Empiric antibiotic therapy in acute uncomplicated urinary tract infections and fluoroquinolone resistance: a prospective observational study

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to determine the antimicrobial susceptibility patterns of urinary isolates from community acquired acute uncomplicated urinary tract infections (uUTI) and to evaluate which antibiotics were empirically prescribed in the outpatient management of uUTI.</p> <p>Methods</p> <p>Among the patients which were admitted to outpatient clinics of Ankara University Medical Faculty, Ibni-Sina Hospital during 2005-2006, a total of 429 women between the age of 18 and 65 years old who were clinically diagnosed with uUTI and to whom prescribed empirical antibiotics were enrolled in this prospective observational study. Patients' demographical data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed.</p> <p>Results</p> <p>Totally 390 (90.9%) patients among all study population were requested for urine culture by their physicians. 150 (38.5%) of these urine cultures were positive. The most common isolated uropathogen was <it>Escherichia coli (E. coli) </it>(71.3%). The variations of uropathogens according to age and menopause status were not significantly different.</p> <p>The resistance rates of <it>E. coli </it>isolates for ampicillin, ampicillin-sulbactam, amoxicillin-clavulonate, cefuroxime, ceftriaxone, fluoroquinolones (FQ), co-trimoxazole (TMP-SMX) and gentamicin were 55.1%, 32.7%, 32.7%, 23.4%, 15.9%, 25.2%, 41.1%, 6.1% respectively. FQ were the most common prescribed antibiotics (77.9%) (<it>P </it>< 0.001), followed by TMP-SMX (10.7%), fosfomycin (9.2%), nitrofurantoin (2.1%). Treatment durations were statistically longer than the recommended 3-day course (<it>P </it>< 0.001).</p> <p>Conclusion</p> <p>Empirical use of FQ in uUTI should be discouraged because of increased antimicrobial resistance rates.</p

Unilateral Periorbital Edema and Erythema: A Rare Presentation of Chronic Cutaneous Lupus Erythematosus

We present a case of a 55-year-old female with unilateral periorbital edema and erythema over the past one year without systemic features or other skin signs, who had photosensitivity and positive antinuclear antibody and also SS-A 60kD antibody. Treatment with topicalcorticosteroids had remained unsuccessful along one year. We suspected a clinical picture association with cutaneous lupus erythematosus including photosensitivity,chronic cutaneous lesion finding and positive autoantibodies and observed a fovarable clinical response to systemic antimalarialtherapy within a short time. The observation has confirmed our diagnosis. Similar cases were rarelyreported in literature. The persistent edema and erythema involving periorbital area can occur asa rare manifestation of chronic cutaneous lupus erythematosus

Calcinosis Cutis Universalis in a Patient with Systemic Sclerosis

Systemic sclerosis (Scl) is a multisystemic autoimmune disorder that is characterized by immune dysregulation, vasculopathy, and overproduction of collagen leading to skin and internal organ fibrosis. Calcinosis is a well known manifestation of Scl, which occurs the deposition of calcium in the dermis and subcutaneous tissues with normal levels of serum calcium and phosphorus. However, calcinosis on extremities and trunk is unfrequently seen. Herein we present the case of a 44-year-old female patient with diffuse cutaneous systemic sclerosis who has calcinosis stiutated bilaterally at upper and lower extremities and trunk which is an unfrequent condition

Adult-Onset Still’s Disease: Persistent Pruritic Erythematous Plaques and Papules

We present a case of a 24 year-old woman with high fever, pruritic erythematousplaques and papules on the trunk and extremities, inflammatory peripheral joint symptoms andsore throat for two weeks. The patient had neutrophilic leucocytosis, elevated acute phase proteins(erythrocyte sedimentation rate, C-reactive protein and ferritin) and increased liver enzymes. Abdominal ultrasonography revealed mild splenomegaly. After the exclusion of infection, malignancyand other rheumatic inflammatory diseases, the patient was diagnosed with adult-onset Still’s disease (AOSD) meeting to Yamaguchi criteria. Clinical symptoms and abnormal laboratory tests rapidly improved within days of starting glucocorticoid treatment. The presence of typical evanescentskin rash (salmon-pink) is one of the major criteria of disease, however different skin lesions suchas persistent pruritic erythematous plaques and papules have been occasionally reported in association with AOSD on trunk and extremities, which may be confused with other diseases. Therefore, the recognition of the atypical skin lesions with AOSD is necessary for diagnosis and choicetreatment of disease

Intestinal Behçet disease: Evaluation with MR enterography - a case-control study

