Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

The impact of carotid stenting on the hemodynamic parameters and cerebrovascular reactivity of the ipsilateral middle cerebral artery

ObjectiveThe study was conducted to determine the effect of carotid angioplasty and stenting (CAS) on the hemodynamic parameters and cerebrovascular reactivity (CVR) of the ipsilateral middle cerebral artery (MCA) and examine the relation between preprocedural exhausted CVR and perioperative neurologic events.MethodsThe study included 29 patients with severe extracranial carotid stenosis undergoing CAS. Transcranial Doppler imaging was performed before the procedure, 2 days, and 2 to 4 months postoperatively. Peak systolic velocity, end-diastolic velocity, mean flow velocity, and pulsatility index of the ipsilateral MCA were recorded at rest. CVR was assessed with the breath holding test: the increase of mean flow velocity and the breath holding index were calculated.ResultsPeak systolic and mean flow velocities increased significantly in both postoperative studies compared to the preoperative values, end-diastolic velocity was significantly elevated only in the first study, and pulsatility index did not change significantly. When stimulated by breath holding, preoperative mean flow velocity did not increase significantly compared with the resting values; however, it did increase significantly during breath holding in both studies after CAS. The breath holding index improved significantly from −0.35 (−0.71 to 0.55) to 0.38 (0.12 to 0.61) at 2 days (P = .049) and 0.44 (0.31 to 0.92) at 2 to 4 months (P = .020). Exhausted CVR of the MCA preoperatively was associated with increased risk of neurological complications during or after the procedure (P = .006).ConclusionsCAS may improve the hemodynamic parameters and the vasomotor reactivity in the ipsilateral MCA. Exhausted CVR is associated with an increased risk of periprocedural neurologic complications

Dealing with Pheochromocytoma during the First Trimester of Pregnancy

Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment