65 research outputs found
Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis
No full textBeraud, Guillaume/0000-0002-4705-0916; Ghaydaa, Shehata/0000-0002-3631-893X; Senbayrak, Seniha/0000-0002-4983-6613; Gunst, Jesper/0000-0002-3787-0259; Kanj, Souha/0000-0001-6413-3396; Karabay, Oguz/0000-0003-0502-432X; Larsen, Lykke/0000-0002-4113-4182; Stahl, Jean Paul/0000-0002-0086-3557; johansen, isik somuncu/0000-0002-2189-9823; VAHABOGLU, Haluk/0000-0001-8217-1767WOS: 000358623200015PubMed: 25779579Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome
Changes in Antimicrobial Resistance of Urinary Tract Infections in Adult Patients over a 5-Year Period
No full textVahaboglu, H/0000-0001-8217-1767; Culpan, Meftun/0000-0001-8573-1192; caskurlu, hulya/0000-0002-6760-2052Objectives: We aimed to determine the most common bacteria that cause urinary tract infections (UTIs), the rate of antibiotic resistance of these uropathogens, and the changes in resistance rates over the years for adult patients diagnosed with UTIs. Methods: We retrospectively reviewed urine cultures and antibiotic susceptibility results of patients >17 years of age from our outpatient clinic between 2014 and 2018. The most common uropathogens and their antibiotic resistance rates were identified in different age groups (18-39, 40-59, and >= 60 years) and with respect to gender and date of admission. In addition, the change in antibiotic resistance of Escherichia coli between 2014 and 2018 was also examined. Results: A total of 9,556 positive urine cultures were included. The most common uropathogen was E. coli, and its prevalence was higher in females than males (70.6 vs. 53.4%, respectively). The majority of isolates were from patients >= 60 years of age. E. coli resistance was most pronounced for ampicillin (61.56%), followed by trimeth-oprim-sulfamethoxazole (49.80%), amoxicillin-clavulanic acid (34.69%), and cefazolin (30.72%). E. coli resistance to ampicillin, nitrofurantoin, cefepime, ciprofloxacin, fosfomycin, and amoxicillin-clavulanic acid increased significantly with time (all p = 0.001). For E. coli, resistance to ciprofloxacin, one of the most commonly used antibiotics for UTI, increased from 17 to 43% from 2014 to 2018. Conclusion: Most of the uropathogens displayed high resistance to ampicillin, tri-methoprim-sulfamethoxazole, and amoxicillin-clavulanic acid, and were susceptible to meropenem, ertapenem, and imipenem. Fosfomycin and cefepime were useful in the empirical treatment of community-acquired UTIs. A surprisingly high increase was observed in the resistance of E. coli to antimicrobial agents from 2014 to 2018
Bir Üniversite Hastanesinde Çoklu İlaca Dirençli Acinetobacter baumanii ile Oluşan Enfeksiyonların 15 Yıllık Ara ile Risk Faktörleri ve Prognoz Yönünden Araştırılması
No full textAmaç: Sağlık bakımı ilişkili enfeksiyonlarda (SBİE) Acinetobacter baumannii (AB), yüksek antibiyotik direnç oranları nedeniyle önemli bir sorundur. Bu çalışmada, çoklu ilaca dirençli AB (ÇİDAB) SBİE’lerinin, risk faktörlerinin ve prognozun iki farklı zaman diliminde değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Mayıs 2002-Mayıs 2005 (Grup I) ve Ocak 2023-Aralık 2023 (Grup II) tarihleri arasında, ÇİDAB üremesi olan hastaların klinik ve mikrobiyolojik verileri, retrospektif olarak değerlendirildi. ÇİDAB SBİE’lerinin gelişimine ait risk faktörlerini değerlendirmek için, vaka ve kontrol grupları oluşturuldu. Bulgular: Grup I’de 37 vaka ve 26 kontrol hastası, Grup II’de 64 vaka ve 64 kontrol hastası değerlendirildi. En sık SBİE’ler, Grup I’de solunum yolu (%54), Grup II’de kan dolaşımı (%57) enfeksiyonlarıydı. Grup I’de diyabet (p=0,010), kronik akciğer hastalığı (p=0,007) ve hastanede uzun yatış süresi (p=0,004), Grup II’de ise nazogastrik tüp günü (p=0,044) risk faktörü olarak saptandı. Grup I’de kronik akciğer hastalığı, geçirilmiş cerrahi, cerrahi birimlerde yatış, üriner kateter ve nazogastrik tüp kullanımı Grup II’den; Grup II’de, altta yatan hastalık, malignite, YBÜ’ye yatış ve APACHE II skoru Grup I’den yüksekti. Grup I’den II’ye karbapenem kullanımının %43’ten %69’a (p=0,012) ve mortalitenin %30’dan %45’e (p=0,123) arttığı saptandı. Grup II’de %64 tigesiklin direnci