36 research outputs found
Hypogammaglobulinemia and Poor Performance Status are Predisposing Factors for Vancomycin-Resistant Enterococcus Colonization in Patients with Hematological Malignancies
No full textObjective: Vancomycin-resistant enterococci (VRE) are common pathogens of hospital-acquired infection. Long hospitalization periods, use of broadspectrum antibiotics, and immunosuppression are major risks for VRE colonization. We aimed to evaluate patients' characteristics and factors that may contribute to VRE colonization. Materials and Methods: Data of 66 patients with colonization and 112 patients without colonization who were hospitalized in the hematology clinic were collected. Hematological malignancies, preexisting gastrointestinal complaints, the presence of hypogammaglobulinemia at the time of diagnosis, complications like neutropenic enterocolitis (NEC), and Eastern Cooperative Oncology Group (ECOG) and Karnofsky performance statuses were recorded. Results: Ages of the patients ranged between 19 and 95 years (mean: 55.99). Karnofsky and ECOG scores were statistically related to VRE colonization (p7 days) may also be accepted as a risk factor, independent of diagnosis or antibiotic use. Performance status is also an important factor for colonization, which may be related to poorer hygiene and increased external help
Evaluation of Risk Factors in Enterococcal Bloodstream Infections
No full textObjective: The aim of this retrospective case-control study was to determine the epidemiology and to evaluate risk factors for the development of enterococcal bloodstream infections and risk factors involved in mortality of adult patients in a tertiary care teaching hospital between February 2010 and February 2011. Methods: A total of 95 enterococcal bacteremia episodes were identified among 28 593 patients hospitalized during the study period. Control group was selected among patients who had no signs and symptoms of bacteremia and had negative blood cultures during the study period. In each case, there had to be two randomized control cases. Results: The most frequent isolates were Enterococcus faecalis (n=46, 48.4%) and E. faecium (n=45, 47.4%). There was only one vancomycin-resistant E. faecalis (vanA genotype) and one E. gallinarum. Eighty four (88.4%) patients were identified to have nosocomial infection. The most common primary sites were central venous catheter (32.7%) and urinary tract (14.7%). Six cases of infective endocarditis and two cases of meningitis due to enterococci were also identified. Polymicrobial bacteremia occurred in 39 (41%) patients. Immunosuppression, cardiovascular disease, chronic liver parenchymal disease, gastrointestinal tract disease, chronic renal failure, hemodialysis, an open wound, Foley catheter, surgery other than abdominal operation, antacid use, hospitalization in the last one month, prolonged hospitalization (> 15 days), exposure to antimicrobial therapy prior to bacteremia and inappropriate empirical therapy were the risk factors significantly associated with enterococcal bloodstream infections. In the multivariate logistic regression analysis, three factors were independently associated with mortality including high Charlson index (p=0.000), intensive care unit admission (p=0.016) and isolation of E. faecium from blood cultures (p=0.49). Conclusions: It should be considered that severely ill patients with prolonged hospitalization, those undergoing invasive procedures or receiving inappropriate antibiotic therapy have a high risk of enterococcal bacteremia and those with serious underlying comorbidities are likely to be unresponsive to treatment and have a higher mortality
Trakya bölgesinde hastalardan izole edilen Brucella kökenlerinin in vitro antibiyotik duyarlılığı