OBJECTIVE. The purposes of this study were to discern imaging findings that distinguish Behcet disease from small-bowel Crohn disease, to find initial performance estimates for these findings, and to evaluate the diagnostic value of MR enterography (MRE) for detecting intestinal Behcet disease. MATERIALS AND METHODS. The MRF, examinations of 30 consecutively registered patients with established intestinal Behcet disease were reviewed by two blinded readers. The frequencies of MRE findings were compared with those obtained for 30 control subjects with small-bowel Crohn disease who were matched for sex and age. The performance estimates were generated with ileocolonoscopic and histopathologic findings as the reference standard. RESULTS. Polypoid pattern and homogeneous mural enhancement were the findings seen more frequently in Behcet disease (p = 0.000) than in Crohn disease (p = 0.003). Stricture formation, long-segment disease, and involvement of more proximal ileal segments favored small-bowel Crohn disease. The ROC AUCs for polypoid pattern and homogeneous mural enhancement in the detection of intestinal Behcet disease were 0.806 and 0.779. The accuracy of MRE was 70.00% (95% CI, 50.60-85.27%); sensitivity, 57.14% (95% CI, 34.02-78.18%), and specificity, 100% (95% Cl, 66.37-100%). CONCLUSION. MRE has potential for use as a radiation-free alternative for clarifying the cause of nonspecific gastrointestinal symptoms in patients with known Behcet disease. However, additional studies are needed to determine the actual value of MRE in patients with Behcet disease and to validate the clinical usefulness of the technique in the detection of unknown intestinal Behcet disease

Response to Rituximab in a Case of Lupus Associated Digital Ischemia

We report the case of a 38-year-old female patient with systemic lupus erythematosus (SLE) and Jaccoud arthritis (JA) that sequentially developed digital ischemic lesions of the hands. In spite of follow-up treatment with glucocorticoids, immunosuppressant, antiaggregant, and potent vasodilatator agents, a serious progression to digital gangrene over a one-month period was observed. Surprisingly, her nonhealing digital lesions improved after two cycles of rituximab (RTX) administration

Association between single nucleotide polymorphisms in prospective genes and susceptibility to ankylosing spondylitis and inflammatory bowel disease in a single centre in Turkey

To establish the prevalence of the single nucleotide polymorphisms (SNPs) of endoplasmic reticulum aminopeptidase 1 (ERAP1), IL-23 receptor (IL-23R), signal transducer and activator of transcription 3 (STAT-3) and Janus kinase 2 (JAK-2) in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) in a Turkish population.Materials and Methods: A total of 562 subjects who presented at the Ankara University internal medicine departments of rheumatology and gastroenterology outpatient clinics were recruited in this study, including 365 patients with AS, 197 patients with IBD and 230 healthy controls. ERAP1, IL-23R, STAT-3 and JAK-2) were genotyped in competitive allele-specific polymerase chain reactions. Results: The ERAP1 (rs26653) polymorphism was found to increase the disease risk in patients with AS and IBD compared with the control group (p=0.02 and p=0.01, respectively). In addition, this polymorphism revealed a significant relationship with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) in patients with AS (r=0.829, p&lt;0.001 and r=0.731, p&lt;0.001, respectively). Conclusion: The ERAP1 gene polymorphism might be a risk factor in the pathogenesis of AS and IBD. In contrast, IL-23R gene polymorphisms may serve a protective role in AS and IBDTo establish the prevalence of the single nucleotide polymorphisms (SNPs) of endoplasmic reticulum aminopeptidase 1 (ERAP1), IL-23 receptor (IL-23R), signal transducer and activator of transcription 3 (STAT-3) and Janus kinase 2 (JAK-2) in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) in a Turkish population.Materials and Methods: A total of 562 subjects who presented at the Ankara University internal medicine departments of rheumatology and gastroenterology outpatient clinics were recruited in this study, including 365 patients with AS, 197 patients with IBD and 230 healthy controls. ERAP1, IL-23R, STAT-3 and JAK-2) were genotyped in competitive allele-specific polymerase chain reactions. Results: The ERAP1 (rs26653) polymorphism was found to increase the disease risk in patients with AS and IBD compared with the control group (p=0.02 and p=0.01, respectively). In addition, this polymorphism revealed a significant relationship with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) in patients with AS (r=0.829, p&lt;0.001 and r=0.731, p&lt;0.001, respectively). Conclusion: The ERAP1 gene polymorphism might be a risk factor in the pathogenesis of AS and IBD. In contrast, IL-23R gene polymorphisms may serve a protective role in AS and IB

Spontaneous Coronary Artery Dissection in a Male Patient with Takayasu’s Arteritis and Antiphospholipid Antibody Syndrome

We present a case of a 34-year-old male who presented to the emergency ward with fever and abdominal pain. The diagnosis of Takayasu’s arteritis and also antiphospholipid syndrome was made during an imaging workup of deep-vein thrombosis. A spontaneous coronary artery dissection was revealed in coronary CT angiography requested for chest pain and dyspnea. The patient was treated medically and discharged on close followup. The concurrence of spontaneous coronary artery dissection with antiphospholipid syndrome and Takayasu’s arteritis has not been reported in the previous literature. The possibility of a spontaneous coronary artery dissection should be considered in patients presenting with both diseases