ve %5,4 kolistin direnci vardı. Sonuç: Bu çalışmada, geçmişten günümüze ÇİDAB ilişkili kan dolaşımı enfeksiyonlarında belirgin artış, malignitesi olan ve YBÜ’ye yatan hastalarda ÇİDAB enfeksiyonu sıklığı dikkat çekicidir. SBİE öncesi karbapenem kullanımında artış, tigesiklin ve kolistine artan direnç ve yüksek doz tigesiklin kullanım onayının olmaması önemli sorunlardır. Günümüzde mortalite oranlarındaki artış da dikkate alındığında, ÇİDAB enfeksiyonlarına yönelik çok yönlü enfeksiyon kontrol müdahalelerine gereksinim duyulduğu aşikardır.Objective: Growing antibiotic resistance and limited treatment options make Acinetobacter baumannii (AB) in healthcare-associated infections (HAI) difficult. This study compares MDRAB-related HAI risk factors and prognosis in our hospital over two time periods. Materials and Methods: MDRAB growth patients’ clinical and microbiological data from May 2002–May 2005 (Group I) and January 2023–December 2023 (Group II) were retrospectively examined. MDRAB-caused HAI risk factors were assessed in case and control groups. Results: This study evaluated 37 cases and 26 controls in Group I and 64 cases and 64 controls in Group II. Most HAIs were respiratory tract infections (54%) in Group I and bloodstream infections (57%) in Group II. Diabetes (p=0.010), chronic lung disease (p=0.007), and prolonged hospital stay (p=0.004) were risk factors in Group I, while nasogastric tube days (p=0.044) were in Group II. Group I had more chronic lung disease, prior surgery, surgical unit admission, urinary catheter, and nasogastric tube use than Group II. Group II had higher underlying disease, malignancy, ICU admission, and APACHE II score than Group I. The mortality rate rose from 30% to 45% (p=0.123), and carbapenem use rose from 43% to 69% (p=0.012). Group II had 64% tigecycline and 5.4% colistin resistance. Conclusion: The study shows a significant rise in MDRAB-related bloodstream infections, especially in malignancy and ICU patients. High carbapenem use before HAI, rising tigecycline and colistin resistance, and the lack of high-dose tigecycline approval are major issues. The rise in mortality rates makes multifaceted infection control interventions for MDRAB infections necessary
Ribavirin for Patients with Crimean-Congo Haemorrhagic Fever: A Systematic Review and Meta-Analysis
No full textBackground: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal tick-borne infection. The virus is widely distributed around the world and reports of sporadic cases and outbreaks have recently increased significantly. Some authors have proposed that ribavirin improves survival in CCHF and this view appears to be widely accepted. Methods: We evaluated the efficacy of ribavirin in reducing mortality by conducting a systematic review and meta-analysis. We included randomized controlled trials and observational studies that compared the outcomes of CCHF patients who were treated with ribavirin with those of patients that were not treated. The main endpoint we assessed was survival. We also evaluated secondary endpoints, i.e. adverse events, length of stay in the hospital, time taken for laboratory values to return to normal and requirement for blood products. A pooled estimate of the relative risks for survival from each study was obtained by using random effects models. Results: One randomized controlled trial and seven observational studies met our inclusion criteria. Most observational studies suffered from different types of bias due to inappropriate selection of controls. Compilation of data from all included studies showed that ribavirin did not improve survival in CCHF (relative risk 1.06, 95% confidence interval 0.97-1.16). Analysis of secondary endpoints did not suggest a clinically significant beneficial effect either. Conclusions: Our systematic review and meta-analysis revealed that the available data in the literature are inadequate to support a claim of efficacy of ribavirin in CCHF. We believe a real uncertainty exists over the benefit of ribavirin in the treatment of CCHF, which necessitates the urgent conduct of a randomized placebo-controlled trial.WoSScopu
OXA-162, a novel variant of OXA-48 displays extended hydrolytic activity towards imipenem, meropenem and doripenem
