Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital

<p>Abstract</p> <p>Background</p> <p>Multidrug resistant <it>Acinetobacter baumannii</it>, (MRAB) is an important cause of hospital acquired infection. The purpose of this study is to determine the risk factors for MRAB in a city hospital patient population.</p> <p>Methods</p> <p>This study is a retrospective review of a city hospital epidemiology data base and includes 247 isolates of Acinetobacter baumannii (AB) from 164 patients. Multidrug resistant <it>Acinetobacter baumannii </it>was defined as resistance to more than three classes of antibiotics. Using the non-MRAB isolates as the control group, the risk factors for the acquisition of MRAB were determined.</p> <p>Results</p> <p>Of the 247 AB isolates 72% (177) were multidrug resistant. Fifty-eight percent (143/247) of isolates were highly resistant (resistant to imipenem, amikacin, and ampicillin-sulbactam). Of the 37 patients who died with Acinetobacter colonization/infection, 32 (86%) patients had the organism recovered from the respiratory tract. The factors which were found to be significantly associated (p ≤ 0.05) with multidrug resistance include the recovery of AB from multiple sites, mechanical ventilation, previous antibiotic exposure, and the presence of neurologic impairment. Multidrug resistant Acinetobacter was associated with significant mortality when compared with sensitive strains (p ≤ 0.01). When surgical patients (N = 75) were considered separately, mechanical ventilation and multiple isolates remained the factors significantly associated with the development of multidrug resistant Acinetobacter. Among surgical patients 46/75 (61%) grew a multidrug resistant strain of AB and 37/75 (40%) were resistant to all commonly used antibiotics including aminoglycosides, cephalosporins, carbepenems, extended spectrum penicillins, and quinolones. Thirty-five percent of the surgical patients had AB cultured from multiple sites and 57% of the Acinetobacter isolates were associated with a co-infecting organism, usually a Staphylococcus or Pseudomonas. As in medical patients, the isolation of Acinetobacter from multiple sites and the need for mechanical ventilation were significantly associated with the development of MRAB.</p> <p>Conclusions</p> <p>The factors significantly associated with MRAB in both the general patient population and surgical patients were mechanical ventilation and the recovery of Acinetobacter from multiple anatomic sites. Previous antibiotic use and neurologic impairment were significant factors in medical patients. Colonization or infection with MRAB is associated with increased mortality.</p

Female genital schistosomiasis as an evidence of a neglected cause for reproductive ill-health: a retrospective histopathological study from Tanzania

BACKGROUND: Schistosomiasis affects the reproductive health of women. Described sequelae are ectopic pregnancy, infertility, abortion, and cervical lesions and symptoms mimicking cervical cancer and STIs. There are indications that cervical schistosomiasis lesions could become co-factors for viral infection such as HIV and HPV. METHODS: In a retrospective descriptive histopathological study clinical specimens sent between 1999 and 2005 to the pathology department of a consultant hospital in Tanzania were reviewed to analyse the occurrence and features of schistosomiasis in female genital organs. RESULTS: During the study period, schistosomiasis was histopathologically diagnosed in 423 specimens from different organs (0.7% of all specimens examined in the study period), out of those 40% were specimens from female and male organs. The specimens were sent from 24 hospitals in 13 regions of mainland Tanzania. Female genital schistosomiasis was diagnosed in 125 specimens from 111 patients. The main symptoms reported were bleeding disorders (48%), ulcer (17%), tumor (20%), lower abdominal pain (11%) and infertility (7%). The majority of cases with genital schistosomiasis were diagnosed in cervical tissue (71 cases). The confirmation of cervical cancer was specifically requested for 53 women, but the diagnosis could only be verified for 13 patients (25%), in 40 cases only severe cervical schistosomiasis was diagnosed. Vulval/labial schistosomiasis was seen in specimens from young women. Infertility was reported in four patients with schistosomiasis of the Fallopian tubes. CONCLUSION: Genital schistosomiasis adds to the disease burden of women in all age groups. Pathological consequences due to the involvement of different genital organs can be damaging for the affected women. Clinical unawareness of genital schistosomiasis can lead to misdiagnosis and therefore false and ineffective therapy. In endemic areas cervical schistosomiasis should be considered as differential diagnosis of cancer

Pharmacogenetics: data, concepts and tools to improve drug discovery and drug treatment

