Richter's transformation; the cause of fever of unknown origin in a case with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most common leukemia in many countries. Infections are the most common causes of morbidity and mortality; lymphoid cell dysfunction and neutropenia associated with chemotherapy are main predisposing conditions for infection. For this reason infectious conditions must be excluded in a case with CLL and fever. Richter's transformation (RT) is a kind of lymphoma that is a rare condition in CLL cases Fever of unknown origin is a rare finding in Richter's transformation (RT) but it has been reported as anecdotal reports. Here a case with RT as the cause of fever in a case with CLL was reported and literature was reviewed

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

Invasive device-associated nosocomial infections of a teaching hospital in Turkey; four years' experience [Türkiye'deki bir hastanenin invazif araç ilişkili enfeksiyon hızları; dört yıllık deneyim]

Aim: To determine our setting's IDAI rates, infecting microorganisms, and their resistance patterns to achieve standardization and make comparisons among other Turkish and developed country hospitals all over the world. Materials and methods: The numbers of total patient days, ventilator days, central catheter days and, urinary catheter days in the ICUs were recorded and IDAI rates were calculated. Clinical specimens were obtained from patients, cultivated at appropriate culture media, and infecting microorganisms and resistance patterns were determined. Results: Totally 1450 invasive device-associated infection episodes were determined (16.4% of patients) with a rate of 21.12/1000 days. Ventilator associated pneumonia rate was 22.05/1000 ventilator days and most common microorganism was Acinetobacter baumannii. Central catheter associated blood stream infection rate was 9.14/1000 central catheter days and the most common infecting organism was A. baumannii. Catheter associated urinary infection rate was 10.12/1000 urinary catheter days and the most common pathogen was Candida species. MRSA rate decreased from 89.6% in 2006 to 61.8% in 2009 (P < 0.001). ESBL production rates were between 70.7% and 45.6% in Escherichia coli and 66.7% and 55.9% in Klebsiella pneumoniae isolates. Vancomycin resistance among Enterococci was between 34.3% and 21.7% in these years. Conclusion: Our hospital infection rates were found to be similar to those of country data but higher than those in developed nations. Considering the high infection and resistance rates to most of the available antibiotics, it is highly urgent that infection control measures be taken and more effective antibiotic control policies be adopted. © TÜBİTAK

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

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

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

OBJECTIVE

Risk factors of carbapenem-resistant Klebsiella pneumoniae infection: A serious threat in ICUs

PubMedID: 25595166Background: Nosocomial infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasing. Our aim in this study was to investigate the risk factors of CRKP infections. Material/Methods: A retrospective cohort study was performed between 1 January and 31 December 2012 in ICU patients. Data was taken from the hospital infection control database for CRKP. The clinical samples collected from the patients were tested by an automatized system and disk diffusion. SPSS software v11.5 was used for statistical analysis. Results: Totally, 105 Klebsiella pneumoniae isolates were found in 2012 and the carbapenem resistance rate was 48%. The first episode of infection was taken into risk factor analysis. Of the 98 patients, 61 (62.2%) were male and the mean and median ages were 30.4±29.8 and 25 (0–93). The length of stay was longer in the resistant group (p=0.026). Mortality was 48% in the whole group and similar between groups (p=0.533). There was a relationship between meropenem and third-generation cephalosporin use and resistance (OR 3.244 (1.193–8.819) and OR: 3.590 (1.056–12.209). The other risk factors in univariate analysis were: Immunosuppression OR: 2.186 (1.754–2.724), nasogastric catheter OR: 3.562 (1.317–9.634), peripheral arterial catheter OR: 2.545 (1.027–6.307), and being admitted to the neurosurgical unit OR: 4.324 (1.110–16.842). The multivariate analysis showed use of third-generation cephalosporin OR: 4.699 (1.292–17.089), nasogastric catheter use OR: 3.983 (1.356–11.698), and being admitted to neurosurgical ICU OR: 4.603 (1.084–19.555) as independent risk factors. Conclusions: Restriction of third-generation cephalosporin and carbapenem use and invasive procedures, along with infection control precautions and disinfection policies, may be effective in reducing the carbapenem resistance in ICUs. © Med Sci Monit, 2015