A Case of Enterobacter cloacae Meningitis Secondary to Urinary Tract Infection

WOS: 000464106200018Gram-negative bacterial meningitis can usually be seen in neonates and elderly patients, after head trauma or interventions such as prostate biopsy and brain surgery. Typical findings of acute bacterial meningitis such as fever, headache and meningeal irritation signs may not be observed, and mortality rate is high in these patients. In this report, we present a case of Gram-negative bacterial meningitis secondary to bacteremia probably due to urinary tract infection. The patient died despite appropriate antibiotic therapy. Central nervous system infection should be kept in mind especially when elderly patients with comorbid diseases do not respond to antibiotic treatment and changes in mental status develop

Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused by Pseudomonas aeruginosa

Background. Pseudomonas aeruginosa (P. aeruginosa) is resistant to various antibiotics and can cause serious nosocomial infections with high morbidity and mortality. In this clinical study, we investigated the risk factors in patients who were diagnosed with P. aeruginosa-related nosocomial infection. Methods. A retrospective case control study including patients with P. aeruginosa-related nosocomial infection. Patients who were resistant to any of the six antibiotics (imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, amikacin, and ceftazidime) constituted the study group. Results. One hundred and twenty isolates were isolated. Various risk factors were detected for each antibiotic in the univariate analysis. In the multivariate analysis, previous cefazolin use was found as an independent risk factor for the development of imipenem resistance (OR = 3.33; CI 95% [1.11–10.0]; p = 0.03), whereas previous cerebrovascular attack (OR = 3.57; CI 95% [1.31–9.76]; p = 0.01) and previous meropenem use (OR = 4.13; CI 95% [1.21–14.07]; p = 0.02) were independent factors for the development of meropenem resistance. For the development of resistance to ciprofloxacin, hospitalization in the neurology intensive care unit (OR = 4.24; CI 95% [1.5–11.98]; p = 0.006) and mechanical ventilator application (OR = 11.7; CI 95% [2.24–61.45]; p = 0.004) were independent risk factors. Conclusion. The meticulous application of contact measures can decrease the rate of nosocomial infections

Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused by Pseudomonas aeruginosa

Background. Pseudomonas aeruginosa (P. aeruginosa) is resistant to various antibiotics and can cause serious nosocomial infections with high morbidity and mortality. In this clinical study, we investigated the risk factors in patients who were diagnosed with P. aeruginosa-related nosocomial infection. Methods. A retrospective case control study including patients with P. aeruginosa-related nosocomial infection. Patients who were resistant to any of the six antibiotics (imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, amikacin, and ceftazidime) constituted the study group. Results. One hundred and twenty isolates were isolated. Various risk factors were detected for each antibiotic in the univariate analysis. In the multivariate analysis, previous cefazolin use was found as an independent risk factor for the development of imipenem resistance (OR = 3.33; CI 95% [1.11-10.0]; = 0.03), whereas previous cerebrovascular attack (OR = 3.57; CI 95% [1.31-9.76]; = 0.01) and previous meropenem use (OR = 4.13; CI 95% [1.21-14.07]; = 0.02) were independent factors for the development of meropenem resistance. For the development of resistance to ciprofloxacin, hospitalization in the neurology intensive care unit (OR = 4.24; CI 95% [1.5-11.98]; = 0.006) and mechanical ventilator application (OR = 11.7;]; = 0.004) were independent risk factors. Conclusion. The meticulous application of contact measures can decrease the rate of nosocomial infections

Risk Factors For Linezolid-Associated Thrombocytopenia And Negative Effect Of Carbapenem Combination

Introduction: Linezolid is a synthetic antimicrobial agent with a broad spectrum of activity against virtually all Gram-positive bacteria. Although linezolid is generally well tolerated, the prolonged use of linezolid can lead to myelosuppression, including neutropenia, thrombocytopenia, and anemia. The aim of this study was investigating the risk factors for thrombocytopenia in patients who received linezolid therapy. Methodology: This retrospective study was performed on patients who received linezolid therapy between July 2007 and December 2017. Thrombocytopenia was defined as either a platelets count of < 100x10(9)/L or a 25% reduction from the baseline platelet count. Results: A total of 371 patients, (198 (53%) male and 173(47%) female were included into the study. Mean duration of therapy was 12.81 +/- 5.19 days. Linezolid-induced thrombocytopenia was detected in a total of 111 patients. Using the univariate analysis advanced sex, serum urea concentration, baseline platelet level and low eGFR value were found to be risk factors for linezolid associated thrombocytopenia (p < 0.05). According to a multivariate analysis, patients undergoing carbapenem treatment combination therapy (p = 0.003) and with a baseline platelet level of < 200x10(9)/L (p = 0.00) were found to have a high risk of developing thrombocytopenia. Conclusions: Several factors may influence of linezolid associated thrombocytopenia. Platelet count should be monitored during therapy and thrombocytopenia should be kept in mind in patients with baseline platelet level of < 200x10(9)/L, low eGFR, linezolid-carbapenem combination therapy.WoSScopu

Zwiększenie przedsionkowego opóźnienia elektromechanicznego analizowanego za pomocą tkankowej echokardiografii doplerowskiej u chorych z uogólnionymi zaburzeniami lękowymi

