Le Grand écho du Nord de la France

31 mars 19381938/03/31 (A120,N90).Appartient à l’ensemble documentaire : NordPdeC

Effects of mannose-binding lectin and mannose-binding lectin polymorphisms on treatment response in patients with chronic hepatitis C

Background/Aims: The natural course and clinical outcome of hepatitis C virus (HCV) infection is related to the interaction between HCV and the immune response of the host. Only a limited number of studies have investigated the role of mannose-binding lectin (MBL) levels in HCV infection. The aim of the present study was to explore the relationship between MBL levels and gene polymorphisms on treatment response in patients with chronic hepatitis C (CHC).Materials and Methods: Serum MBL levels from 50 CHC patients who completed treatment at least 24 weeks before the present study and 75 healthy HCV-negative controls were measured. In addition, the presence of codon 54 mutations was investigated. Correlational analyses were performed to determine relationships between MBL levels and treatment response.Results: In patients, mean serum MBL levels were lower and the rate of codon 54 mutations was higher. However, these differences were not statically significant. In both patients and controls, serum MBL levels were significantly lower in individuals with codon 54 mutations. Moreover, serum MBL levels and the rate of the codon 54 mutation were similar in patients regardless of treatment response.Conclusion: Our findings suggest that low MBL levels do not increase the susceptibility for HCV infection. Furthermore, MBL levels were not found to have a significant effect on the course of the disease or treatment response.Background/Aims: The natural course and clinical outcome of hepatitis C virus (HCV) infection is related to the interaction between HCV and the immune response of the host. Only a limited number of studies have investigated the role of mannose-binding lectin (MBL) levels in HCV infection. The aim of the present study was to explore the relationship between MBL levels and gene polymorphisms on treatment response in patients with chronic hepatitis C (CHC).Materials and Methods: Serum MBL levels from 50 CHC patients who completed treatment at least 24 weeks before the present study and 75 healthy HCV-negative controls were measured. In addition, the presence of codon 54 mutations was investigated. Correlational analyses were performed to determine relationships between MBL levels and treatment response.Results: In patients, mean serum MBL levels were lower and the rate of codon 54 mutations was higher. However, these differences were not statically significant. In both patients and controls, serum MBL levels were significantly lower in individuals with codon 54 mutations. Moreover, serum MBL levels and the rate of the codon 54 mutation were similar in patients regardless of treatment response.Conclusion: Our findings suggest that low MBL levels do not increase the susceptibility for HCV infection. Furthermore, MBL levels were not found to have a significant effect on the course of the disease or treatment response

Daptomycin Experience Between Years 2009-2013: Review of 139 Cases

Introduction: Daptomycin is an agent effective on gram-positive pathogens, which has been used since 2009 for skin and soft tissue infections and endocarditis. In this study, our aim was to see how daptomycin was used in our hospital besides clinical studies, and determine the characteristics of the patients and responses to treatment. Materials and Methods: The patients who were started on daptomycin between 2009 and 2013 were retrospectively evaluated. Demographic characteristics, the clinics of the patients, underlying diseases, infection data, isolated microorganism, treatment and clinical response, and adverse events were recorded. SPSS v20.0 was used for analysis. Results: The mean age of 139 patients were 52.9 ± 16.4, and 48.2% of the patients was male, 51.8% was female. Of the patients, 52 (37.4%) were treated for skin and soft tissue infection; whereas, 53 (38.1%) had osteomyelitis,16 (11.5%) had prosthetic infections, seven had primary blood stream infections (three port infections, three catheter associated bacteremia and one laboratory confirmed bacteremia), four had endocarditis, three had septic arthritis, and four had other infections. Treatment was started empirically in 77% of the patients (n= 107). Eighty-six microorganisms were isolated, of which 68.6% was gram positive and 30% was gram negative. Only ten patients (7.2%) had used glycopeptides before. End of treatment response was 85.6% (119/139) for all patients and 87.7% (50/57) for patients whose specimens yielded gram-positive microorganism. Twelve patients had adverse events (8.6%). The adverse events were seven possible eosinophilic pneumonia, two CK elevations, one palpable purpura, one rash, and one renal function impairment. Conclusion: Daptomycin is an alternative choice for complicated patient groups with complicated skin and soft tissue infections and osteomyelitis, randomized controlled studies especially on bone and joint infections are needed in the future