Variation in the human genome is a most important cause of variable response to drugs and other xenobiotics. Susceptibility to almost all diseases is determined to some extent by genetic variation. Driven by the advances in molecular biology, pharmacogenetics has evolved within the past 40 years from a niche discipline to a major driving force of clinical pharmacology, and it is currently one of the most actively pursued disciplines in applied biomedical research in general. Nowadays we can assess more than 1,000,000 polymorphisms or the expression of more than 25,000 genes in each participant of a clinical study – at affordable costs. This has not yet significantly changed common therapeutic practices, but a number of physicians are starting to consider polymorphisms, such as those in CYP2C9, CYP2C19, CYP2D6, TPMT and VKORC1, in daily medical practice. More obviously, pharmacogenetics has changed the practices and requirements in preclinical and clinical drug research; large clinical trials without a pharmacogenomic add-on appear to have become the minority. This review is about how the discipline of pharmacogenetics has evolved from the analysis of single proteins to current approaches involving the broad analyses of the entire genome and of all mRNA species or all metabolites and other approaches aimed at trying to understand the entire biological system. Pharmacogenetics and genomics are becoming substantially integrated fields of the profession of clinical pharmacology, and education in the relevant methods, knowledge and concepts form an indispensable part of the clinical pharmacology curriculum and the professional life of pharmacologists from early drug discovery to pharmacovigilance

Severe degeneration of a sub-coronary pulmonary autograft in a young adult

Background. The pulmonary autograft is currently the best valve substitute in terms of longevity and performance. However, there is no agreement about the optimal method of insertion (sub-coronary position or freestanding root). Objectives. We sought to examine the clinical status, detailed imaging and morphometric changes in an explanted pulmonary autograft 22 years after sub-coronary implantation. Methods. A 30-year-old female underwent pulmonary autograft replacement of a severely stenotic valve at the age of 7 years, after presenting to us with signs of moderate to severe heart failure. She underwent clinical examination, detailed imaging including echocardiographic and CT examination with computerised image analysis. The explanted valve was examined by morphometry. Results. Clinical examination showed signs of heart failure (NYHA III). Trans-thoracic and trans-oesophageal 2D echo showed severe malfunction of both the aortic and pulmonary valves associated with dilatation and hypertrophy of both the right and left ventricles. Surgical correction was performed by replacing both the pulmonary and aortic valves with Medtronic 27mm Freestyle valves. The pulmonary autograft showed degeneration of the trilamellar layering of the leaflets, loss and disorganisation of GAGs, increased collagen with fibrotic overgrowth, and markers of fibrosis, inflammation, and calcification. Post-operative imaging showed good correction of the haemodynamic lesions. Conclusion. The pulmonary autograft implanted into the sub-coronary position presented with adverse remodelling, which was detrimental to the functionality and longevity of the valve. Authorship. NL, AM, MN all contributed equally to this paper

Aspergilose invasiva do seio esfenoidal e paralisia do sexto nervo

A aspergilose do seio esfenoidal é doença rara e pode se apresentar sob diferentes formas clínicas devido a envolvimento de. diversas estruturas anatomicamente adjacentes ao seio esfenoidal. Relatamos o caso de uma paciente com 74 anos de idade, diabética, com paralisia do sexto nervo esquerdo secundária a aspergilose do seio esfenoidal. Não havia história de cefaléia ou de queixas sugestivas de alergia respiratória. A tomografia computadorizada revelou lesão etmoídeo-esfenoidal à esquerda, com presença de imagem cálcica em seu interior e destruição óssea. A paciente foi submetida a cirurgia com retirada de material necrótico e debridamento da lesão, seguida de tratamento com anfote-ricina B e 5-fluorocitosina. Exame histológico revelou a presença de hifas sugestivas de Aspergilius sp. Após três meses de tratamento a paciente apresentou recuperação total da paresia do nervo abducente. O diagnóstico clínico pré-operatório de aspergilose do seio esfenoidal é difícil. No entanto, a presença de imagem cálcica ou de densidade metálica à radiografia simples de crânio ou à tomografia computadorizada sugere fortemente o diagnóstico. O exame hihstológico revela a presença de hifas dicotomatosas em 45,0 típicas do Aspergilius. O tratamento inclui excisão e debridamento da lesão seguida do uso de anfo-tericina B associada a 5-fluorocitosina ou rifampicina