No full textAmaç: Bu çalışmada, Brucella kökenlerinde tür tayini yapılması ve in vitro olarak doksisiklin, rifampisin, streptomisin, seftriakson, siprofloksasin ve ofloksasinine karşı antimikrobiyal duyarlılık oranlarının belirlenmesini amaçladık. Yöntem: Trakya Üniversitesi Tıp Fakültesi Hastanesi, Klinik Mikrobiyoloji Laboratuvarında, yatan hastalardan alınan klinik örneklerde (bir adet BOS ve 41 adet kan kültürü örneğinde) 42 Brucella suşu izole edildi. Konvansiyonel yöntemler ile 42 Brucella suşunun, 41’i Brucella. melitensis, bir tanesi ise Brucella abortus olarak tanımlandı. Agar dilüsyon yöntemi ile farklı iki pH’da (pH: 5, pH: 7) 48 ve 72 saatlik inkübasyon süreleri sonunda antibiyotiklerin etkinliği karşılaştırıldı. Minimum inhibitör konsantrasyonu (MİK) değerleri, intraselüler patojenlerin antibiyotik duyarlılık testi için hazırlanmış ‘Eucast Discussion Document E.Dis 6.1’de önerildiği şekilde değerlendirildi. Bulgular: pH: 7’de 48 ve 72 saatlik inkübasyonlar sonrası elde edilen sonuçlar karşılaştırıldığında, sadece ofloksasinin MİK50 ve MİK90 değerlerinin iki katına yükseldiği görüldü. pH: 5’te 72 saatlik inkübasyon süresi sonunda rifampisinin etkinliği artarken, doksisiklin etkinliğinin değişmediği gözlenirken, Streptomisin, seftriakson, siprofloksasin ve ofloksasinin ise etkinliklerinin azaldığı gözlenmiştir. Sonuç: Bu çalışmada pH: 7’de ve 48 saatlik inkübasyon süresi sonunda MİK90 değerlerine göre antibakteriyel ilaçlar Brucella kökenleri üzerine etkili olarak saptandı. Doksisiklin, pH: 5 ve pH: 7’de, 48 ve 72 saatlik inkübasyon süreleri sonunda MİK90 değerlerine göre en etkili antibakteriyel ilaç olarak saptandı. Brucella cinsinde yer alan bakteriler fakültatif hücre içi mikroorganizmalardır ve hücre içi benzeri pH: 5 olan ortamda streptomisin, seftriakson, siprofloksasin ve ofloksasinin etkinlikleri azalmaktadır. Bruselloz tedavisinde bu durum göz önünde bulundurulmalıdır
Etiologic agents and risk factors in nosocomial urinary tract infections
No full textNosocomial urinary tract infection (NUSI) is one of the most common hospital acquired infections. In this study, we aimed to determine the risk factors, frequency and the bacterial etiology of NUSI in hospitalized patients at Trace University Hospital, Turkey. Between September 1(st) 2004 to March 1(st) 2005, 104 NUSI episodes from 91 adult patients (mean age; 60.8 +/- 16.1 years; 46 were female) were determined among 8704 patients admitted to the hospital. During the study period, cumulative incidence of NUSI was 1.04% and episode rate of NUSI was 1.19%. The most important risk factors for NUSI were detected as urinary catheterization (78.8%), antimicrobial therapy within the previous 15 days (60.6%), fecal incontinence (33.7%) and surgical operations [29.8% (42% of them were urological pertainings)]. In 37.8% of the episodes urinary catheterization was considered as performed unnecessarily. In 26% of the episodes another infection (pneumoniae, abdominal infection, wound infection) accompanied. The causative microorganisms were resistant to the antibiotics used for therapy in 93.6% of the episodes. A total of 118 microorganisms (14 were polymicrobial) have been isolated from the urine cultures. The most frequently isolated ones were Escherichia coli (n: 48; 40.8%), Candida spp. (n: 27; 23%), Enterococcus spp. (n: 13; 11%), Pseudomonas aeruginosa (n: 9; 7.6%), Klebsiella pneumoniae (n: 8; 6.8%) and Acinetobacter spp. (n: 5; 4.2%). The highest susceptibility rates of E.coli isolates were against imipenem and nitrofurantoin (100%) and amikacin (97.7%), the lowest susceptibility rates were against ampicillin (26.7%) and amoxycillin-clavulonate (44.4%). No glycopeptid resistance was detected for Enterococcus spp. while the susceptibility rates to penicilin and nitrofurantoin were 38.5% and 63.6%, respectively. Since the number of the other bacterial, species was low (<10) their antimicrobial resistance rates were not evaluated. Extended-spectrum beta-lactamase (ESBL) production was determined in 27% of E.coli and in 25% of K.pneumoniae isolates, and cases with ESBL producing strains had significiantly higher antibiotic consumption rate in the previous 15 days (p=0.004). Blood cultures which were collected during NUSI episodes yielded positive results in 31.8%. The mortality rate due to NUSI was significantly higher in cases with bloodstream infection (p=0.000). In conclusion, the high rates of NUSI associated with bloodstream infections and mortality detected have pointed out serious problems in our hospital, and indicated that more attention should be paid on urinary catheterisation, rational antibiotic usage and control of nosocomial infections