Stenotrophomonas maltophilia Infections from 2007 to 2011

Introduction: Stenotrophomonas maltophilia is a gram-negative microorganism with low virulence, which is commonly found in environmental, water, plant, and animal sources. It usually causes nosocomial infections in the presence of abnormal host defenses. Being seen in various clinical situations, it attracts attention with its high mortality and resistance to antibiotics. In this study, it was aimed to evaluate the properties of infections caused by S. maltophilia and their change over time and to determine the antibiotic susceptibility patterns of the pathogens. Materials and Methods: The clinical features, risk factors and results of nosocomial infections caused by S. maltophilia in our hospital’s intensive care units between January 2007 and December 2011 were evaluated retrospectively. Results: Sixty-eight S. maltophilia infections were detected in 63 patients. The infection rate was calculated as 0.32 per 1000 patient days and 2.75 per 1000 admissions, and a statistically significant decrease was detected. The median age was 10 (0-83) years and 55.6% of the patients were male. Median time to infection was 17.5 (1-232) days. Most of the diagnoses were pneumonia (ventilator-associated pneumonia 55.4%, nosocomial pneumonia 14.7%) and blood stream infections (catheter-associated BSI 20.6%, laboratory-confirmed BSI 5.9%). Accompanying pathogens were detected in 61.8% of the patients, and the most common were Acinetobacter baumannii and Pseudomonas aeruginosa. The most commonly seen underlying conditions were hematogenous malignancies (20.6%), renal failure (10.3%), and diabetes mellitus (10.3%). The most common risk factors were detected as antibiotic usage (91.2%), mechanical ventilation (72.1%), and respiratory failure (64.7%). The most commonly used antibiotic groups were glycopeptides (69.1%), carbapenems (64.7%), and aminoglycosides (45.6%). Mechanical ventilation (p= 0.029), urinary catheterization (p= 0.014) and hospitalization more than 14 days (p= 0.046) were identified as risk factors associated with mortality. The most effective antibiotics were trimethoprim-sulfamethoxazole (81.8%), colistin (73.9%) and levofloxacin (73.5%). Conclusion: Evaluation of the risk factors and application of appropriate infection control measures would be more effective than treatment of these infections with this resistant microorganism, which carries high mortality

Causative Pathogens at Hip and Knee Prosthetic Joint Infections, Treatment Regimens and Evaluation of Prognosis

Introduction: Prosthetic joints, increasingly used in recent years, raises the prosthetic joint infections which are important due to increased mortality, morbidity and cost. Appropriate treatment protocols according to the patient and sufficient time for treatment are vital. This study aimed at identifying the source of infection, microorganisms, risk factors, treatment strategies and prognose for the patient diagnosed with hip prosthetic joint infection and followed at our hospital and thereby contributing to future patient management. Materials and Methods: The files of patients admitted to our Clinical Microbiology and Infectious Diseases and Orthopedics inpatient and outpatient clinics, diagnosed with knee and hip prosthetic joint infection and treated and followed between 1998-2009 were respectively examined. Results: Mean age of the 88 patients of whom 57 were female (64.8%) was 58.8 ± 15.9. The most frequent reason of prosthesis insertion for the patients was trauma (n= 36) (40.9%) and the most frequent symptom was pain 80 (90.9%). The stages in the emergence of symptoms were as follows; early stage in 36 (40.9%) patients delayed stage in 18 (20.5%) and late stage in 34 (38.6%). Previous surgery at the same joint was associated with infection (p= 0.008). The most frequent isolated microorganisms in both discharge and perioperative cultures were coagulase negative staphylococcus. The discharge and perioperative cultures were consistent in 24 (53.3%) patients. The pathogen could not be isolated in 17 (19.3%) of the patients. The mean level of CRP and ESR were high. In the patients who underwent two-stage revision, good result rate was higher (75.9%) (p= 0.016). The total treatment time for hip and knee prosthetic joint infections in the patient with good results was longer (p< 0.001 and p< 0.001 respectively). Conclusion: Pathogen isolation in prosthetic joint infections is important since it determines the surgery method and antimicrobial treatment. In addition, a prolonged antimicrobial treatment accompanied by appropriate surgical method for the patient makes the eradication of infection possible

Vitamin D Düzeyleri ve Kronik Hepatit B: Bir İlişki Var mı?

