Comparative activity of carbapenem testing (the COMPACT study) in Turkey

<p>Abstract</p> <p>Background</p> <p>Recent evidence indicates that Gram-negative bacterial pathogens, the most common of which are <it>Pseudomonas </it>spp., <it>Enterobacteriaceae</it>, and <it>Acinetobacter baumannii</it>, are frequent causes of hospital-acquired infections. This study aims to evaluate the in vitro activity of doripenem and comparator carbapenem antibiotics against Gram-negative clinical isolates collected from COMParative Activity of Carbapenem Testing (COMPACT) study centres in Turkey.</p> <p>Methods</p> <p>Ten centres in Turkey were invited to submit <it>Pseudomonas aeruginosa</it>, <it>Enterobacteriaceae</it>, and other Gram-negative isolates from intensive care unit (ICU)/non-ICU patients with complicated intra-abdominal infections, bloodstream infections, or nosocomial pneumonia, including ventilator-associated pneumonia, between May and October 2008. Susceptibility was determined by each centre using E-test. A central laboratory performed species confirmation as well as limited susceptibility and quality-control testing.</p> <p>Results</p> <p>Five hundred and ninety six isolates were collected. MIC₉₀values for doripenem, meropenem, and imipenem, respectively, were 32, ≥ 64, and ≥ 64 mg/L against <it>Pseudomonas </it>spp.; 0.12, 0.12, and 0.5 mg/L against <it>Enterobacteriaceae</it>; and ≥ 64 mg/L for each against other Gram-negative isolates. In determining the susceptibility of hospital isolates of selected Gram-negative pathogens to doripenem, imipenem, and meropenem, we found that against all pathogens combined, the MIC₉₀for ICU compared with non-ICU isolates was higher.</p> <p>Conclusions</p> <p>Doripenem showed similar or slightly better activity than meropenem and better activity than imipenem against the Gram-negative pathogens collected in Turkey.</p

Oral Amoxicillin/Clavulanate and Ciprofloxacin Treatment in Low-Risk Febrile Neutropenic Patients with Solid Tumors

Objective: The aim of this study was to collect the data of low-risk febrile neutropenic patients with solid tumors orally treated with amoxicillin/clavulanate and ciprofloxacin. Material and Methods: Adult patients with solid tumors who were treated with conventional dose of chemotherapy, presented with fever (axillary temperature 38 degrees C on two occasions or 38.3 degrees C on a single occasion) and neutropenia (absolute neutrophil count, 500 cells/mL), and met low risk criteria (above 20) according to "The Multinational Association for Supportive Care in Cancer" (MASCC) were eligible for this study. All patients received empirical therapy with oral ciprofloxacin (500 mg twice daily) plus amoxicillin/clavulanate (1000 mg, three times daily). Results: Twenty-one episodes of febrile neutropenia in 20 patients (including two episodes of a patient with lung cancer) were studied retrospectively. The mean age was 55.5 years (range, 30 to 77 years), and most were females (70%). On the initial evaluation, two of these patients had mild diarrhea and the others had a fever of unknown origin. Treatment was successful in 76% of the episodes. Twenty-seven percent of episodes required modification of initial antibiotic therapy to intravenous administration of antibiotics. No death was observed due to the febrile neutropenic episode. Conclusion: In low-risk patients with solid tumors who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin/clavulanate seems to be an effective alternative approach for empirical therapy

Screening for hepatocellular carcinoma: summary of current guidelines up to 2018

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related to worldwide death with a great geographical variation. To be eligible for curative therapy at the time of diagnosis is important. However, the majority of cases are diagnosed at late stages. This can be achieved with applicable screening modalities. Until now, many organizations around the world have developed guidelines according to their own evidence-based data for screening of HCC. The purpose of this article is to review the screening modalities of HCC to assist gastroenterologists and providers involved in the management of HCC

Appendiceal neoplasms: evaluation of 4761 appendectomy specimens

Acute appendicitis is the most diagnosed intraabdominal pathology in emergency surgery meanwhile appendiceal neoplasms are infrequent and mostly detected in postoperative pathological work-up. In this study, we aimed to identify the incidence of appendiceal neoplasms and histopathological distribution of appendectomy specimens of our patients operated with the diagnosis of acute appendicitis. Between January 2010 and December 2020 postoperative results of patients who were operated with the diagnosis of acute appendicitis in a tertiary hospital were evaluated. Appendiceal neoplasms and subtypes of neoplasms according to pathology specimens are noted and long-term results of patients diagnosed with malignancy are given. 4761 patients operated for acute appendicitis while 55 (1.1%) of them had neoplasms on postoperative pathological evaluation. Eighteen out of 55 patients (32.7%) there were neuroendocrine tumor and in 36 patients there were mucinous lesions with different grades. Low-grade appendiceal mucinous neoplasms were the most common mucinous lesions. No statistically difference in terms of age and sex between group1 (patients who had appendicitis) and group 2 (patients who had neoplasm). Acute appendicitis is an emergent situation where the routine histopathological examination of specimens should be carefully performed to rule out malignancy. [Med-Science 2022; 11(1.000): 116-9

