Effects of Carbapenem consumption on the prevalence of Acinetobacter infection in intensive care unit patients.

BACKGROUND: The consumption of carbapenems has increased worldwide, together with the increase in resistant gram negative bacilli. Subsequently, the prevalence of carbapenem-resistant Acinetobacter infections has increased rapidly and become a significant problem particularly in intensive care unit patients. The aim of the present study was to evaluate the changes in the prevalence of Acinetobacter infection by restricting the consumption of carbapenems in intensive care unit patients. METHODS: This study was conducted between May 1, 2011 and February 28, 2013. The amount of carbapenem consumption and the number of patients with multi-drug resistant Acinetobacter baumannii (MDRAB) isolates during the study period were retrospectively obtained from the records of the patients, who were hospitalized in the intensive care unit. The study period was divided into two periods named as: Carbapenem non-restricted period (CNRP) and carbapenem-restricted period (CRP). During CNRP, no restrictions were made on the use of carbapenems. During CRP, the use of carbapenems was not allowed if there was an alternative to carbapenems. Primary Endpoint: MDRAB infection after ICU admission. The definition of nosocomial infections related to Acinetobacter spp. was based on the criteria of the Center for Disease Control (CDC). The correlation between the amount of carbapenem consumption and the number of infections with MDRAB strains between the two periods were evaluated. RESULTS: During the study period, a total of 1822 patients' (1053 patients in CNRP and 769 patients in CRP) records were evaluated retrospectively. A total of 10.82 defined daily dose (DDD/100 ICU days) of anti-pseudomonal carbapenem were used in CNRP, and this figure decreased to 6.95 DDD/100 ICU days in CRP. In the 8-month CNRP, 42 (3.98%) MDRAB-related nosocomial infections were detected, and 14 (1.82%) infections were detected in CRP (p = 0.012). CONCLUSION: The prevalence of MDRAB strains isolated in the CNRP was 2.24-fold higher than the prevalence in the CRP. The prevalence of Acinetobacter infections can be reduced by taking strict isolation measures as well as by implementing good antibiotics usage policy.

[Factors associated with mortality in Acinetobacter baumannii infected intensive care unit patients]. / Yogun Bakim Hastalarinda Gelisen Acinetobacter baumannii Enfeksiyonunda Mortaliteyi Etkileyen Faktörler.

Acinetobacter baumannii can survive for prolonged periods in unsuitable environmental conditions and easily spread to patients in the hospital settings leading to healthcare-associated infections. Major risk factors for A.baumannii infections are mechanical ventilation, invasive procedures such as central venous catheter or urinary catheter and the use of broad-spectrum antibiotics. The mortality rates of nosocomial A.baumannii infections have been reported between 50-60%, changing due to several factors. The aim of this study was to investigate the factors associated with mortality in intensive care unit (ICU) patients diagnosed as nosocomial A.baumannii infections. The demographical, clinical and microbiological data of the patients who were followed in ICUs between September 2008 to March 2010 were evaluated retrospectively, and analyzed regarding the factors related to mortality. Blood, urine and tracheal aspirate samples were collected from suspected patients and cultivated on conventional agar media. The identification of the isolates and antibiotic susceptibilities were performed by using VITEK-2 (bioMerieux, USA) automated system. The patients with A.baumannii infections were grouped as "died" and "survived" cases, and the groups were compared according to following factors: age, gender, isolation day of bacteria in intensive care unit, type of clinical sample, implementation day of the central venous catheter, implementation of tracheotomy and/or intubation, operation, presence of diabetes mellitus, antibiotic use, day of hospitalization, day of mechanical ventilation and APACHE (Acute Physiology and Chronic Health Evaluation)-II score. A.baumannii infection was identified in 56 patients (29 female, 27 male; mean age: 63 years) in the intensive care units during the study period, and the total mortality rate was estimated as 77% (43/56). The implementation of intubation, mechanical ventilation, high APACHE II score and recovery of bacteria from respiratory tract were found statistically significant for A.baumannii infections related mortality (p< 0.05 for each parameter). Our data showed that Acinetobacter infection in the respiratory tract, implementation of intubation, mechanical ventilation and high APACHE II scores were the major risk factors related to mortality.

Concurrent acute interstitial pneumonia and pulmonary embolism during treatment with peginterferon alpha-2a and ribavirin in a patient with hepatitis C.

The case presented is the first patient with concurrent acute interstitial pneumonia and pulmonary embolism associated with combined treatment of peginterferon and ribavirin for hepatitis C.

The value of fingertip blood impregnated paper in hepatitis B surface antigen screening.

Hepatitis B surface antigen (HBsAg) screening is an important procedure to determine the prevalence of hepatitis B (HBV) in a community. However, it is difficult, time consuming and expensive. In this study we aim to investigate the efficacy and usefulness of fingerprint blood impregnated paper in HBsAg screening. To our knowledge, blood impregnated paper is a practical, useful method for HBsAg screening in the community.

Comparison of efficacy and safety of oseltamivir and zanamivir in pandemic influenza treatment.

AIM: In 2009, a flu pandemic caused panic worldwide. Oseltamivir and zanamivir were widely used in this pandemic. Currently, there are a limited number of studies comparing the efficacy and tolerability of these two drugs. This study aimed to compare the efficacy and tolerability of these two drugs in the treatment of influenza. MATERIALS AND METHODS: Patients diagnosed with influenza at our infectious disease outpatient clinic during the influenza season between October 1, 2009 and February 1, 2010 were included in the study. Study data were obtained retrospectively from files for consecutive patients. A total of 136 subjects were selected. After exclusion criteria were applied, 56 subjects were discarded. The information for 80 patients in whom oseltamivir or zanamivir therapy was initiated (40 for each therapy) was compiled, and the efficacy and tolerability of the drugs were compared. RESULTS: There was no significant difference in efficacy for the two drugs (P>0.05). Temperature normalization was significantly faster in patients taking zanamivir (P=0.0157). Drowsiness was the most frequent adverse event for both drugs (38% for the oseltamivir group, and 22% for the zanamivir group). Respiratory distress was observed in five patients in the zanamivir group, whereas it was not observed in patients in the oseltamivir group (P<0.05). One patient had to discontinue therapy in the zanamivir group due to respiratory distress. CONCLUSION: Efficacy (in terms of symptom relief and duration to resumption of work) and adverse events were similar for zanamivir and oseltamivir, but temperature normalization was much more rapid in patients using zanamivir. Patients using zanamivir should be monitored for respiratory distress.

Hepatitis B viral breakthrough associated with inappropriate preservation of entecavir.

If virologic breakthrough is observed during chronic hepatitis B treatment, drug resistance or compliance problem should be considered. But in some cases, breakthrough depends on drug preservation conditions. We report the case of a 30-years-old man, who experienced viral breakthrough due to wrong preservation conditions of the drug.