Amaç: Yapılan çalışmalar sonucunda vitamin D’nin hücre farklılaşması, proliferasyonun inhibisyonu ve immun modulasyon gibi çok önemli biyolojik etkilerinin olduğu gösterilmiştir. Vitamin D düzeylerinin, hepatit B virüs (HBV) enfeksiyonu gibi viral enfeksiyonlara karşı immün sistem ve konak yanıtını etkileyebileceği düşünülmektedir. Bu çalışmanın amacı vitamin D düzeyleri ve kronik HBV enfeksiyonu arasında ilişki olup olmadığını araştırmaktır. Gereç ve Yöntemler: Hastanemiz Enfeksiyon Hastalıkları polikliniğine kronik HBV enfeksiyonu tanısıyla Ocak ve Mart 2013 tarihleri arasında başvuran hastalar çalışmaya dahil edilmiştir. Kontrol grubu olarak aynı zaman aralığında polikliniğe başvuran ve kronik herhangi bir hastalığı olmayan hastalar alınmıştır. Bulgular: Doksan hasta ve 76 kontrol hastası, çalışmaya dahil edildi. Kontrol grubunun 33’ü (%42,2) ve olgu grubunun 39’u (%43,3) erkekti. Olgu ve kontrol grubunun ortalama yaş ve vitamin D düzeyleri sırasıyla; 39,9±13,3 yıl ile 43,0±13,3 yıl ve 11,7±6,6 ng/ml ile 16,2±8,7 ng/ml idi. Vitamin D düzeyleri olgu grubunda anlamlı derecede düşüktü (p0,05). HBV DNA ve vitamin D düzeyleri arasında bir korelasyon tespit edilmedi. Sonuç: Olgu-kontrol düzeni ile tasarlamış olduğumuz bu çalışmada vitamin D düzeyleri kronik HBV’li hastalarda daha düşük bulunmuştur. Vitamin D’nin kronik HBV seyri üzerindeki etkisini net olarak gösterebilmek için daha detaylı tasarlanmış, prospektif ve kontrollü çalışmalara ihtiyaç vardır.Objective: It has been shown that vitamin D has very important biologic effects including cell differentiation, inhibition of proliferation and immune modulation. Vitamin D levels may affect the immune system and host response to viral infections, such as hepatitis B virus (HBV) infection. Our aim in this study was to see whether or not there is a relationship between vitamin D levels and chronic HBV infection. Materials and Methods: Patients who were admitted to the infectious diseases outpatient clinic with chronic HBV infection between January and March 2013 were enrolled as cases. Controls were chosen randomly among individuals admitted to the outpatient clinic at the same time period and otherwise healthy. Results: Ninety chronic HBV cases and 76 controls were included in the period of study. Thirty-three (42.2%) of the control and 39 (43.3%) of the case groups were male. The mean age and vitamin D levels of the case and control groups were; 39.9±13.3 years, 43.0±13.3 years and 11.7±6.6 ng/ml, 16.2±8.7 ng/ml, respectively. Vitamin D levels were significantly lower in the case group (0.05). There was no correlation between HBV DNA and vitamin D levels. Conclusion: Vitamin D levels were found to be lower in chronic HBV patients in our study which was designed as case-control. Prospective, well-designed and controlled studies are needed to show its effect on the course of chronic hepatitis B

Akut Karaciğer Yetmezliğinin Tedavisinde Plazmaferez: Olgu Sunumu ve Literatür İncelemesi

