Semra Calangu

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

BackroundWe undertook a prospective study of all new central venous catheters inserted into patients in the intensive care units, in order to identify the risk factors and to determine the effect of glycopeptide antibiotics on catheter – related infections.MethodsDuring the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Data were obtained on patient age, gender, unit, primary diagnosis on admission, catheter insertion site, duration of catheterization, whether it was the first or a subsequent catheter and glycopeptide antibiotic usage.ResultsNinety-one (30.3%) of the catheters were colonized and infection was found with 50 (16.7%) catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32–4.81, p = 0.005). The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05–3.87, p = 0.03). The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49–5.51, p = 0.005). The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01). The most commonly isolated organism was Staphylococcus aureus (n = 52, 37.1%).ConclusionDuration of catheterization and catheter insertion site were independent risk factors for catheter related infection. Use of glycopeptide antibiotic during catheterization seems to have protective effect against catheter related infection.

Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin B and incomplete surgery: a case report

BackgroundMucormycosis (or zygomycosis) is the term for infection caused by fungi of the order Mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis.Case PresentationA 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. Mucormycosis was diagnosed based on these findings. Amphotericin B (AmBisome®; 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin B therapy was approximately 6 months and the total dose of liposomal amphotericin B used was 32 grams. Liposomal amphotericin B therapy was stopped six months later and oral fluconazole was started.ConclusionsAlthough a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone.

Extrapulmonary tuberculosis in immunocompetent adults

Tuberculosis continues to be a significant cause of morbidity and mortality. Although tuberculosis usually attacks the lungs, other organs can also be affected, leading to extrapulmonary tuberculosis (EPT) or disseminated tuberculosis. This study retrospectively analysed the incidence, clinical sites and risk factors for EPT in 252 patients with EPT between 1 January 1991 and 30 June 2003. EPT was defined as clinical, laboratory, imaging, and/or histopathological evidence of mycobacterial infection in a site other than hilar lymph nodes or lung parenchyma. In our study group, tuberculous lymphadenitis (36.5%) was found to be the most common clinical presentation of EPT. 119 (47.2%) patients developed the severe form of EPT, according to the WHO report, and 133 (52.8%) patients developed the less severe form. A case history of pulmonary tuberculosis was found to be a risk factor for the development of EPT (p<0.05). The study showed that EPT is still a public health problem. These findings suggested that pulmonary tuberculosis may play a critical role in the development of EPT. 12-month therapy may be chosen in patients with EPT considering acceptable adverse effects without relapses.

Risk Factors for Mortality of Nosocomial Bacteraemia in Intensive Care Units

Objective: The aim of this study was to follow critically ill patients prospectively in intensive care units (ICUs) to determine risk factors for mortality and outcome associated with nosocomial bacteraemia (NB). Subjects and Methods: A case-control study of 176 patients was conducted to identify the risk factors for mortality of NB in ICU patients. The study was performed in emergency, surgical and general surgical ICUs with 23 beds during a 15-month period. A total of 1,450 patients were admitted to the ICUs during the study period. The USA Center for Disease Control and Prevention definitions were used to diagnose nosocomial infections. Nosocomial bacteraemia was defined as the isolation of one or more organisms from blood cultures taken at least 48 h after admission, which were not related to a problem present on admission. An assessment of whether the isolated organisms represented true bacteraemia rather than contamination was made by clinical or laboratory evidence of infection. Results: A total of 214 bacteraemia episodes were found in the 176 patients (64 female, 112 male; 51.3 ± 21.3 years old), 90 of whom died and 86 survived. The bacteraemia rate was 12.1%. The most common etiological agents of bacteraemia were Klebsiella pneumoniae: 46 (21.5%), methicillin-resistant Staphylococcus aureus: 46 (21.5%), Pseudomonas aeruginosa: 32 (14.9%), and Escherichia coli: 20 (9.3%). Multivariate analysis showed that the requirement of mechanical ventilation for more than 7 days (p < 0.001), total parenteral nutrition (p = 0.034), inotropic drug (p < 0.001), and increased creatinine level (p = 0.034) were independent risk factors for mortality of NB in ICUs. Conclusions: Nosocomial infections caused by Gram-negative bacteria continue to be one of the major sources of morbidity and mortality.

