Impact of Empirical Antibiotic Treatment Duration on Short-term Prognosis of Very Low Birth Weight Newborns

Objective: Probable early infection is one of the most important reasons to begin antibiotics treatment for very low birth weight (VLBW) infants. In most of the cases, antibiotics treatment continues as long as the venous line persist. Long-term empirical antibiotics therapy for premature infants (5 days) create even more danger than the infection itself, such as necrotizing enterocolitis (NEC) and death. In order to reduce the risks of these dangers, antimicrobial therapy must stop in clinical conditions in which the possibility of infection is low. This study makes an effort to evaluate the impact of empirical antibiotic treatment duration on early prognosis of premature infants with VLBW. Materials and Methods: A total of 209 premature infants with birth weight less than 1500 g who were suspicious of having infection, were evaluated in 2 groups of control (107 infants) and intervention (102 infants). All of the infants evaluated for sepsis according to the protocol of the unit. In the control group, antibiotics treatment continued as long as the venous line persist, in the intervention group after day 3 to 5 if the results of blood culture were negative, the infants were checked for C-reactive protein (CRP), and if it was negative too and the patient’s clinical status was good, antibiotic treatment was stopped. The outcome measures were short-term prognosis of with VLBW newborns. Results: The mean gestational age of the studied patients was 30.21 ± 2.69 and 29.57 ± 2.09 g in the control and intervention groups, respectively (P = 0.07). The average days of receiving antibiotics in the control group were 29.21 ± 1.57 while in the intervention group it was 8.11 ± 2.16 (P 0.05). Conclusion: Early discontinuing of antibiotics (5 days or less) had no impact on the mortality rate of VLBW infants and seemed it was safe

An update on renal involvement in hemophagocytic syndrome (macrophage activation syndrome)

Context: Hemophagocytic syndrome (HPS) is mainly characterized by massive infiltration of bone marrow by activated macrophages and often presents with pancytopenia. Thrombotic microangiopathy (TMA) is also present with thrombocytopenia and renal involvement. Both conditions could coexist with each other and complicate the condition. Evidence Acquisition: Directory of Open Access Journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science with keywords relevant to; Hemophagocytic syndrome, macrophage activation syndrome, interferon-gamma and thrombotic microangiopathy, have been searched. Results: Viral infection, rheumatologic disease and malignancies are the main underlying causes for secondary HPS. calcineurin inhibitors and viral infections are also the main underlying causes of TMA in transplant recipients. In this review, we discussed a 39-year-old male who presented with pancytopenia and renal allograft dysfunction. With the diagnosis of HPS induced TMA his renal condition and pancytopenia improved after receiving intravenous immunoglobulin (IVIG) and plasmapheresis therapy. Conclusions: HPS is an increasingly recognized disorder in the realm of different medical specialties. Renal involvement complicates the clinical picture of the disease, and this condition even is more complex in renal transplant recipients. We should consider the possibility of HPS in any renal transplant recipient with pancytopenia and allograft dysfunction. The combination of HPS with TMA future increases the complexity of the situation