Background: It has been shown that psychological status is associated with the likelihood of atrial fibrillation (AF). Prolongation of the duration of atrial electromechanical delay (AEMD) is known to be a precursor for AF development. Aim: Therefore, we aimed to evaluate AEMD in patients with anxiety disorder. Methods: In this prospective study, a total of 82 anxiety disorder and 80 healthy subjects were enrolled. Symptoms of anxiety were evaluated by using the Hamilton Anxiety Rating Scale (HAM-A). P-wave dispersion (PWD) was measured on a 12-lead electrocardiogram. Both intra- and inter-AEMD were measured with tissue Doppler imaging. Results: Basal characteristics were similar between the two groups. PWD, inter- and right intra-AEMD were significantly prolonged in patients with anxiety disorders, compared to the control group (p &lt; 0.05). In the correlation analysis, HAM-A was significantly and moderately correlated with right intra- and inter-AEMD, and PWD. Conclusions: Patients suffering from anxiety disorders are characterised by prolonged AEMD, which can provide significant contributions to evaluate the risk for AF development in this group.  Wstęp: Wykazano, że stan psychiczny chorych wiąże się z ryzykiem wystąpienia migotania przedsionków (AF). Wydłużenie czasu przedsionkowego opóźnienia elektromechanicznego (AEMD) jest uważane za czynnik poprzedzający rozwój AF. Cel: Celem niniejszej pracy była ocena AEMD u chorych z zaburzeniami lękowymi. Metody: Do prospektywnego badania włączono 82 pacjentów z zaburzeniami lękowymi i 80 osób zdrowych. Objawy lęku oceniano za pomocą skali Hamiltona (HAM-A). Dyspersję załamka P (PWD) mierzono na 12-odprowadzeniowym elektrokardiogramie, a między- i wewnątrzprzedsionkowe opóźnienie elektromechaniczne — za pomocą doplera tkankowego. Wyniki: Początkowe parametry były podobne w obu grupach. PWD, opóźnienie elektromechaniczne międzyprzedsionkowe i wewnątrz prawego przedsionka było istotnie większe u chorych z zaburzeniami lękowymi niż u osób z grupy kontrolnej (p &lt; 0,05). W analizie korelacji ocena w skali HAM-A była istotnie i umiarkowanie związana z wewnątrz- i międzyprzedsionkowym opóźnieniem elektromechanicznym oraz z PWD. Wnioski: Chorzy z zaburzeniami lękowymi charakteryzują się wydłużonym AEMD. Ta obserwacja może istotnie przyczynić się do oceny ryzyka rozwoju AF w tej grupie pacjentów.

A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria

Conclusions: The high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment

A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria

Altindis, Mustafa/0000-0003-0411-9669; Karabay, Oguz/0000-0003-0502-432X; KARABAY, OGUZ/0000-0003-1514-1685; Ozdemir, Mehmet/0000-0002-9316-771X; aksaray, sebahat/0000-0002-0552-1337WOS: 000373926600018PubMed: 27099693Background: the prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. Objectives: in this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. Materials and Methods: Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. the blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. Results: Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. the average growth rate in the bottles of blood cultures during the defined period (1259 -26,400/year) was 32.3%. of the growing microorganisms, 67% were causative agents, while 33% were contaminants. the contamination rates of the centers ranged from 1% to 17%. the average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. the most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). Conclusions: the high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment

The clinical and pathological features of 133 colorectal cancer patients with brain metastasis: a multicenter retrospective analysis of the Gastrointestinal Tumors Working Committee of the Turkish Oncology Group (TOG)

Brain metastasis in colorectal cancer is highly rare. In the present study, we aimed to determine the frequency of brain metastasis in colorectal cancer patients and to establish prognostic characteristics of colorectal cancer patients with brain metastasis. In this cross-sectional study, the medical files of colorectal cancer patients with brain metastases who were definitely diagnosed by histopathologically were retrospectively reviewed. Brain metastasis was detected in 2.7 % (n = 133) of 4,864 colorectal cancer patients. The majority of cases were male (53 %), older than 65 years (59 %), with rectum cancer (56 %), a poorly differentiated tumor (70 %); had adenocarcinoma histology (97 %), and metachronous metastasis (86 %); received chemotherapy at least once for metastatic disease before brain metastasis developed (72 %), had progression with lung metastasis before (51 %), and 26 % (n = 31) of patients with extracranial disease at time the diagnosis of brain metastasis had both lung and bone metastases. The mean follow-up duration was 51 months (range 5–92), and the mean survival was 25.8 months (95 % CI 20.4–29.3). Overall survival rates were 81 % in the first year, 42.3 % in the third year, and 15.7 % in the fifth year. In multiple variable analysis, the most important independent risk factor for overall survival was determined as the presence of lung metastasis (HR 1.43, 95 % CI 1.27–4.14; P = 0.012). Brain metastasis develops late in the period of colorectal cancer and prognosis in these patients is poor. However, early screening of brain metastases in patients with lung metastasis may improve survival outcomes with new treatment modalities. © 2014, Springer Science+Business Media New York

Mortality indicators in pneumococcal meningitis: therapeutic implications

Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved