Does vitamin D deficiency exacerbate hidradenitis suppurativa?

In this study, we aimed to compare vitamin D (25 Hydroxy Vitamin D (25 OH D)) levels in Hidradenitis Suppurativa (HS) patients with healthy control groups, and to investigate its possible relationship with disease severity. Our study is a retrospective cross-sectional study. A total of 36 patients diagnosed with HS who presented to our Dermatology clinic between January 2019 and December 2022 were included. Vitamin D levels were recorded by reviewing the patients' files and compared with healthy control groups. The relationship between the patients' 25 OH D levels and disease severity score was determined. The median age of the patient group was 33.5 (IQR; 25.2-42) years, and 30 (83.3%) were male. The median age of the healthy control group was 34.5 (IQR; 24-42), and 21 (58.3%) were male. In patients with severe 25 OH D deficiency, statistically significant findings were observed with a higher frequency of Hurley-3 disease severity score, whereas patients with mild to moderate deficiency or normal 25 OH D levels showed a higher frequency of disease severity classified as Hurley-1. (p=0.022). Additionally, patients with severe vitamin D deficiency had significantly higher C-reactive protein levels and body mass index (p=0.036 and p=0.044, respectively). Among patients with active lesions such as abscesses, nodules, and fistula, significantly lower vitamin D levels were observed compared to those without such lesions (p=0.020, p=0.032, and p=0.017, respectively). Vitamin D level in patients with HS (13.42 ng/mL (IQR: 8.00-18.65)) compared to the healthy control group (18.00 ng/mL (IQR: 14.12-22.87)) was statistically significant. was significantly lower (p=0.001). Vitamin D levels of HS patients are lower than healthy control groups. Inflammatory lesions are more common in patients with severe vitamin D deficiency and the disease tends to be more severe. [Med-Science 2023; 12(3.000): 859-64

Antimicrobial Resistance Rates and Risk Factors for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli-Associated Urinary Tract Infections in Older Outpatients in East Anatolia from 2011-2019

Background: Community-acquired urinary tract infection is among the most common infections in older adults. Regardless of age, the most frequently detected causative microorganism is Escherichia coli. In parallel with the increase in antibiotic use, the frequency of community-acquired extended-spectrum beta-lactamase-producing E. coli (ESBL-E. coli) has reached critical levels. The use of empirical antibiotic therapy is determined by assessing patient-based risk factors. Therefore, knowing the risk factors and the frequency of antimicrobial resistance can guide the treatment to shape the treatment.Objectives: This study aimed to determine the risks and resistance frequencies to guide the empirical treatment selection for ESBL-E. coli-associated urinary tract infection (UTI) in elderly patients.Methods: This study is a retrospective cohort study. It was carried out between 2011-2019. Escherichia coli growth of >= 105 colony -forming units (cfu)/mL in urine culture was included in 815 patients aged 65 and over who applied to outpatient clinics.Results: Two hundred and sixty (31.9%) of the patients had ESBL-E. coli. In ESBL-E. coli, antimicrobial resistance rates were highest (100%) for penicillins + beta-lactamase inhibitors. The lowest resistance rates were determined for carbapenems, aminoglycosides, phosphonic acid, and nitrofurantoins. Risk factors for ESBL-producing bacteria were determined. These were the presence of benign prostatic hypertrophy, antibiotic use in the last three months, history of UTI in the last year, urinary catheter uses in the last year, male gender, and hospitalization in the last year (P 0.05). The only independent risk factor was a history of UTI in the last year, which increased the risk of ESBL by 2.8 times.Conclusions: Carbapenems can be chosen as parenteral options, and phosphonic acids and nitrofurantoin as oral options for em-pirical antibiotic treatment, especially in patients with a history of UTI in the past year

A rare cause of healthcare-associated infective endocarditis: Enterobacter cloacae

We report a case of infective endocarditis secondary to healthcare-associated bloodstream infection caused by an uncommon etiologic agent, multidrug-resistant Enterobacter cloacae. The patient was treated with a combination of antimicrobial therapy and surgery, but could not be saved. With this case, we discuss the prevalence, risk factors, treatment options, and outcomes of the rarely encountered Enterobacter cloacae-associated infective endocarditis

Treatment efficacy and superinfection rates in complicated urinary tract infections treated with ertapenem or piperacillin tazobactam

