Prospective observational study on antibiotic-associated bloody diarrhea: report of 21 cases with a long-term follow-up from Turkey

WOS: 000303826200012PubMed ID: 22433794Objective Antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated bloody diarrhea (AABD) in which Clostridium difficile is absent. Although the cause is not exactly known, reports have suggested the role of Klebsiella oxytoca and/or C. difficile. Materials and Methods Between 2001 and 2006, stool samples of 21 consecutive patients with AABD were cultured for common enteric pathogens and K. oxytoca, and were tested for the presence of parasites and C. difficile toxin A + B within the first 24 h of their initial admission and a colonoscopy was performed when available. The patients were followed up prospectively by telephone interviews. Results The occurrence of symptoms ranged between 6 h and 14 days following the first dose of the antibiotic responsible and the duration of the AABD ranged between 6 h and 21 days. The antibiotic responsible was oral ampicillin/sulbactam in 18 (85%) cases. C. difficile toxin A + B production by enzyme-linked immunosorbent assay and K. oxytoca growth in stool cultures were detected in six (29%) and 11 (51%) of 21 patients, respectively. Endoscopic morphology and histology in a limited number of patients revealed no more than a nonspecific inflammation and acute colitis, respectively. Conclusion This study confirms that antibiotic-associated hemorrhagic colitis, as a distinct entity in relation to K. oxytoca, is seen in half of the patients with AABD. Most of the cases are seen within a week following the antibiotic use. Almost all of the patients did not develop any flares during the long-term antibiotic-free follow-up. In some of the patients with AABD, there was coexistence of K. oxytoca with C. difficile toxin A + B. Eur J Gastroenterol Hepatol 24: 688-69

Macrolide-Lincosamide-Streptogramin B (Mlsb) Resistance Phenotype in Staphylococcal Isolates

Aim: The aim of this study was to determine the incidence of macrolide-lincosamide-streptogramin B (MLSB) resistance in staphylococcal isolates from various clinical samples. Methods: In this study, we included a total of 100 staphylococcal isolates, 35 Staphylococcus aureus and 65 coagulase-negative staphylococci (CNS), from specimens obtained from patients followed up in our hospital between 2009 and 2010. Methicillin resistance of these isolates was determined using cefoxitin disc diffusion method. MLSB resistance was investigated by D-test method using erythromycin and clindamycin disks. Results: Of 35 S. aureus isolates, 14 were methicillin-resistant (MRSA) and 21 were methicillin-sensitive (MSSA). Of 65 CNS isolates, 41 were methicillin-resistant (MRCNS) and 24 were methicillin-sensitive (MSCNS). In 79 strains, there was at least one MLSB resistance phenotype. The most frequent resistance phenotypes were inducible (35%) and constitutive (30%) among all isolates, while the constitutive one was more common in S. aureus strains (62%). Conclusion: Since the resistant community- and hospitalacquired staphylococcal infections have become a therapeutic problem, it is very important to detect MLSB resistance routinely in microbiology laboratories. D-test is a cheap and reliable diagnostic method which can be performed in every laboratory. In order to prevent treatment failure, D-test should be routinely used and the results should be reported to the clinician before starting a therapy with MLSB group of antibiotics. (The Me di cal Bul le tin of Ha se ki 2011; 49: 102-4

Surveillance of Device-associated Nosocomial Infections in an Intensive Care Unit at a 550-Bed Research Hospital during 2009

Aim: Nosocomial infections that cause high mortality rates are most frequently observed in intensive care units (ICUs). In this study, device-associated nosocomial infections in Anesthesia and Reanimation Unit of our hospital during 2009 are studied. Methods: ICU serves as a third-level treatment unit with 22 beds out of the total 550 beds in the training hospital. Nosocomial Infections are monitored by infectious disease and clinical microbiology specialists and infection control nurses using laboratory- and patient-based active surveillance method and diagnosed according to the Centers for Diseases Control and Prevention criteria. Results: 109 nosocomial infection attacks were detected in ICU. Among them, 28 were catheter-associated urinary tract infection, 26 were ventilator-associated pneumonia, and the rest 55 were circulatory system infection. Central line-associated bloodstream infection rate was 0.45%, urinary catheter-associated urinary tract infection rate - 3.82%, and ventilator-associated pneumonia infection rate was 4.33%. Conclusion: Since bacteria causing infection in ICU are more resistant, the condition of the patients is more severe. Surveillance is of great importance for nosocomial infection control and monitoring. (The Medical Bulletin of Haseki 2011; 49: 30-3

Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicenter observational study (CarDINe Study).

Background: Infections of cardiovascular implantable electronic devices (CIED) are mainly due to gram-positive bacteria (GPB). Data about gram negative bacteria CIED (GNB-CIED) infections are limited. Aims of our work are to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. Methods: Multicenter, international, retrospective, case-control-control study on patients undergoing CIED implantation from 2015 to 2019 in 17 centers across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. Results: 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No differences regarding clinical presentation, diagnostic and therapeutic managements were found between the groups. A trend toward higher rate of FDG PET/CT positivity was observed among patients with GN than in those with GPB-CIED infection (85.7% vs. 66.7%, p=0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (RRR=1.211, P= 0.011), obesity (RRR: 5.122, P=0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker (PM-VVI) implantation (RRR: 3,027, P=0.006) and the right subclavian vein site of implantation (RRR: 5.014, P=0.004). At 180-day survival analysis GNB-CIED infection was associated with increased mortality risk (HR=1.842, P=0.067). Conclusions: Obesity, high number of comorbidities, and right subclavian vein implantation site are associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided by the use of FDG PET/CT is suggested in patients with GNB-CIED infection considering the poorer outcome observed in this group