Factors Affecting Inadequate Empirical Antimicrobial Therapy and the Clinical Course of Upper Urinary Tract Infections in Elderly Patients: A Multicenter Study

7th International Congress of Infectious-Diseases-and-Clinical-Microbiology-Speciality-Society-of-Turkey -- MAY 08-13, 2018 -- Antalya, TURKEYIntroduction: In this study, we aimed to determine the risk factors associated with inadequate empirical antibiotherapy (IEAT) and hospital-related mortality in elderly patients being treated for upper urinary tract infections (UTI). Materials and Methods: This study included individuals aged 65 years and over who were hospitalized after being diagnosed of community-acquired UTI or community-onset healthcare-associated UTI and followed-up in clinics and/or intensive care units (ICU) of 33 hospitals between March and September 2017. Results: A total of 525 patients (48% males; mean age: 76.46 +/- 7.93 years) were included in the study. Overall, 68.2% of the patients were hospitalized through the emergency department and 73.9% of patients were followed-up for pyelonephritis. Gram-negative, Gram-positive, and Gram-negative and positive mix growths were determined in 88%, 9.3%, and 2.7% of urine cultures, respectively. Fifty-six (10.7%) of the patients died. In multivariate analysis, the presence of chronic obstructive pulmonary disease [Odds ratio (OR): 2.278], age 85 years and over (OR: 2.816), admission to the ICU (OR: 14.831), and IEAT (OR: 2.364) were independent factors that significantly affected mortality. The presence of a urinary catheter, being followed-up in the ICU, benign prostate hypertrophy, use of antibiotics other than piperacillin-tazobactam and carbapenem were determined as independent factors that significantly affected IEAT (p<0.05). Conclusion: In our study, we found a direct correlation between IEAT and mortality. Therefore, knowing the most frequent microorganisms and antibiotic susceptibility profiles observed in the UTI of elderly patients may help to decrease the mortality and morbidity associated with these infections.Infect Dis & Clin Microbil Special Soc Turkiy

In Vitro Susceptibility of Tigecycline and Colistin Against Stenotrophomonas maltophilia

Introduction: Gram-negative bacillus Stenotrophomonas maltophilia is resistant to drugs (multi-drug resistance-MDR) and it can be isolated from nature. Treatment of the infections resulting from S. maltophilia could be problematic due to multi-resistance. Materials and Methods: 72 S. maltophilia strains isolated from clinical samples were included into the study. Sensitivity was determined using Tigecycline and Colistin E-test MIC method performed in the Clinical Microbiology laboratory of Baskent University, Medical Faculty between 2010 and 2014. Results: In our study, colistin MIC range was found as 0.016-8 mg/L. MIC50 and MIC90 values were determined respectively as 1.5 mg/L and 12 mg/L. Tigecycline MIC range was 0-96 mg/L, and MIC50 was 0.19 mg/L and MIC90 was 1.5 mg/L. Furthermore, one tigecycline resistant strain was detected. Conclusion: We believe that the determination of novel treatments and protocols and their standardization using multidisciplinary approaches can facilitate to cope with problematic and resistant nosocomial infections developed by S. maltophilia

A Case of Relapsed Brucellosis Progressing with Cardiac Tamponade

As a zoonotic infection widely seen in the world, brucellosis is also seen in our region endemically. Cardiovascular involvement is a rare complication and primary pericarditis is even rarer. In this report, it was aimed to present an 80-year-old female patient who presented with complaints including fever and chest pain that started a month ago and who was found to have pericardial effusion and cardiac tamponade. The patient had brucella standard tube agglutination positivity and was strated rifampicin and doxycycline therapy. When toxic hepatitis developed in thefi rst month of treatment, the therapy was replaced with trimethoprim-sulfamethoxazole and ciprofl oxacin. The patient was given treatment for three months in total. She was administered subxiphoida lpericardial tube drainage due to cardiac tamponade. The patient’s complaints regressed from the third day of therapy and a decrease was found in the pericardial effusion in her echocardiography. At the end of the treatment, she had full recovery as per her clinical, laboratory, and echocardiography results. It should be born in mind that brucellosis may lead to pericarditis and even cardiac tamponade in regions where it is seen endemically