Akut karaciğer yetmezliği (AKY) altta yatan hastalığı olmayan kişilerde bile oldukça zor yönetilen bir ölümcül durumdur. Bu olguda, transplantasyonun bir seçenek olmadığı kolestatik fulminant hepatit için tedavi önerisini paylaşmak istedik. Otuz altı yaşında orak hücreli anemisi (OHA) ve glukoz 6 fosfat eksikliği olan bir hasta sarılık ve ateş ile başvurdu. Yatış sırasında, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), total bilirubin, direk bilirubin ve INR seviyeleri 335 mg/dl, 430 mg/dl, 30 mg/dl, 18 mg/dl ve 1,2 idi. HBsAg pozitif ve HBV DNA 64.000.000 IU/ml idi. Üçüncü haftada ALT, AST, total bilirubin ve direk bilirubin seviyeleri yükselerek 270 mg/dl, 460 mg/dl, 71 mg/dl ve 47 mg/dl oldu. Uluslararası normalleştirilmiş oran (UNO) uzaması eşlik etti ve ensefalopati gelişti. Entekavir 1x1 mg ve taze donmuş plazma tedavisi başlandı. Hasta kötüleşmeye devam etti ve MELD skoru 38 olarak hesaplandı. Iki kez plazmaferez uygulanması sonrasında ALT, AST, total bilirubin, direk bilirubin ve UNO seviyeleri 30 mg/dl, 90 mg/dl, 9 mg/dl, 4 mg/dl, 1,2'ye düştü. Genel durumu düzelen hasta taburcu edildi. Karaciğer transplantasyonunun tedavi seçeneği olmadığı hastalarda veya transplantasyon beklenen durumlarda plazmaferez tedavide düşünülebilir.Acute liver failure (ALF) is a fatal and challenging disease even for patients without underlying diseases. In this paper, we aimed to share our opinion about a treatment option for cholestatic fulminant hepatitis where transplantation is not an option. A 36-year-old male with sickle-cell anemia (SCA) and G6PD deficiency presented with jaundice and fever. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin and international normalized ratio (INR) levels were 335 mg/dl, 430 mg/dl, 30 mg/dl, 18 mg/dl and 1.2, respectively at the admission. HBsAg was positive. Hepatitis B virus (HBV) DNA was 64.000.000 IU/ml. On the third week of admission, ALT, AST, total bilirubin and direct bilirubin levels increased up to 270 mg/dl, 460 mg/dl, 71 mg/dl and 47 mg/dl, respectively. INR prolongation accompanied. Hepatic encephalopathy developed. Entecavir 1x1 mg and fresh frozen plasma was started. The condition of the patient continued to deteriorate and, MELD score was 38. After two sessions of plasmapheresis, ALT, AST, total bilirubin, direct bilirubin and INR levels decreased to 30 mg/dl, 90 mg/dl, 9 mg/dl, 4 mg/dl, 1.2, respectively. The patient was discharged eventually. Plasmapheresis can be thought as treatment for patients in whom liver transplantation is not an option or for patients pending transplantation

Causative Pathogens at Hip and Knee Prosthetic Joint Infections, Treatment Regimens and Evaluation of Prognosis