Spontaneous ascitic infection in different cirrhotic groups: prevalence, risk factors and the efficacy of cefotaxime therapy.

Objective: To investigate the prevalence of spontaneous ascitic infection (SAI) in different cirrhotic groups, the risk factors for development of SAI, and the efficacy of cefotaxime therapy. Design: A prospective study. Setting: In‐patient clinic of a university hospital. Patients: Eighty cirrhotic patients with ascites were assigned to four groups: hepatitis B or D virus‐related 34, alcoholic 18, hepatitis C virus‐related 14, miscellaneous 14. Interventions: Paracentesis was performed on 80 patients during 92 consecutive hospitalizations. Ascitic fluid was cultured by the method of bedside inoculation of blood culture bottles with ascites. The patients with SAI were treated with cefotaxime (2g, three times daily, intravenously) for 5 days. Main outcome measures: Frequency of SAI in cirrhotic groups; clinical, bacteriological and biochemical findings of SAI; rate of recovery from infection. Results: Twenty SAI episodes (22%) were found in 16 patients; 8 episodes were spontaneous bacterial peritonitis, 2 bacterascites, and 10 culture‐negative neutrocytic ascites. SAI occurred more frequently in patients with hepatitis B or D virus‐related liver cirrhosis (32%) than in the alcoholic (6%, P<0.05), hepatitis C virus‐related (14%) or miscellaneous (14%) cirrhotic groups. In multivariate analysis, independent predictive factors associated with the development of SAI are chronic hepatitis B virus infection, ascitic fluid total protein and serum bilirubin. Escherichia coli was obtained in 5 of 10 positive ascitic fluid cultures. Cure of the infection was achieved in 95% of episodes. Hospitalization mortality rate in infected patients was 20%. Conclusion: Spontaneous ascitic infection occurs in approximately 20% of cirrhotic patients hospitalized with ascites. The patients with low ascitic protein concentration, high serum bilirubin level or hepatitis B virus cirrhosis are more predisposed to SAI. Cefotaxime may be an effective first‐choice antibiotic for ascitic fluid infection.

A randomised, multinational study with sequential therapy comparing ciprofloxacin twice daily and ofloxacin once daily

