity and mobility due to neurological damage or drugs such as sedatives and muscle relaxants. Pressure is the most important cause of pressure ulcers. Contact surfaces such as patient’s bed or wheelchair, and some medical devices such as pulse oximetry probe and urethral catheter can result in pressure. The case is reported here of a very rare cause of a pressure ulcer, which was a single hair on the patient’s face.

Pandemic Influenza A (H1N1) Infection and Subconjunctival Hemorrhage: Report of Three Cases.

Subconjunctival hemorrhage (SCH) is defined as blood between the conjunctiva and the sclera. It can be caused by heavy lifting, coughing, and vomiting or by some infectious diseases. While conjunctivitis due to H1N1 influenza is reported, there is no SCH reported in the literature subsequent to H1N1 infection. We describe SCH in three patients with pandemic influenza H1N1 infection who were treated in intensive care unit (ICU). The first case is a 25-year-old pregnant woman with a 5-day history of runny nose mild cough and unilateral SCH. The second patient is a 37-year-old woman, with the diagnosis of pandemic H1N1 infection and diagnosed with bilateral SCH. Lastly, the third patient, a 49-year-old woman, was admitted to ICU with a 4-day history of cough, sputum and shortness of breath and diagnosed with bilateral SCH after 13 days of stay in ICU. None of these patients complained about visual changes, lacrimation or pain. Any increase in severity of SCH did not occur, and the findings resolved spontaneously within a few days in all patients. These cases suggest that intensivists and ophthalmologists should be aware of ocular manifestation such as subconjunctival hemorrhage in patients with H1N1 infection.

Evaluation of a clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia

The most important dilemma in the diagnosis of ventilator-associated pneumonia (VAP) based on only clinical findings is overdiagnosis. The aim of the study is to prospectively evaluate the Clinical Pulmonary Infection Score (CPIS) in relation to VAP diagnosis.