Giriş: Son yıllarda giderek artan oranlarda kullanılan protez eklemler beraberinde protez eklem infeksiyonlarını da gündeme getirmektedir. Protez infeksiyonları artmış mortalite ve morbidite oranları ve maliyeti nedeniyle de önemini korumaktadır. Protez eklem infeksiyonlarında etkene ve hastaya göre uygun tedavi protokollerinin seçilmesi ve yeterli süre tedavi verilmesi hayati önem arz etmektedir. Bu çalışma ile hastanemizde diz ve kalça protez eklem infeksiyonu tanısı alan, tedavi ve takip edilen hastaların infeksiyon kaynağı, etken mikroorganizmalar, risk faktörleri, tedavi stratejileri ve prognozu tespit edilerek gelecekteki hasta yönetimimize katkı sağlamak amaçlanmıştır.Materyal ve Metod: Araştırmada 1998-2009 yılları arasında hastanemizin infeksiyon hastalıkları ve klinik mikrobiyoloji ve ortopedi klinik ve polikliniklerine başvuran, diz ve kalça protez eklem infeksiyonu tanısı alan, tedavi ve takip edilen hastaların dosyaları retrospektif olarak incelenmiştir. Bulgular: Protez eklem infeksiyonu tanısı alan 88 hastanın yaş ortalaması 58.8 ± 15.9 yıl olup 57 (%64.8)'si kadındır. En sık protez takılma nedeni 36 (%40.9) hastada travma olarak tespit edilmiştir. Semptomların ortaya çıkış zamanına göre 36 (%40.9) hastada erken evre, 18 (%20.5) hastada gecikmiş, 34 (%38.6) hastada ise geç evre protez eklem infeksiyonu saptanmıştır. En sık semptom 80 (%90.9) hastada ağrı olarak tespit edilmiştir. Aynı eklemde geçirilmiş cerrahi öyküsü varlığının sonuçla ilişkisi istatistiksel olarak anlamlı bulunmuştur (p= 0.008). Hem akıntı hem de peroperatif kültürlerde en sık izole edilen etkenler koagülaz-negatif stafilokoklardır. Hastaların %53.3'ünde akıntı kültürü ile peroperatif kültür uyumlu bulunmuştur. Hastaların 17 (%19.3)'sinde etken izole edilememiştir. Çalışmamızda C-reaktif protein ve eritrosit sedimentasyon hızı düzeyi ortalamaları yüksek tespit edilmiştir. İki aşamalı revizyon yapılan hastalarda iyi sonuç alınma oranı %75.9 ile daha yüksek bulunmuştur (p= 0.016). İyi sonuç alınan hastalarda diz ve kalça eklemi protez infeksiyonlarında toplam tedavi süreleri daha uzun bulunmuştur (sırasıyla p< 0.001 ve p< 0.001).Sonuç: Protez eklem infeksiyonlarında etkenin izole edilmesi cerrahi yaklaşımı ve antimikrobiyal tedaviyi yönlendirdiği için önem taşımaktadır. Ancak hastaya uygun seçilmiş cerrahi yöntem eşliğinde uzun süreli antimikrobiyal tedavi ile infeksiyonun eradikasyonu mümkün olabilmektedir.Introduction: Prosthetic joints, increasingly used in recent years, raises the prosthetic joint infections which are important due to increased mortality, morbidity and cost. Appropriate treatment protocols according to the patient and sufficient time for treatment are vital. This study aimed at identifying the source of infection, microorganisms, risk factors, treatment strategies and prognose for the patient diagnosed with hip prosthetic joint infection and followed at our hospital and thereby contributing to future patient management. Materials and Methods: The files of patients admitted to our Clinical Microbiology and Infectious Diseases and Orthopedics inpatient and outpatient clinics, diagnosed with knee and hip prosthetic joint infection and treated and followed between 1998-2009 were respectively examined. Results: Mean age of the 88 patients of whom 57 were female (64.8%) was 58.8 ± 15.9. The most frequent reason of prosthesis insertion for the patients was trauma (n= 36) (40.9%) and the most frequent symptom was pain 80 (90.9%). The stages in the emergence of symptoms were as follows; early stage in 36 (40.9%) patients delayed stage in 18 (20.5%) and late stage in 34 (38.6%). Previous surgery at the same joint was associated with infection (p= 0.008). The most frequent isolated microorganisms in both discharge and perioperative cultures were coagulase negative staphylococcus. The discharge and perioperative cultures were consistent in 24 (53.3%) patients. The pathogen could not be isolated in 17 (19.3%) of the patients. The mean level of CRP and ESR were high. In the patients who underwent two-stage revision, good result rate was higher (75.9%) (p= 0.016). The total treatment time for hip and knee prosthetic joint infections in the patient with good results was longer (<0.001 and <0.001 respectively). Conclusion: Pathogen isolation in prosthetic joint infections is important since it determines the surgery method and antimicrobial treatment. In addition, a prolonged antimicrobial treatment accompanied by appropriate surgical method for the patient makes the eradication of infection possible