Candida glabrata : Etiologic agent of soft tissue abscess in a diabetic patient
No full text[Abstract Not Available
Acute liver ınjury in a patient with secondary syphilis and acute viral hepatitis B coinfection
No full textEvaluation of Risk Factors in Community-Acquired Urinary Tract Infections Caused by Extended Spectrum ?-Lactamase-Producing Escherichia coli
No full textObjective: The objective of this study was to determine the risk factors in community -acquired urinary tract infections (UTIs) caused by extended spectrum 13-lactanriase (ESBL)producing Escherichia coli, and antibiotic resistance rates in these strains. Methods: Patients who had been admitted to the Trakya University Health Center for Medical Research and Practice Infectious Diseases and Clinical Microbiology Department with the diagnosis of UTI from January 1, 2008 through January 1, 2018 and had F. coli growth in urine culture were analyzed retrospectively. Patients who had ESBL-positive E. coil growth in their urine cultures were the case group and patients with the ESBL-negative E. coli growth in their urine cultures were the control group. Results: In the study, 379 UTI episodes were detected in 346 patients. There were 117 (30.9%) episodes in the case group and 262 (69.1%) episodes in the control group. In univariate analysis, young age (approximately 62 19.6 years in the case group, 68 19.4 years in the control group), malignancy in a solid organ, urinary pathologies, urinary catheterization, history of urological procedure in the last six months, history of hospitalization in the last three months, history of antibiotic use in the last three months and recurrent UTI were statistically significant for ESBL production (p<0.05). In multivariate analysis, malignancy in a solid organ (OR: 2.267; CI: 1.205-4.266; p=0.011), urinary catheterization (OR: 2.266; CI: 1.186-4.330; p=0.013), and antibiotic use in the last three months (OR: 5.050; CI: 3.038-8.395; p=0.000) were found to be the independent risk factors for ESBL production. Empirical treatment effectiveness rate was lower and hospital stay was longer in the case group. F. coli strains were found to have higher resistance rates to antibiotics other than fosfomycin and nitrofurantoin and they were not suitable for empirical treatment of UTIs. Conclusions: Knowing the risk factors and antibiotic resistance rates in terms of ESBL production in the community patients will both increase the empirical treatment success of UTIs and reduce unnecessary antibiotic use
Evaluation of Patients with Acute Viral Hepatitis
No full textThirty-eight patients with acute viral hepatitis were admitted to Trakya University Hospital from January 2001 to June 2004. These patients were evaluated according to their complaints, clinical findings and laboratory results, retrospectively. Twenty-one (55.3%) of the patients were acute viral hepatitis A; 17 (44.7%) were acute viral hepatitis B. In SPSS software, clinical findings were evaluated with Fisher's exact test and laboratory results were evaluated in independent groups with non parametric t-test. The symptoms of the patients were weakness (85.7%, 88.2%), jaundice (85.7%, 88.2%), anorexia (76.2%, 52.9%), nausea (76.2%, 64.7%), darkening of urine color (71.4%, 76.5%), vomitting (57.1%, 41.2%) in hepatitis A and B, respectively. the signs of the patients were icterus (95.2%, 100%), hepatomegaly (28.6%, 47.1%), splenomegaly (9.5%, 23.5%) in hepatitis A and