Risk of infection in health care workers following occupational exposure to a noninfectious or unknown source

Background: The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers

THE RATE OF INDUCIBLE CLINDAMYCIN RESISTANCE AND SUSCEPTIBILITIES TO OTHER ANTIMICROBIAL AGENTS IN STAPHYLOCOCCI

Staphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics used by oral route such as erythromycin, clindamycin, trimethoprim-sulphamethoxazole (TMP-SMX) and quinolones are of value especially in the treatment of community acquired infections and resistance to those antibiotics may lead to therapeutic failure. Therefore in this study, susceptibility of staphylococci to TMP-SMX, rifampin, tetracycline, gentamicin, ciprofloxacin and vancomycin and the presence of inducible clindamycin resistance were investigated in two distinct university hospitals in Turkey. A total of 286 staphylococcus strains [184 Staphylococcus aureus, 102 coagulase negative staphylococci (CoNS)] were studied. Of the 90 hospital-acquired S.aureus, 44.6% were methicillin-resistant while all of the community acquired strains were methicillin-susceptible. All of the CoNS strains were isolated from nosocomial infections and 71.6% of them were resistant to methicillin. Inducible clindamycin resistance rate of CoNS strains (34.3%) was higher than that of S.aureus strains (7.1%) and the difference was statistically significant (p = 0.00001). Positive D-test among CoNS were significantly higher in S.hominis strains (p = 0.00001). Susceptibilities of S.aureus strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 56%, 59%, 56%, 56% and 99%, respectively. Susceptibilities of CoNS strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 73%, 72%, 39%, 40% and 46%, respectively. None of these strains were vancomycin resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive and negative S.aureus strains were found statistically significant. Although among CoNS isolates, no. statistically significant difference was found between the resistance rates, D-test positive strains were determined to be more resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive S.aureus and CoNS strains were found statistically significant. It can be concluded that inducible clindamycin resistance should be tested for staphylococci during routine antibiotic susceptibility testing. According to the presented data, clindamycin still can be used empirically in methicillin-susceptible S.aureus infections in our region, however, the routine use of rapid, easy, reproducible and economic D-test for the determination of inducible clindamycin resistance in erythromycin resistant strains should be considered in clinical microbiology laboratories. Inducible clindamycin resistance must be anticipated carefully while considering therapeutic options especially for CoNS infections

Neoadjuvant chemotherapy in patients with stage IVB uterine serous carcinoma: a Turkish multicentric study

The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (p < 0.001, p = 0.026 and p = 0.044, respectively). Adnexal metastasis (positive vs. negative) and type of cytoreductive surgery (maximal vs. optimal and suboptimal) had statistical significance for DSS (p = 0.041 and p = 0.015, respectively). Receiving NACT did not affect DFS and DSS in stage IVB uterine serous carcinoma patients. As our sample size was small, precise conclusions could not be made for suggesting the use of NACT in advanced stage uterine serous carcinoma. For more accurate results, more randomized controlled studies are needed in this patient group.IMPACT STATEMENT What is already known on this subject? Endometrial carcinoma is the most common type of gynecologic tract malignancies and usually it is diagnosed at early stages. Although the favorable prognosis, uterine serous carcinoma (USC), one of the rarest subtypes, has a poorer prognosis when compared to other histological subtypes. USC has a propensity to spread beyond pelvis. Due to this aggressive behavior, surgical intervention could not be feasible in advanced stage disease. What do the results of this study add? Our study evaluated the prognostic factors that affect survival in advanced stage USC patients. Also we investigated that neoadjuvant chemotherapy (NACT) could improve oncologic outcomes. Performing lymphadenectomy, presence of paraaortic lymph node and adnexal metastasis, number of metastatic lymph nodes and type of cytoreductive surgery improved survival in advanced stage USC patients. However, NACT did not have a statistical significance as a predictor for disease-specific survival (DSS) and disease-free survival (DFS). What are the implications of these findings for clinical practice and/or further research? Maximal surgical effort should be performed in advanced stage USC according to our results. On the other hand, NACT had no impact on DSS and DFS rates. For this reason, we could not be able to suggest the routine use of NACT in advanced stage USC. But more randomized controlled trials are warranted for confirmation of our results