SummaryIn a multinational, open, randomised, controlled clinical study, 474 hospitalised patients with moderate or severe infections were treated with sequential regimens of ofloxacin or ciprofloxacin. Ofloxacin 400 mg once daily or ciprofloxacin 200 mg twice daily were given intravenously for at least 3 days followed by oral treatment with ofloxacin 400 mg once daily or ciprofloxacin 500 mg twice daily. Overall cure rates of 86.8% (85.7%) in the ofloxacin group and 89.6% (89.5%) in the ciprofloxacin group were achieved in the intention-to-treat analysis (per protocol analysis). The overall bacteriological response rate (ofloxacin 89.5%, ciprofloxacin 89.0%) was comparable to the clinical cure rate. Both drugs were well tolerated and adverse events were rarely observed. It is concluded that ofloxacin and ciprofloxacin can be used successfully in the treatment of hospitalised patients with aerobic gram-positive and gram-negative infections. Ofloxacin has the advantage of a oncedaily regimen, compared to the twice-daily regimen with ciprofloxacin.ZusammenfassungIn einer multinationalen, offenen, randomisierten, kontrollierten klinischen Studie wurden 474 hospitalisierte Patienten mit mittelschweren oder schweren Infektionen mit einer sequentiellen Therapie behandelt. Für mindestens 3 Tage wurde Ofloxacin 400 mg 1× täglich oder Ciprofloxacin 200 mg 2× täglich intravenös verabreicht. Anschließend wurde die Therapie oral fortgesetzt mit 400 mg Ofloxacin 1× täglich oder 500 mg Ciprofloxacin 2× täglich. Die Heilungsrate betrug 86,8% (85,7%) in der Ofloxacin- und 89,6% (89,5%) in der Ciprofloxacin-Gruppe in der „intention-to-treat“-Analyse („per-protocol“-Analyse). Die bakteriologische Wirksamkeit (Ofloxacin 89,5%, Ciprofloxacin 89,0%) war der klinischen Heilungsrate vergleichbar. Nebenwirkungen wurden selten beobachtet, die Verträglichkeit der beiden Therapien war gut. Die Ergebnisse haben gezeigt, daß Ofloxacin und Ciprofloxacin erfolgreich in der Behandlung hospitalisierter Patienten mit grampositiven (Aerobier) und gramnegativen Infektionen eingesetzt werden kann. Ofloxacin hat den Vorteil der Einmalgabe, Ciprofloxacin muß 2× am Tag verabreicht werden.In a multinational, open, randomised, controlled clinical study, 474 hospitalised patients with moderate or severe infections were treated with sequential regimens of ofloxacin or ciprofloxacin. Ofloxacin 400 mg once daily or ciprofloxacin 200 mg twice daily were given intravenously for at least 3 days followed by oral treatment with ofloxacin 400 mg once daily or ciprofloxacin 500 mg twice daily. Overall cure rates of 86.8% (85.7%) in the ofloxacin group and 89.6% (89.5%) in the ciprofloxacin group were achieved in the intention-to-treat analysis (per protocol analysis). The overall bacteriological response rate (ofloxacin 89.5%, ciprofloxacin 89.0%) was comparable to the clinical cure rate. Both drugs were well tolerated and adverse events were rarely observed. It is concluded that ofloxacin and ciprofloxacin can be used successfully in the treatment of hospitalised patients with aerobic gram-positive and gram-negative infections. Ofloxacin has the advantage of a oncedaily regimen, compared to the twice-daily regimen with ciprofloxacin. In einer multinationalen, offenen, randomisierten, kontrollierten klinischen Studie wurden 474 hospitalisierte Patienten mit mittelschweren oder schweren Infektionen mit einer sequentiellen Therapie behandelt. Für mindestens 3 Tage wurde Ofloxacin 400 mg 1× täglich oder Ciprofloxacin 200 mg 2× täglich intravenös verabreicht. Anschließend wurde die Therapie oral fortgesetzt mit 400 mg Ofloxacin 1× täglich oder 500 mg Ciprofloxacin 2× täglich. Die Heilungsrate betrug 86,8% (85,7%) in der Ofloxacin- und 89,6% (89,5%) in der Ciprofloxacin-Gruppe in der „intention-to-treat“-Analyse („per-protocol“-Analyse). Die bakteriologische Wirksamkeit (Ofloxacin 89,5%, Ciprofloxacin 89,0%) war der klinischen Heilungsrate vergleichbar. Nebenwirkungen wurden selten beobachtet, die Verträglichkeit der beiden Therapien war gut. Die Ergebnisse haben gezeigt, daß Ofloxacin und Ciprofloxacin erfolgreich in der Behandlung hospitalisierter Patienten mit grampositiven (Aerobier) und gramnegativen Infektionen eingesetzt werden kann. Ofloxacin hat den Vorteil der Einmalgabe, Ciprofloxacin muß 2× am Tag verabreicht werden.

The clinical and pharmacoeconomic analysis of invasive aspergillosis in adult patients with haematological diseases.

Invasive pulmonary aspergillosis (IPA) poses major management problems for clinicians caring for patients with haematological diseases. The clinical courses of patients with IPA who had been hospitalised in Hematology Unit, Bone Marrow Transplantation Unit and Infectious Diseases and Clinical Microbiology Unit between 1998 and 2005, the efficacy and adverse effects and costs of antifungal drugs (conventional amphotericin B deoxycholate, liposomal amphotericin B, amphotericin B lipid complex and caspofungin) used in the therapy of these patients were analysed in this study. Ninety‐three patients with IPA were reviewed retrospectively. Mean age of the patients was 40.4 ± 15.1 years (range 14–70 years). Fifty‐eight male patients and 35 female patients were included in the study. Manageable hypopotassemia, nausea/vomiting and headache were the most commonly observed side‐effects during antifungal (AF) therapy. While it was not found to be statistically significant with regard to the mean time to resolution of fever (P = 0.8), it was found to be statistically significant with regard to radiological regression at 30th day, and mean duration of therapy between patients who were dead or alive (P < 0.05, P < 0.001). Total cost of AF therapy for 93 patients was found to be US

Treatment of tuberculous meningitis in Turkey.

4 461 824 (minimum US

Neisseria meningitidis with Decreased Susceptibility to Penicillin in Istanbul, Turkey

387‐maximum US

Acute prostatitis as an uncommon presentation of brucellosis

279 023). Of this amount, US