B, respectively. The-re was no significant difference in clinical findings. The mean age was 21.5 in hepatitis A and 33 in hepatitis B. In hepatitis A, mean aspartate aminotransferase (AST) value was 1345 U/L and mean alanine aminotransferase (ALT) value was 1910 U/L; in hepatitis B mean AST value was 1475 U/L, mean ALT was 2445 U/L. The level of ALT in hepatitis B cases was significantly higher than hepatitis A. In hepatitis A, mean total bilirubin value was 5.9 mg/dL, direct bilirubin was 3.5 mg/dL. In hepatitis B, total bilirubin was found 11.4 mg/dL, direct bilirubin was 7.7 mg/dL. Bilirubin levels in hepatitis B cases were significiantly higher than hepatitis a cases. There was no significant difference between two groups in the other laboratory findings. Although ALT and bilirubin levels in hepatitis B is higher than hepatitis A, the etiology of acute viral hepatitis can not be determined with the initial clinical and laboratory results
Evaluation of Epidemiological Characteristics and Risk Factors of Candidemia in Adult Patients in a Tertiary-Care Hospital
No full textCandida species which are currently the fourth most common cause of nosocomial bloodstream infections, are associated with a significant morbidity and mortality. The aim of this retrospective case-control study which included adult patients was to determine the epidemiology of candidemia and to evaluate risk factors for the development of candidemia and mortality at a tertiary-care education hospital over a 1-year period. A total of 38 candidemia cases (23 were male; age range: 17-82 yrs; mean age: 61.4 +/- 13.5 years) were identified among 22.507 patients hospitalized during the study period (January 1-December 31, 2008) and the overall incidence was found as 16.8 per 10.000 hospital admissions. Control group (n= 36; 22 were male; mean age: 60.9 +/- 16.3 years) was selected among patients who had no signs and symptoms of candidemia and had negative blood cultures during the study period. Thirty-six (95%) patients with candidemia were identified as nosocomial infection. The most frequently isolated species were C.albicans (55.2%) and C.parapsilosis (28.9%) and the primarily identified origin of infection was central venous catheter use (39%). Candida spp. isolation was most frequent in patients hospitalized in intensive care units (13/38; 34.2%), followed by surgery (n= 8; 21%) and chest diseases (n= 5; 13). Univariate analysis revealed that presence of a central venous catheter [odds ratio (OR): 4.33; 95% confidence interval (Cl): 1.63-11.47, p= 0.003] and the length of hospitalization (OR: 0.97; CI: 0.94-1.00, p= 0.01) were the most frequently associated factors with an increased risk of candidemia compared to controls. However, multivariate analysis exhibited presence of a central venous catheter (OR: 2.90; CI: 1.04-8.11, p= 0.04) as the only independent risk factor for the development of candidemia. Therapy was initiated with intravenous fluconazole (mean duration of therapy 13.2 +/- 6.25 days) and in three patients following fluconazol use step-up therapy was initiated. Total mortality rate was 58% (22/38) in our case series. Risk factors for mortality due to candidemia in the univariate analysis were detected as no response to antifungal treatment (OR: 0.23; CI: 0.11-0.51, p< 0.001), underlying disease other than trauma (OR: 0.06; CI: 0.003-1.24, p= 0.02), and high Charlson index (OR: 0.60; CI: 0.38-0.93, p= 0.03), however those factors were not found significant by multivariate analysis. There was also a statistically significant correlation between Charlson index and treatment response (mean Charlson index was 3.5 +/- 1.9 in therapy-responded patients and 4.8 +/- 1.8 in non-responders; p= 0.03). Since the risk of developing candidemia was significantly higher in severely diseased patients using central venous catheter or with prolonged hospitalization, response to antifungal therapy may be insufficient, leading to higher mortality
