Otpornost na trimetoprim-sulfametoksazol i stope osjetljivosti na fosfomicin kod nekompliciranih infekcija mokraćnog sustava – je li vrijeme za promjenu preporučenih antimikrobnih lijekova

Urinary tract infections (UTIs) are among the most common bacterial infections in adult population. They are prevalent in all age groups both in women and men. Also, UTIs are the most frequent indication for empirical antibiotic treatment in emergency department. The aim of this study was to determine the antibiotic resistance rates in the treatment of uncomplicated UTIs. Adult patients admitted to emergency department with uncomplicated UTIs were included in this cross-sectional study. Mid-stream urine samples were obtained under sterile conditions and cultured quantitatively. After 24 hours, the samples showing 105 colony forming unit per milliliter (CFU/mL) were tested for antibiotic susceptibility. Resistance to fosfomycin-trometamol (FT), amoxicillin-clavulanic acid (AC), ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (TMPSMX) and cefpodoxime (CEF) was tested by Kirby-Bauer disc diffusion system. Escherichia (E.) coli accounted for the vast majority (93.4%) of the organisms isolated in the study. Among the E. coli positive patients, resistance to TMP-SMX was the most common antibiotic resistance. The E. coli species detected in our study group were least resistant to FT (2.4%). The resistance rates, especially to CEF, AC and CIP, were significantly higher in patients over 50 years of age. In conclusion, in the treatment of uncomplicated UTIs, TMP-SMX should be excluded from empirical treatment, while fosfomycin could be a viable option in all age groups.Infekcije mokraćnog sustava (urinary tract infection, UTI) spadaju među najčešće bakterijske infekcije u odrasle populacije, a učestale su u svim dobnim skupinama i u oba spola. Isto tako, UTI su najčešća indikacija za empirijsko liječenje antibioticima u hitnoj službi. Cilj ovoga istraživanja bio je utvrditi stope otpornosti na antibiotike u liječenju nekomplicirane UTI. U ovo poprečno ispitivanje bili su uključeni odrasli bolesnici primljeni na hitni odjel s nekompliciranom UTI. Uzorci srednjeg mlaza mokraće uzeti su pod sterilnim uvjetima i kvantitativno kultivirani. Nakon 24 sata uzorci koji su pokazivali 105 CFU/mL testirani su na osjetljivost na antibiotike. Otpornost na fosfomicin-trometamol (FT), amoksicilin-klavulansku kiselinu (AC), ciprofloksacin (CIP), trimetoprim-sulfametoksazol (TMP-SMX) i cefpodoksim (CEF) ispitana je pomoću Kirby-Bauerova sustava disk difuzije. Većinu organizama izoliranih u ovom istraživanju činila je Escherichia (E.) coli (93,4%). Među bolesnicima pozitivnim na E. coli najčešća je bila otpornost na TMP-SMX. Vrste E. coli otkrivene u ovoj skupini bolesnika pokazale su najmanju otpornost na FT (2,4%). Stope antibiotske otpornosti, poglavito na CEF, AC i CIP, bile su značajno više u bolesnika starijih od 50 godina. Zaključuje se kako bi u liječenju nekomplicirane UTI trebalo iz empirijskog liječenja isključiti TMP-SMX, dok bi fosfomicin mogao biti koristan u svim dobnim skupinama

Comparison of Emergency medicine physician's decision and Pecarn scale suggestions on pediatric head trauma patients

INTRODUCTION: To determine head CT scan necessity in pediatric head trauma patients and to compare the decisions of Emergency medicine physicians (EMP) and PECARN scale suggestions on head CT scan necessity. METHODS: Our study was conducted retrospectively in our third stage hospital between January 2014 and December 2014. Patients under the age of 13 with head injury because of fall were included. Registry of all patients was analyzed and PECARN scale was applied to each patient's data retrospectively. Suggestions of PECARN scale were noted. Head CT scans were reported by radiologist. EMP's decision and PECARN scale suggestions were compared. Patients whom should had CT scan by PECARN scale suggestions but had no imaging were contacted and questioned about any other reasons to seek medical care. RESULTS: PECARN suggestion and EMP's decisions of CT necessity compared. Concordance analysis of two results are determined as 76.6% (Kappa coefficient: 0.766). EMP's decisions had 88.76% sensitivity, 91.09% specificity, 78.22% positive predictive value, 95.74% negative predictive value and 90.48% accuracy. DISCUSSION AND CONCLUSION: In assessment of children with minor head injury EMP decision and PECARN scale were found coherent and sufficient. Instead of early decision of CT scan, observation of patient can reduce radiation exposure, but cost effectivity of this approach should be evaluated by further studies

Carbamazepine overdose after exposure to simethicone: a case report

<p>Abstract</p> <p>Introduction</p> <p>Carbamazepine is an anticonvulsant drug and is also used as a treatment for patients with manic-depressive illness, post-herpetic neuralgia or phantom limb pain. The drug itself has many drug interactions. Simethicone is an antifoaming agent and is reported to be an inert material with no known drug interaction with carbamazepine.</p> <p>Case presentation</p> <p>We present a case of a patient who was routinely using carbamazepine 400 mg three times per day and levetiracetam 500 mg twice daily, and experienced carbamazepine overdose after exposure to simethicone. After cessation of simethicone therapy normal drug levels of carbamazepine were obtained again with the standard dose of the drug. The mechanism of interaction is unknown but the risk of overdose should be considered when prescribing simethicone to a patient who is using carbamazepine.</p> <p>Conclusion</p> <p>Simethicone and carbamazepine, when taken together, may be a cause of carbamazepine toxicity. The risk of carbamazepine overdose should be considered when prescribing simethicone to a patient who is using carbamazepine.</p

Clinical Problems in the Hospitalized Parkinson's Disease Patient: Systematic Review

The problems Parkinson's disease (PD) patients encounter when admitted to a hospital, are known to be numerous and serious. These problems have been inventoried through a systematic review of literature on reasons for emergency and hospital admissions in PD patients, problems encountered during hospitalization, and possible solutions for the encountered problems using the Pubmed database. PD patients are hospitalized in frequencies ranging from 7 to 28% per year. PD/parkinsonism patients are approximately one and a half times more frequently and generally 2 to 14 days longer hospitalized than non-PD patients. Acute events occurring during hospitalization were mainly urinary infection, confusion, and pressure ulcers. Medication errors were also frequent adverse events. During and after surgery PD patients had an increased incidence of infections, confusion, falls, and decubitus, and 31% of patients was dissatisfied in the way their PD was managed. There are only two studies on medication continuation during surgery and one analyzing the effect of an early postoperative neurologic consultation, and numerous case reports, and opinionated views and reviews including other substitutes for dopaminergic medication intraoperatively. In conclusion, most studies were retrospective on small numbers of patients. The major clinical problems are injuries, infections, poor control of PD, and complications of PD treatment. There are many (un-researched) proposals for improvement. A substantial number of PD patients' admissions might be prevented. There should be guidelines concerning the hospitalized PD patients, with accent on early neurological consultation and team work between different specialities, and incorporating nonoral dopaminergic replacement therapy when necessary. © 2011 Movement Disorder Societ