Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in the treatment of brucellosis

PubMedID: 12235463Objective: The aim of this study was to compare the efficacy, tolerability and side effects of 2 treatment regimens for brucellosis. Methods: Fifty-seven patients with brucellosis were followed up in our clinic. The patients were given rifampicin plus doxycycline or rifampicin plus quinolone. Thirty patients (group one) received rifampicin 600mg/daily plus doxycycline 100mg twice daily and 27 patients (group 2) received quinolones (ofloxacin 200mg twice daily peroral) plus rifampicin 600mg/daily. Both regimens were administered for 45-days. During the course of treatment, patients were followed for the disappearance of physical signs and symptoms. All patients were followed up at least 6-months after cessation of therapy. Diagnosis of brucellosis was established by utilizing the following criteria; Isolation of brucella species in blood, body fluids (Sceptor, Becton-Dickinson, United States of America), compatible clinical picture supported by the detection of specific antibodies at significant titers or demonstration, or both, of an at least 4 fold rise in antibody titer in serum specimens taken after 2-weeks. Significant titer was determined to be >one/160 in the standart tube agglutination test (Brucella abortus Cromatest, Linear Chemicals, Spain). Results: Of patients 14 (24.5%) were male and 43 (75.5%) were female. Mean age was 36.8 ± 11.3 years (range 15-65). Sacroiliitis was the most common involvement in both groups 9 (30%) versus 6 (22%), followed by peripheral arthritis 6 (20%) versus 6 (22%). In this study, relapse rate was found 7.2% and 6.7% for ofloxacin plus rifampicin and doxycycline plus rifampicin for a 6-week therapy (p>0.05). No significant adverse effects were associated with either combination. Conclusion: These results indicated that a 45-day course of doxycycline plus ofloxacin combination was as effective as the doxycycline plus rifampicin combination in patients with brucellosis

A clinical review of 40 cases with tuberculous spondylitis in adults

The purpose of this clinical review was to review clinical presentations, laboratory, and radiologic findings and difficulties on management of tuberculous spondylitis from a series of 40 cases. We carried out a retrospective analysis of 40 adult patients (50% male) with tuberculous spondylitis between January 1997 and December 2003. Infection was diagnosed in patients having a presentation compatible with characteristic histologic and/or microbiologic evidence of tuberculous spondylitis and diagnostic radiographic features, or following adequate response to antituberculous therapy with highly suggestive imaging features. Outcome was assessed according to clinical, radiologic, and laboratory criteria. Mean age was 44.7±19 years. Thirty percent of patients had a history of contact with a patient having active pulmonary tuberculosis. The most frequent symptom and sign were back pain (92.5%) and, spinal tenderness (55%). Magnetic resonance imaging was found to be the most helpful technique for diagnosis. Lumbar spine was the most common affected region (82.5%). Thirty (75%) patients had paraspinal abscess and, 4 (10%) had concomitant sacroiliitis. Spinal biopsy had a yield of 76.5%, 52.9%, and 47% granulomas, positive culture, and acid-fast smear, respectively. Resistance to antituberculous drugs was 44.4%. Although medical treatment alone was given in 15% cases, 85% required additional surgical intervention. The mean duration of therapy was 12±12 months. The improvement without sequela was 77.5% of the patients. In developing countries, diagnostic delay in tuberculous spondylitis is still common and disastrous. Bacteriologic confirmation and susceptibility testing should be achievable in all adult cases. © 2006 Lippincott Williams & Wilkins, Inc

Clinical appearance of brucellosis in adults: Fourteen years of experience [Erişkinlerde brusellozun klinik görünümü: Ondört yıllık deneyim]

Aim: To indicate the clinical course and results of brucellosis in our region during the recent years, and to compare these findings to the literature. Materials and methods: This study was based on a review of the medical records of adult patients older than 14 years who were followed with the diagnosis of brucellosis from March 1997 to October 2010. Results: Included in this analysis were 317 patients, including 136 males (43%), with an average age of 40 ± 17 years. In 66 patients (21%), reproduction of Brucella was identified in the blood. Of the patients, 61% were identified as having the acute form, 35% the subacute form, and 4% the chronic form. Arthralgia, fever, weight loss, sacroiliitis, and spondylitis were the most frequent symptoms and findings accompanying the disease. There was a significant relationship between advanced age and the development of both spondylitis and arthritis (P = 0.000 and P = 0.028, respectively). Furthermore, there was a significant relationship between a high erythrocyte sedimentation rate and the presence of spondylitis, sacroiliitis, and visceral abscesses (P = 0.001, P = 0.013, and P = 0.049, respectively). Conclusion: This study provides a review of the disease and its complications. Osteoarticular involvement, and particularly the presence of spondylitis in patients and the complications in elderly patients, should be studied. Laboratory parameters, the patient's age, and the duration of symptoms may help to identify complicated cases. © TÜBİTAK

Furuncular Myiasis Caused by Dermatobia hominis in a Traveler Returning from the Amazon Jungle

PubMedID: 29035248A 39-year-old man who was returning from the Amazon Jungle and had no medical history presented with a furuncular lesion on his right parietal scalp. Despite receiving appropriate antimicrobial treatment, his lesion did not heal. After surgical intervention, a Dermatobia hominis larva was extracted. The human botfly D. hominis is the most common causative agent of furuncular myiasis among travelers returning from Central and South America. Surgery is the main treatment option, and secondary bacterial infection should be kept in mind

Hospital-acquired bloodstream infections in cancer patients between 2005 and 2007 in a Turkish university hospital

Objective: This study is aimed to determine the local profile of blood culture isolates and changes in the susceptibility patterns to guide the antibiotic therapy in oncology and haematology units. Methods: Microbiologically documented hospital-acquired bloodstream infections were reviewed between 2005 - 2007 as a part of infection control surveillance in haematologyoncology department of a university hospital. Results: 194 microorganisms were isolated in 170 bloodstream infections episodes. Among these episodes, 79,1% (n=31), 80,9% (n=51) and 70,5% (n=48) were monomicrobial in years 2005, 2006 and 2007, respectively. Among the isolated 194 microorganisms, the ratio of the gram-negative bacteria were slightly increasing throughout these three years; 68,9%, 70,4% and 77%, whereas the gram-positive bacteria were decreasing 31,1%, 23,9% and 19,2%, respectively and Candida species were the cause of 4 episodes (5,6%) in 2006 and 3 episodes in 2007 (3,8%) (p>0.05). The majority of the cases were primary bloodstream infections. The most prevalent secondary cause of bacteremia was urinary tract infections in year 2005 and 2007 and pneumonia in 2006. Extended spectrum beta lactamases (ESBL) rate among E.coli and Klebsiella spp. isolates were 69,6%, 40% and 79,2% in years 2005, 2006 and 2007 respectively. Vancomycin resistance was high; 15/20 among Enterococcus species in the three years. The most effective agents against gram negative bacteria were aminoglycosides and carbapenems. Conclusion: As a conclusion, gram negative microorganisms especially the Enterobacteriaecea are the major cause of bacteremia in haematology and oncology patients. Due to the high resistance rates, antibiotic therapy should be selected strictly. © Under License of Creat ive Commons Attribution 3.0 License

The causes of postoperative meningitis: The comparison of gram-negative and gram-positive pathogens

PubMedID: 30192362AIM: To determine the microbiological etiology in critically ill neurosurgical patients with nosocomial meningitis (NM) and to show the impact of Gram-negative rods and the differences between patient characteristics and the clinical and prognostic measures in Gram-negative and Gram-positive meningitis. MATERIAL and METHODS: In this prospective, single-center study, we reviewed all adult patients hospitalized during a 12-year period and identified pathogens isolated from post-neurosurgical cases of NM. Demographic, clinical, and treatment characteristics were noted from the medical records. RESULTS: Of the 134 bacterial NM patients, 78 were male and 56 were female, with a mean age of 46±15.9 and a median age of 50 (18-80) years. One hundred and forty-one strains were isolated; 82 (58.2%) were Gram-negative, 59 (41.8%) were Grampositive. The most commonly isolated microorganism was Acinetobacter baumannii (34.8%). Comparison of mortality data shows that the patients who have meningitis with Gram-negative pathogens have higher mortality than with Gram-positives (p=0.034). The duration between surgery and meningitis was shorter in Gram-negative meningitis cases compared to others (p=0.045) but the duration between the diagnosis and death was shorter in Gram-positive meningitis cases compared to Gram-negatives (p=0.017). Cerebrospinal fluid protein and lactate levels were higher and glucose level was lower in cases of NM with Gram-negatives (p values were respectively, 0.022, 0.039 and 0.049). CONCLUSION: In NM, Gram-negative pathogens were seen more frequently; A. baumanni was the predominant pathogen; and NM caused by Gram-negatives had worse clinical and laboratory characteristic and prognostic outcome than Gram-positives. © 2018 Turkish Neurosurgical Society

