Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study.

Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56-3.14); prior exposure to N-acetylcysteine, 0.11 (0.03-0.34) and prior surgical intervention, 1.26 (0.76-2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

An evaluation of the effect of ertapenem in rats with sepsis created by cecal ligation and puncture.

BACKGROUND: Intra-abdominal adhesions are still a major problem which is expected to be reduced by the provision of bacterial decontamination. Various antibiotics have been used to prevent the formation of adhesion in the septic abdomen. This study aims to investigate the efficacy of ertapenem in sepsis of rats induced by cecal ligation and puncture. METHODS: Twenty-eight Wistar rats were divided into four groups randomly. In all groups, bacterial peritonitis was created by cecal ligation and puncture method. Group 1 was considered as sham group. Groups 2, 3 and 4 were given, respectively, saline, a single dose of ertapenem and a dose of ertapenem intraperitoneally every day. Intra-abdominal adhesions were assessed seven days after surgery by histopathological examination. Microbiological examination was performed through the ascites obtained. TNF-α was measured from blood taken from rats. RESULTS: Adhesion score decreased significantly by the application of ertapenem (p<0.001) and fibrosis scores were found to be significantly lower (p=0.005). Among all groups, the relationship between the decrease in the number of colonies and antibiotics application was not statistically significant (p=0.109). No statistically significant difference was found between the group given a single dose of ertapenem and the group given multiple ertapenem (p=1). CONCLUSION: Peritoneal lavage with ertapenem appears to be effective in preventing the adhesion in the septic abdomen. As no difference was detected at the end of a single dose and multiple-dose administration of antibiotics in the adhesion scores, a single dose after surgery seems to be enough. The findings suggest that the results should be evaluated in a clinical trial.

Staphylococcal empyema secondary to IgA nephropathy.

A 27-year-old male patient, applied to the emergency unit with complaints of high fever, nausea, vomiting, and hematuria. In his physical examination, fever was 38 °C with normal findings in all other systems. The laboratory values were as follows: urea 58 mg/dL, creatinine 2.4 mg/dL, white blood cell count 15.9K/µL (PNL: 79 %). In his urine analysis; +1 proteinuria and +3 hematuria were detected. Kidney biopsy was performed. Kidney biopsy interpreted in favor of IgA nephropathy. As the patient had tonic-clonic seizures, cranial CT examination was performed. In the cranial CT, there was a subdural effusion in the anterolateral area of the right cerebral hemisphere with the left shift in the midline secondary to the effusion. Empyema fluid, which was drained postoperatively, was cultured. In the direct examination of the empyema fluid, Gram positive cocci and abundant amount of PNLs were observed. There was no growth in the culture. Although the most commonly encountered agents for post-infectious glomerulonephritis are streptococcus infections, it has been reported that glomerulonephritis attacks may be rarely observed due to staphylococcus infections. Proliferative glomerulonephritis cases are rarely encountered conditions characterized by mesangial IgA accumulations secondary to staphylococcus infections.