Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Neisseria meningitidis W135, Turkey

We describe the first case of Neisseria meningitidis W135 meningitis in Turkey. The strain was genotypically unrelated to the clone (W)ET-37, isolated from Hajj pilgrims in 2000

In Vitro Effectiveness of Ertapenem Against Enterobacteriaceae Isolates

Members of Enterobacteriaceae family are important causative agents of several infections. Extended spectrum beta-lactamase (ESBL) producing species are serious threats to therapeutic efficacy. Ertapenem is a new carbapenem resistant to inactivation by most ESBL’s and has the advantage of single daily use. The aim of the study is to test in vitro activity of ertapenem, that is not available in Turkey, against ESBL producing and nonESBL producing Enterobacteriaceae isolates by disk diffusion method and to compare its activity with the other carbapenems. The resistance rates of ertapenem, meropenem and imipenem were 1.65%, 1.24%, and 1.24% for ESBL producing isolates and 2.46%, 0.49%, and 0.98% for non-ESBL producing isolates, respectively. According to these results, it was determined that the in vitro activity of ertapenem was similar with other carbapenems against both ESBL producing and non-ESBL producing microorganisms (p= 0.90 and p= 0.19, respectively)

Comparison of Culture and PCR Methods in Detection of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis in Children with Otitis Media with Effusion

The etiology and pathogenesis of otitis media with effusion (OME) is still unclear despite many studies within the last four decades. Polymerase chain reaction (PCR) based procedures are suggested for detection of the causative bacteria supposed to inflict multiple infections. In the current study, culture and PCR based approaches were used to detect the frequency of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, which have been known as common pathogens in middle ear effusions (MEE) of patients with otitis media. Material and Methods: The DNAs of these three bacteria were detected by standard and multiplex PCR techniques in MEE specimens and their diagnostic values were evaluated in comparison to the conventional culture method. Results: Samples from 67 OME suspected children were analysed retrospectively. Two H. influenzae and two M. catarrhalis isolates were recovered by conventional culture method (6.0%; 4/67). Out of the 67 samples, seven S. pneumoniae, nine H. influenzae, and eleven M. catarrhalis isolates were detected vith PCR. In five samples, two concurrent bacteria were detected in following combinations: two S. pneumoniae and H. influenzae, two S. pneumoniae and M. catarrhalis, and one H. influenzae and M. catarrhalis. Sensitivity, specificity, positive predictive value and negative predictive value rates of the PCR technique were 100.0%, 71.4%, 18.2% and 100.0%, respectively. The difference between culture and PCR was statistically significant (p<0.001). Conclusion: Although the specificity and positive predictive values are low, PCR, which allows rapid screening is feasible for detecting the most common fastidious bacteria that lead to OME

Arising Prevalence Of Oxa-48 Producer Escherichia Coli And Oxa-48 With Ndm Co-Producer Klebsiella Pneumoniae Strains

Background/aim: This prospective study aimed to determine the presence of the most common carbapenemase genes, blaOXA-48, blaKPC, blaIMP, blaVIM and blaNDM on carbapenem resistant clinical K.pneumoniae and E.coli isolates. Materials and methods: Isolates were selected according to EUCAST guideline; gradient test and disc diffusion with both meropenem and ertapenem discs. Resistance rates of these isolates to other antimicrobial agents were also examined by disc diffusion method. Carbapenem resistance gene were investigated by using Real-Time PCR. Results: A total of 3845 E. coli and 1689 K. pneumoniae isolates from clinical samples between January 2015 and April 2017 were evaluated. The 419 isolates were found as carbapenem resistant but only the first resistant isolate (n=155; 126 K. pneumoniae and 29 E.coli) of each patient were included. Carbapenem resistant isolates were most frequently isolated from intensive care units (48.8%). Colistin was the most effective antibiotic (91.0%). The 121 (78.1%) of the tested isolates were positive for OXA-48 (103 K. pneumoniae and 18 E. coli) and 9 K. pneumoniae carrying blaNDM were also positive for blaOXA-48. VIM, IMP and KPC type carbapenemases were not detected in any isolates. Conclusion: Carbapenem-resistant pathogens have been shown to be able to develop resistance mechanisms with more than one carbapenemase encoding gene.Wo

Comparison of culture and PCR methods in detection of haemophilus influenzae, streptococcus pneumoniae and moraxella catarrhalis in children with otitis media with effusion Efüzyonlu orta kulak iltihabi olan çocuklarda haemophilus influenzae, streptococcus pneumoniae ve moraxella catarrhalis saptanmasinda, kültür ve pzr yöntemlerinin karsilastirilmasi

The etiology and pathogenesis of otitis media with effusion (OME) is still unclear despite many studies within the last four decades. Polymerase chain reaction (PCR) based procedures are suggested for detection of the causative bacteria supposed to inflict multiple infections. In the current study, culture and PCR based approaches were used to detect the frequency of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, which have been known as common pathogens in middle ear effusions (MEE) of patients with otitis media. Material and Methods: The DNAs of these three bacteria were detected by standard and multiplex PCR techniques in MEE specimens and their diagnostic values were evaluated in comparison to the conventional culture method. Results: Samples from 67 OME suspected children were analysed retrospectively. Two H. influenzae and two M. catarrhalis isolates were recovered by conventional culture method (6.0%; 4/67). Out of the 67 samples, seven S. pneumoniae, nine H. influenzae, and eleven M. catarrhalis isolates were detected vith PCR. In five samples, two concurrent bacteria were detected in following combinations: two S. pneumoniae and H. influenzae, two S. pneumoniae and M. catarrhalis, and one H. influenzae and M. catarrhalis. Sensitivity, specificity, positive predictive value and negative predictive value rates of the PCR technique were 100.0%, 71.4%, 18.2% and 100.0%, respectively. The difference between culture and PCR was statistically significant (p<0.001). Conclusion: Although the specificity and positive predictive values are low, PCR, which allows rapid screening is feasible for detecting the most common fastidious bacteria that lead to OME

In Vitro Activity Of Turkish Propolis Samples Against Anaerobic Bacteria Causing Oral Cavity Infections

The aim of this study was to evaluate the antimicrobial activity of propolis samples collected from different regions of Turkey against anaerobic bacteria causing especially oral cavity infections. A total of eleven anaerobic bacterial strains have been tested in this study. The strains were tested by agar dilution method for detecting minimum inhibitory concentration (MIC) and by macro dilution broth method for detecting minimum bactericidal concentration (MBC). Turkish propolis samples were found highly effective against all tested anaerobic bacteria compared with ethanol control, without statistical differences. The MIC and MBC of propolis samples ranged from 0.4-0.6 mg/ml to 108.1-186.2 mg/ml, respectively. Actinomyces odontolyticus was the most susceptible strains; whereas Prevotella intermedia was was the least susceptible strain to all tested propolis samples. Ilic/Erzincan (ER-I) propolis sample was the more effective against all tested anaerobic bacteria; whereas Bartin (BA) propolis sample was the less effective. Gram-positive anaerobic bacteria were detected to be the most sensitive to propolis samples; with the MIC values ranging from 0.4 to 6.1 mg/ml compared with Gram-negative anaerobic bacteria with MIC ranging from 5.8 to 108.1 mg/ml (P<0.05). As a result of, Turkish propolis samples had antibacterial activity against anaerobic bacteria especially causing oral cavity infections. Because of the high rate of resistance of the anaerobic bacteria isolated from oral cavity infections, standardized preparations of propolis are suggested to use in treatment of this kind of infections. However, further studies are needed to be performed on the clinical applications of propolis in oral cavity infections.Wo