No full textComparison in a rat thigh abscess model of imipenem, meropenem and cefoperazone-sulbactam against <it>Acinetobacter baumannii </it>strains in terms of bactericidal efficacy and resistance selection
No full textAbstract Background We compared imipenem, meropenem and cefoperazone-sulbactam against hospital originated A. baumannii strains in terms of bactericidal efficacy and selection of resistant mutants during treatment in a rat thigh abscess model. Methods A total of 18 strains were inoculated in 54 animals (one strain for three animals). Randomly selected 10 among these 18 strains were inoculated in another 10 rats as the control group. Imipenem, meropenem and cefoperazone-sulbactam were the antibiotics compared. After four days of treatment, Wistar albino rats (200 to 250 g) were sacrificed and the abscess materials were processed for mean colony counts and for the presence of resistant mutants. Results The mean CFUs per gram (mean ± (std. deviation) [×104]) of the abscess were: 9,14 (25,24), 2,11 (3,78), 1,20 (1,70) in the imipenem (n = 17), meropenem (n = 18) and cefoperazone-sulbactam (n = 17) groups, respectively. The differences were not significant. On the other hand, no resistant mutant was detected in abscess materials. Conclusion This study indicated; first, cefoperazone-sulbactam is comparable to carbapenems in bactericidal efficacy in this particular abscess model and second, emergence of resistance due to spontaneous mutations is not at least a frequent phenomenon among A. baumannii.</p
Investigation of Carbapenemase Genes and Clonal Relationship in Carbapenem Resistant Klebsiella pneumoniae Strains
No full textObjective: Resistant Gram-negative bacteria isolated from health-related infections are a worldwide problem. Increasing Frequency of infections particularly caused by Enterobacteriaceae producing expanded spectrum beta lactamase, leads to the use of more carbapenem group antibiotics which, in turn, leads to bacterial resistance. In this study, we aimed to evaluate carbapenem resistance in Klebsiella pneumaniae (K. pneumoniae) isolates, the mechanisms causing this resistance and the clonal relationship between these isolates. Methods: Ninety-one K. pneurnolliae strains isolated from clinical samples obtained in our laboratory were included to the study. The identification of the bacteria was performed with Matriks assisted laser desorption ionization time of flight mass spectrometry (bioMerieux, Marcy-I'Etoile, France) and antimicrobial susceptibility with VITEK-2 (bioMerieux), and the carhapenem resistance was confirmed by ertapenem E-test (bioMerieux). Reverse transcription polymerise chain reaction method was used for the investigation of genes causing carbapenemase production (bla(OXA-)(48), bla(NDM-1), bla(KPC), bla(IMP), bla(VIM-1)). The clonal relationship between isolates was investigated by pulsed-field jel elektroforez. Results: In carbapenem resistant isolates, bla(OXA-)(48) positivity was found to be 55 % , bla(NDM-1) positivity 37.4%, bla(KPC) and bla(VIM-1) positivity 1.1%. A total of 10 isolates was identified with different resistance genes. In 73 of the isolates included in the study, the clonal relationship was examined, and 16 different groups were identified. Twenty isolates were not clonally associated with any other isolates. The most common resistance mechanism causing the carbapenem resistance was bia(OXA-48) gene that is known to be endemic in Turkey. Conclusion: As a result, the carbapenem resistance that we found as 3.13% in our study is similar to the rates obtained in other studies performed in our country which indicates that this resistance is not at a high level yet in our country. However, the ability of carbapenem resistance genes to spread between strains can he a major problem in the near future. Molecular methods arc gold standard in carbapenemase detection, but because of having high cost they can not be used in laboratories routinely. Modified Hodge test or carbapenemase inactivation test are alternative tests with low costs that can be used in the determination of carbapenemase
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