Background/aim: In this retrospective study, the efficacy of ertapenem and piperacillin tazobactam was compared in the treatment of complicated urinary tract infections (cUTIs). Treatment responses were also evaluated for both antibiotics. Materials and methods: A total of 230 patients were enrolled in the study. Of these, 170 received ertapenem and 60 received piperacillin-tazobactam. Results: In both groups, urine cultures after 48 h were negative for the initial uropathogen. The frequency of superinfection was 29.4\% in the ertapenem group and 8.3\% in the piperacillin-tazobactam group over the duration of treatment (P < 0.05). Urinary catheterization increased the superinfection risk 2.88-fold in the ertapenem group and diabetes mellitus increased the risk 8.50-fold in the piperacillin-tazobactam group (CI: 1.44-5.76 and 1.16-62.09, respectively, P < 0.05). The main pathogen isolated from superinfection in the ertapenem group after 48 h was Enterococcus spp. (71.4\%). Conclusion: Both ertapenem and piperacillin-tazobactam were effective in the treatment of cUTIs caused by ESBL-producing microorganisms. A high frequency of superinfection in the ertapenem group was the result of Enterococcus and Pseudomonas spp., against which ertapenem is not active. In the presence of urinary catheterization, diabetes mellitus, and urological intervention, patients should be closely monitored for the development of a superinfection, especially patients receiving ertapenem

Factors Associated with Mortality in Patients with Decubitus Ulcers Treated with Negative Pressure Wound Therapy

timur, ozge/0000-0002-7296-5536; tosun, pinar/0000-0002-2617-4610; sevinc, can/0000-0002-4069-9181WOS: 000512305000016Introduction: Decubitus ulcer is a common geriatric syndrome encountered in patients receiving palliative care support. Negative pressure wound therapy is one of the methods used to promote wound healing. the aim of this study was to determine factors associated with mortality in patients with decubitus ulcer treated with negative pressure wound therapy in our palliative care unit. Materials and Methods: Data from patients who were admitted to the palliative care unit for follow-up and who underwent negative pressure wound therapy due to decubitus ulcer were retrospectively evaluated. Categorical data were compared using chi-square test, and continuous data were compared using nonparametric Kruskal-Wallis and Mann-Whitney U tests. A Cox regression model was created including presence of microbiological response, presence of polymicrobial agent, presence of agent in initial wound culture, concurrent bacteremia, final C-reactive protein (CRP), final albumin, and final leukocyte counts. Results: the study included 53 palliative care patients. Their mean age was 73.6 +/- 17.3 years and 33 (62.3%) were females. Bacterial growth was detected in 39 (73.6%) of the wound site cultures obtained before treating decubitus ulcers with negative-pressure wound dressing. Multiple microorganisms were isolated in 17 (47.2%) of the positive cultures. Escherichia coli was the most common isolate (39.2%). Twenty-five (47.2%) patients died and 28 (52.8%) could be discharged. Positive culture before negative pressure wound therapy was associated with statistically higher mortality rate. A Cox regression model using the variables that differed significantly between the deceased and surviving patients (microbiological response, polymicrobial infection, agent detected in initial wound culture, concurrent bacteremia, and final CRP, albumin, and leukocyte counts) showed that the presence of multiple microorganisms in decubitis ulcer increased mortality by 3.793 fold and was an independent risk factor for mortality. Conclusion: in patients with decubitus ulcer treated with negative pressure wound therapy, the presence of pre-negative pressure wound therapy hypoalbuminemia, positive wound culture, and isolation of multiple agents are independent risk factors associated with higher mortality

Factors Determining Mortality in Geriatric Palliative Care Patients

WOS: 000533539600005Background: As life expectancy at birth increases, the elderly population is growing, both in Turkey and globally. the aim of this study was to investigate the factors associated with 12-month mortality in patients receiving geriatric palliative care. Methods: Geriatric inpatients who were treated for 48 hours or more in the palliative care unit of our hospital between January 2016 and January 2017 were included in the study. Results: A total of 233 geriatric palliative care patients (50.6% women) with a mean age of 77.6 +/- 11.0 were included in the study. Eighty of the patients in our study died while in palliative care. Chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) were significantly more common among the deceased patients. of the 153 surviving patients, 94 (61.4%) died within 12 months of discharge and 59 (38.6%) survived beyond 12 months. Presence of CKD was associated with a 2.17-fold reduction in survival time and albumin level 20.5, 1.60-fold shorter with Charlson Comorbidity Index (CCI) > 6.5, and 1.98-fold shorter with albumin levels < 3.2 mg/L. Conclusion: CKD and low albumin were identified as independent risk factors for reduced hospital survival time. Independent risk factors for shorter post-discharge survival time included the presence of solid organ malignancy, high APACHE-II score, high CCI, and low albumin level. Copyright (C) 2020, Taiwan Society of Geriatric Emergency & Critical Care Medicine

