Kivanc Serefhanoglu

Bloodstream infections caused by ESBL-producing E. Coli and K. pneumoniae: risk factors for multidrug-resistance

This prospective case-control study was conducted from October 2003 to June 2007 to evaluate risk factors for multidrug resistance among extended-spectrum-b-lactamase-producing Escherichia coli and Klebsiella spp. (ESBL-EK) isolates in blood cultures. All adult patients (>18 years old) whose blood cultures grew ESBL-EK during the study period were included. An ESBL-EK isolate was defined as MDR if it was resistant to at least one member of following two classes of antibiotics: aminoglycosides (amikacin, gentamicin, or netilmycin) and fluoroquinolones (ofloxacin, or ciprofloxacin). Case patients were those with a MDR ESBL-EK isolate, and control patients were those with a non-MDR ESBL-EK isolate. A total of 94 bloodstream infections, including 37 (39,4%) bloodstream infections with ESBL-producing E. coli and 57 (60,6%) with ESBL-producing K. pneumoniae,in 86 patients were enrolled. Thirty episodes (31.9%) were due to MDR ESBL-EK. The only independent risk factor for MDR ESBL-EK was duration of hospitalization before bacteraemia (OR 3.88; 95% CI 1.55-9.71; p=0.004). The rate of multidrug resistance among ESBL-EK bloodstream isolates was high, and duration of hospitalization before bacteraemia was the only indeepended risk factor for the MDR ESBL-EK bloodstream infections.

Evaluation of Oxidative Status in Patients with Brucellosis

Oxidative stress can be defined as an increase in oxidants and/or a decrease in antioxidant capacity. We aimed to determine total antioxidant capacity (TAC), total peroxide, malondialdehyde and catalase levels in plasma samples, and calculation of oxidative stress index (OSI) in patients with brucellosis to evaluate their oxidative status using a novel automated method. Sixty-nine patients with brucellosis and 69 healthy control subjects were included in the present study. Plasma levels of total peroxide and malondialdehyde were significantly increased in patients as compared with healthy controls (p<0.001 and p<0.001, respectively). In contrast, TAC level was significantly lower in patients as compared with controls (p<0.001). There was no statistically significant difference between the catalase results of the two groups (p>0.05). OSI level was significantly increased in patients as compared with healthy controls (p<0.001). In conclusion, oxidants were increased and antioxidants were decreased in patients with brucellosis. Oxidative stress was increased in patients with brucellosis.

Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis

BACKGROUND/PURPOSE The objective of this study was to describe factors associated with bloodstream infections (BSIs) with non-albicans Candida species (NAC), compared with Candida albicans BSIs, and antifungal susceptibility patterns in adult intensive care unit (ICU) patients with chronic renal failure undergoing hemodialysis. To the best of our knowledge, this is the first study to report the potential factors for NAC candidemia in ICU patients with end-stage renal disease on chronic hemodialysis. METHODS This prospective, observational, multicenter study was conducted in the two centers of Baskent University between January 2007 and July 2010. All adult patients excluding patients with neutropenia, malignancy, glucocorticoid treatment or AIDS, were included. RESULTS Sixty cases (58.8%) of candidemia were due to C. albicans and 42 (41.2%) to NAC. Multivariate regression analysis revealed that the presence of a central venous catheter was the only risk factor independently associated with BSI due to NAC (p=0.046, odds ratio: 5.90, 95% confidence interval: 1.032-33.717). Mortality was more frequent in those with NAC than C. albicans BSIs (64.3% vs. 55%), but the difference was not significant (p=0.067). Except for two Candida glabrata strains, which were dose-dependently fluconazole susceptible, all Candida species were susceptible to fluconazole, caspofungin, voriconazole and amphotericin B. CONCLUSION Central venous catheterization was the only factor significantly associated with BSI due to NAC in ICU patients with end-stage renal disease.