Brucellar and tuberculous spondylitis in 87 adult patients: A descriptive and comparative case series

Our aim was to compare the clinical and evaluative features of a series of cases with spondylitis of the 2 most frequent etiologies, brucellosis and tuberculosis, in Turkey.Of the 87 patients with spondylitis, 44 had brucellosis and 43 had tuberculosis. Patients with tuberculosis were more likely to have a history of pulmonary disease, longer time to diagnosis, and higher erythrocyte sedimentation rates and C-reactive protein levels. Fever, night sweating, and arthralgia were more frequent complaints in brucellosis, whereas weakness and neurological involvement were in tuberculous spondylitis. Vertebral destruction and compression, kyphosis, paraspinal masses, and cord compression were more frequent in tuberculosis. Sacroiliitis and discitis were significantly associated with brucellosis. Need for surgical treatment, unfavorable outcome, and death were more common in tuberculosis.In countries with high prevalence of both diseases, documented history, clinical presentation, laboratory and histological examination, and radiographic imaging can be highly suggestive and sufficient for empirical treatment. © 2008 Lippincott Williams & Wilkins, Inc

Colonization and resistance patterns of gram-positive and gram-negative bacteria in patients had no recent history of hospitalization

OBJECTIVE

Investigation of the antibiotic susceptibility patters of pathogens causing nosocomial infections

PubMedID: 15494811Objective: The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years. Methods: This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria (390 Gram-negative, 180 Gram-positive) against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase (ESBL) production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips. Results: Meropenem was the most effective antibiotic against Gram-negative organisms (89.0%); this was followed by imipenem (87.2%) and piperacillin/tazobactam (66.4%). The most active antibiotic against Gram-positive bacteria was imipenem (87.2%) and this was followed by piperacillin/tazobactam (81.7%) and meropenem (77.8%). The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year (21.7%, 22.1% and 45.5%). All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates. Conclusion: As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance

Antibiotic resistance in community-acquired urinary tract infections: Prevalence and risk factors

PubMedID: 20424552Background: This study aimed to identify the agents causing community-acquired urinary tract infections (CAUTIs) and their resistance patterns and to investigate risk factors for ESBL production. Material/Methods: Patients diagnosed at the Department of Infectious Diseases in the Cukurova University School of Medicine Hospital with CAUTI between January 2006 and April 2007 were included prospectively. Patient data were recorded and the microorganisms and their sensitivity patterns were evaluated by the university's central microbiology laboratory. Results: A total 146 patients with CAUTIs, 109 women and 37 men (mean age: 50.9±18.44 years), were included in the study. The most common infectious agents were Escherichia coli (76.9%), Klebsiella pneumoniae (9.2%), Proteus mirabilis (4.1%), and Enterococcus spp. (1.6%). The ciprofloxacin resistance rate for E. coli was 35% and resistance to TMP-SMZ 43%, whereas amikacin resistance was substantially low (3%). Four of 12 K. pneumoniae strains were resistant to ciprofloxacin and 2 to TMP-SMZ. Resistance to amikacin was not found in the K. pneumoniae strains. ESBL production was identified in 25 of the 112 E. coli and K. pneumoniae strains. A history of a UTI within the last 6 months (p=0.029) and a history of frequent UTI (p=0.028) were found to be significant risk factors for ESBL production by univariate analysis. The only independent risk factor was a history of urinary system infection in the past 6 months (p=0.025) according to multivariate regression analysis. Conclusions: These high resistance rates to antimicrobials and particularly the extremely high rate of ESBL production in CAUTI should be carefully considered. © Med Sci Monit, 2010