Evaluation of Asymptomatic Bacteriuria and Urinary Tract Infection in Patients With Primary Sjogren's Syndrome

Objectives: This study aims to determine the frequency and risk factors of bacteriuria and urinary tract infection (UTI) in patients with primary Sjogren's syndrome (SS) and their differences from healthy individuals and rheumatoid arthritis (RA) patients. Patients and methods: The study included 107 female primary SS patients (mean age 50.7 +/- 11.6 years; range, 23 to 76 years), 53 healthy female control subjects (mean age 46.8 +/- 15.5 years; range 21 to 80 years), and 40 females with RA (mean age 51.7 +/- 14.2 years; range, 25 to 79 years). Participants were questioned for UTI risk factors and symptoms. Middle stream urine samples were taken and cultured. All participants were examined with urinary symptom questioning survey of American Urological Association (AUA-7). Results: The urine cultures were positive in 18 primary SS patients (16.8%), eight RA patients (20%), and two healthy controls (3.7%). Escherichia coli, enterococci, Klebsiella, streptococci, and candida were detected in SS patients' cultures. Extended-spectrum beta-lactamase was positive in three cultures. Asymptomatic bacteriuria was not detected in any SS patient. The highest AUA-7 score was determined in SS group (p=0.031). Nineteen SS patients had vaginal dryness symptom and their AUA-7 scores were higher than the rest of the SS group. The risk of UTI development was not different between those who had or did not have vaginal dryness. Conclusion: Urinary tract infections are seen more often in SS patients rather than normal population, which may be caused by SS' urinary system effects. It is difficult to distinguish between asymptomatic bacteriuria and infection because of the underlying urinary symptoms. Clinicians must be careful in patients receiving immunosuppressive therapy due to the high frequency of UTIs

The value of C-reactive protein in infection diagnosis and prognosis in elderly patients

WOS: 000433140500002PubMed ID: 28856612Background The aim of this study was to determine the value of C-reactive protein level in the diagnosis and prognosis of infection in elderly patients. Study population This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients' demographic data, Acute Physiology and Chronic Health Evaluation score, and Charlson Comorbidity Index were recorded. Results A total of 233 patients were included in the study. A total of 199 instances of infection were diagnosed in 175 of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of infection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 h. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 h and 20% at 96 h. Conclusion In elderly patients with infection, the initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis

Evaluation of Asymptomatic Bacteriuria and Urinary Tract Infection in Patients With Primary Sjogren's Syndrome

Objectives: This study aims to determine the frequency and risk factors of bacteriuria and urinary tract infection (UTI) in patients with primary Sjogren's syndrome (SS) and their differences from healthy individuals and rheumatoid arthritis (RA) patients. Patients and methods: The study included 107 female primary SS patients (mean age 50.7 +/- 11.6 years; range, 23 to 76 years), 53 healthy female control subjects (mean age 46.8 +/- 15.5 years; range 21 to 80 years), and 40 females with RA (mean age 51.7 +/- 14.2 years; range, 25 to 79 years). Participants were questioned for UTI risk factors and symptoms. Middle stream urine samples were taken and cultured. All participants were examined with urinary symptom questioning survey of American Urological Association (AUA-7). Results: The urine cultures were positive in 18 primary SS patients (16.8\%), eight RA patients (20\%), and two healthy controls (3.7\%). Escherichia coli, enterococci, Klebsiella, streptococci, and candida were detected in SS patients' cultures. Extended-spectrum beta-lactamase was positive in three cultures. Asymptomatic bacteriuria was not detected in any SS patient. The highest AUA-7 score was determined in SS group (p=0.031). Nineteen SS patients had vaginal dryness symptom and their AUA-7 scores were higher than the rest of the SS group. The risk of UTI development was not different between those who had or did not have vaginal dryness. Conclusion: Urinary tract infections are seen more often in SS patients rather than normal population, which may be caused by SS' urinary system effects. It is difficult to distinguish between asymptomatic bacteriuria and infection because of the underlying urinary symptoms. Clinicians must be careful in patients receiving immunosuppressive therapy due to the high frequency of UTIs