A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis

Brucellosis is a systemic infection involving many organs and tissues. The musculoskeletal system is one of the most commonly affected. The disease can present with sacroiliitis, peripheral arthritis, spondylitis, paraspinal abscess, bursitis, and osteomyelitis. A 25-year-old male patient was admitted with fever of 20-day duration, right-sided hip pain, and night sweating. A Brucella standard tube agglutination test was positive at a titer of 1/160. Magnetic resonance imaging (MRI) of the hip joint showed right sacroiliitis and a hyperintense, nodular, lobulated mass within the right iliacus muscle, consistent with abscess. The patient was started on intramuscular streptomycin at a dose of 1 g/day, oral rifampin 600 mg/day, and doxycycline 200 mg/day. On day 20 of treatment, the patient was admitted with swelling and pain over the left elbow for the past week. MRI of the left elbow was performed, which showed fluid edema suggestive of olecranon bursitis. Taking the patients complaints into consideration, rifampin and doxycycline treatment were maintained for a year. Pain at the hip joint and elbow resolved and MRI findings disappeared. Abscess of the iliacus muscle, which has not been reported before, and the olecranon bursitis that developed during treatment make this case worth presenting.

Bacteremia among liver and kidney transplant recipients: etiologic agents and antimicrobial susceptibilities

Dear Editor,In this retrospective study, we compared eti-ologies and antibiotic susceptibility patterns among kidney and liver transplant recipi-ents with bacteremia in two 1-year periods, 2005 and 2009. Time of bacteremia onset were computed in the two post-transplant periods, first six months (early period) and more than six months (late period) after the transplantation. Clinical characteristics including age, sex, previous antibiotic or antifungal therapy within three months, co-morbidities, central venous catheterization (CVC), mechanical ventilation, cytomeg-alovirus (CMV) disease, hemodialysis after transplantation, intra-abdominal drainage or biliary stenting, origin of bacteremia, al-lograft dysfunction, mortality, microbiolog -ical isolates, total parenteral nutrition were collected for the analysis. There were 14 bacteremic episodes among six kidney and eight liver recipients in the year 2005, and there were 23 episodes among six kidney and 17 liver recipients in the year 2009. Characteristics of the episodes in the two study periods of 2005 and 2009 were similar. Overall, there were 15 bacteremic episodes in the early period and 22 in the late period. Trimethoprim-sulphamethoxazole (TMP-SMX) prophylaxis (n = 13

Effect of cefazolin prophylaxis on postoperative infectious complications in elective laparoscopic cholecystectomy: a prospective randomized study.

Background In patients with symptomatic cholelithiasis, laparoscopic cholecystectomy (LC) is the standard method of treatment. Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure. Objectives This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy. Additionally, we determined the risk factors of cases with postoperative infection. Patients and Methods A total of 753 patients were enrolled in the study. Among these, 206 were excluded from the study. As a result, 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospective study. Patients were randomized consecutively and divided into 2 groups: patients in the cefazolin (CEF) group (n = 278) received 1 g of cefazolin and those in the control group (n = 269) received 10 mL of isotonic sodium chloride solution. Patient characteristics and overall surgical outcomes were compared between the groups. All patients were followed for development of postoperative infections. Results Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group; no significant difference existed in this regard(P = .44). Risk of infection increased in patients with previous cholecystitis and/or endoscopic retrograde cholangiopancreatography (P < 0.001), patients with ruptured gallbladders, and patients for whom a suction drain was used (respectively, P < 0.001 and P < 0.001). Conclusions No correlation existed between cefazolin prophylaxis and postoperative infections in elective laparoscopic cholecystectomy patients. There may be an increased risk of infection in patients with previous cholecystitis or endoscopic retrograde cholangiopancreatography. In addition, there was an increased risk of postoperative infection in patients with gallbladder rupture and suction drain use.

Reply to “Non-albicans Candida related candidemia among patients with chronic hemodialysis in the intensive care unit: True incidence or cluster infections?”

We appreciate Dr Pan’s interest in our article on risk factors for candidemia with non-albicans Candida spp. among patients with end-stage renal disease in the intensive care unit. Dr Pan suggested that cluster infection should be ruled out by genetic identification. Although genotyping was not performed in our study, and of course cluster infection cannot be ruled out, no infectious outbreaks caused by Candida spp. were reported during the study period (conducted for more than 3 years in two centers). These factors decreased the possibility of the cluster infection effect. In addition, the primary purpose of the original study, which was to describe factors associated with bloodstream infections with non-albicans Candida species compared with bloodstream infections caused by Candida albicans, was not affected verymuchwhen the cluster effect was present. Therefore, Dr Pan’s argument is not valid.