Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis

Background: Nosocomial meningitis is a rare complication following neurosurgical procedures and is associated with high morbidity and mortality. Aim: The aim of this study was to describe the clinical characteristics and the risk factors associated with mortality in patients who developed nosocomial meningitis following neurosurgical operations. Setting and design: Tertiary care hospital and an observational study. Materials and Methods: The study subjects included 2265 patients who underwent various neurosurgical operations during 2003-05. The diagnosis of nosocomial meningitis was based on the Center for Disease Control criteria. Statistical analysis: It was performed by using Statistical Package for Social Sciences for Windows 10.0 program. Results: The incidence of postoperative nosocomial meningitis was 2.7% (62 episodes in 49 patients among 2265 patients operated). Staphylococcus aureus and Acinetobacter spp. were the most frequently isolated pathogens. Of the 49 with meningitis 20 (40.8%) patients died. In the logistic regression analysis model, Glascow coma scale score less than 10 (Odds Ratio (OR): 19.419, 95% Confidence Interval (CI); 1.637-230.41, P = 0.001), and low cerebrospinal fluid glucose level (= 30 mg/dL) (OR: 10.272, 95% CI; 1.273-82.854, P= 0.002), and presence of concurrent nosocomial infection (OR: 28.744, 95% CI; 1.647-501.73, P= 0.001) were the independent risk factors associated with mortality. Conclusion: The mortality in patients who developed meningitis was high. The high percentage of concurrent nosocomial infections was associated with a high mortality rate which was a serious problem

Shall We Leave Semple-Type Rabies Vaccines, Why ?

Semple-type vaccines are still being used in few countries. Turkey is one of the few countries, which has been using Semple-type vaccines. It will be more appropriate to discontinue using Semple-type vaccines because of its disadvantages such as, its having numerous side effects, being difficult to administer and its uncertain reliability. But this will be possible b practising series of preventative actions, primarily decreasing the number of suspected bites and vaccinated cases. In that way, budges of vaccination will be reduced to an acceptable level so that Semple-type vaccines will be left, more effective and reliable vaccines will be used

Evaluation of Prognosis and the Factors Effecting Prognosis in Acute Purulent, Viral and Tuberculous Meningitis Cases

In this study, prognosis and the factors effecting prognosis were evaluated retrospectively in a total of 160 menengitis cases, of which 94 were acute purulent, 46 were viral and 20 were tuberculous, in a period of 4 years between January 1991 and December 1994 in Haydarpafla Numune Hospital, Departmet of In-fectious Diseases and Clinical Microbiology. 12 (13%) of acute purulent meningitis cases died, 3 (3%) of them had permanent sequelae and 79 (84%) recovered completely. In viral meningitis cases, 3(7%) of them died and 43 (93%) recovered completely. No sequelae was observed in viral meningitis cases. In tuberculous meningitis cases, 4 (20%) of them died, 4 (20%) of them had remaining sequelae and 12 (60%) recovered completely. Advanced age and changes in consiousness in the beginning were the negative prognostic factors in viral and tuberculous meningitis cases. Although changes in consiousness, the duration of time till antibiotic therapy and septic focus other than meningitis seem to be negative prognostic factors, only advanced age and the etiologic agent’s being Streptococcus pneumoniae were found to be statistically significant prognostic factors in acute purulent meningitis cases

A Case Report of Community Acquired Pneumonia Caused By Legionella pneumophila

In this report, a case of community acquired pneumonia caused by Legionella pneumophila is presented and the related literature is reviewed. It is suggested that, pneumonia caused by this organism could be severe and long lasting, response to treatment could be late and Legionella pneumophila should be considered in the differantial diagnosis of comminty acquired pneumonia

Nasal S. aureus Carriage and Its Relation with Central Venous Catheter Related Infections in Haemodialysis Patients

Haemodialysis patients tend to have a higher nasal S. aureus carriage rate than normal population and staphylococcal infections are one of the leading causes of morbidity and mortality among these patients. The nasal S. aureus carriage rate and its relation with central venous catheter related infections were evaluated prospectively in 77 haemodialysis patients in our hospital. Nasal S. aureus carriage rate was found in 32 (41.5%) patients. One of four patients who were diagnosed to have S. aureus local catheter related infection and five of eight patients who were diagnosed as S. aureus catheter related bacteremia/sepsis, were nasal S. aureus carriers. Six patients with central venous catheter related infection were also nasal S. aureus carriers and four of these patients were undergoing haemodialysis for more than one year

Fever of Unknown Origin: Analysis of 35 Cases

In this study, 35 cases of fever of unknown origin, hospitalized at our department between June 1993 and June 1999, were evaluated. Eighteen (51.4%) of the cases were female and 17 (48.6%) were male. Ages were between 14 and 71 with a mean of 38. The diagnosis was able to be reached in 24 days (range: 5-58 days). Fourteen (40%) of the patients were found to have an infectious disease while 8 (23%) had collagen-vascular diseases, 5 (14%) had neoplasms, 2 (5.7%) had hipersensitivity reactions and 1 (2.8%) had sarcoidosis. No diagnosis has been established in 3 (8.5%) out of 35 patients. Two patients died during evaluation period. Among infectious diseases, tuberculosis was the leading cause with six (42.8%) cases, followed by brucellosis with 4 (28.5%) cases, 2 (14.2%) cases of infective endocarditis and 2 (14.2%) cases of intraabdominal infections. Among collagen-vascular diseases, five were Still’s disease, two were sistemic lupus erythematosus and one was juvenile rheumatoid arthritis. Among 5 neoplastic diseases, 3 were (60%) lymphomas, 1 was colon carcinoma and the other was malign histiocytosis

Incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical hospital in Istanbul, intensive care unit of a teaching Turkey (2004-2006)

The identification of microorganisms causing ventilator-associated pneumonia (VAP) is important for formulating appropriate therapies. In this study, we report the incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients diagnosed with VAP in our medical-surgical intensive care unit (ICU) during the years 2004-2006. VAP was diagnosed by using the clinical criteria of the Centers for Disease Control and Prevention. Antibiotic resistance patterns of isolated microorganisms were defined by standard methods. The VAP incidence rate was 22.6/1,000 ventilator days. The most frequently isolated pathogens were Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Ninety percent of Acinetobacter spp. isolates were resistant to ceftazidime, 64% to imipenem, and 80% to ciprofloxacin. Fifty-nine percent of P. aeruginosa isolates were resistant to ceftazidime, 32% to imipenem, and 62% to ciprofloxacin. Cefoperazone-sulbactam was the most active agent against Acinetobacter spp. In conclusion, the incidence of VAP and the prevalence of multidrug-resistant microorganisms are quite high in our ICU. Comparison of the resistance rates of isolates demonstrates that certain antibiotic agents are more effective than others

Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria

P>In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs