Interdisciplinary correlations regarding the clinical and paraclinical evaluations in HIV-positive pregnant women.

UNLABELLED: HIV infection in pregnancy has an increasing prevalence due to the effectiveness of antiretroviral therapy. The risk of HIV vertical transmission varies between 15-20 % in European women who do not breastfeed and 25-40% in African mothers who breastfeed. The most important predictive factor of the vertical transmission is maternal plasma HIV viral load. Vertical transmission can be largely prevented by prenatal screening, perigestational ART, an adapted obstetrical attitude and exclusively artificial feeding of the infant. MATERIAL AND METHOD: The study included 36 HIV-positive pregnant women, between 2012-2014, at age of 25-32 years. RESULTS AND DISCUSSIONS: It has been found that the birth weight was less than 2,700 grams in all newborns of HIV-positive pregnant women or those with advanced disease (AIDS) and, also, they received an APGAR score less than 7. The primordial desideratum is to decrease the rate of mother-fetus vertical transmission, thus the caesarian section has been established as the birth method in all HIV-positive pregnant women after 38 weeks of amenorrhea, on intact membranes, outside labor, resulting in halving the percentage of HIV-positive children. A very important role belongs to the interdisciplinary collaboration between the obstetrician and the infectious diseases specialist during the pregnancy, but also during the postpartum period. The role of the obstetrician is present in all the moments of pregnancy evolution. The HIV-positive pregnant woman is included in the group of high risk pregnancies.

Hepatorenal dysfunction in sepsis: epidemiological, clinical and laboratory aspects.

UNLABELLED: The major impact of sepsis-induced multiple organ dysfunction on healthcare system in the European Union was estimated at 90.4 cases per 100000 inhabitants, compared to 58 per 100000 for breast cancer. The association of organ dysfunctions in terms of both the number of dysfunctions and the degree of organ dysfunction is the most powerful predictor of death in sepsis. AIM: To find medical and statistical correlations in hepatorenal dysfunction in sepsis patients. MATERIAL AND METHODS: This retrospective study included 117 patients diagnosed with sepsis at the Iasi Infectious Diseases Hospital, patients who presented liver/renal and other organ dysfunctions. The clinical, etiological, and laboratory data, and APACHE II prognostic scores were analyzed. The data were processed using SPSS version 16.0. RESULTS: The etiological agents were Gram positive as well as Gram negative bacteria, and 40% of sepsis patients with hepatic/kidney dysfunction presented hepatorenal syndrome. CONCLUSIONS: Over one-third of patients with sepsis-related hepatorenal dysfunction had a creatinine clearance of less than 30 ml/min, and we found statistical correlations between serum creatinine and APACHE II score. There were no statistically significant differences between the survival curves of patients with hepatorenal syndrome and those with sepsis-related hepatorenal dysfunction.

Clinical features and evolution of organ dysfunctions in sepsis.

UNLABELLED: In sepsis, the systemic inflammatory response is adapted to the etiologic agent and the increase in the level of mediators is associated with organ dysfunction. Currently, a rapid assessment of patient ability to develop an adequate immune response is not possible, the response mechanisms being similar in the context of different etiological agents. AIM: To find statistical arguments for the evolution of laboratory parameters in sepsis patients. MATERIAL AND METHODS: This retrospective study included 90 patients diagnosed with sepsis. The clinical, etiological, and laboratory data, and Carmeli and APACHE II prognostic scores were analyzed. The data were processed using SPSS version 16.0. RESULTS: The causative agents was identified in 16 cases; organ involvement and systemic response varied, and no statistical correlations were found between the inflammatory syndrome parameters and Carmeli or APACHE II prognostic scores or identification of the causative agent. CONCLUSIONS: Statistical correlations were found between maximum blood glucose levels and the presence of organ dysfunction in the studied sepsis patients. No correlations were found between sepsis severity and the presence of anemia or thrombocytopenia, or between fever syndrome and inflammatory syndrome.

Infective endocarditis in non-HIV immunosuppressed patients.

UNLABELLED: Infective endocarditis is a septic illness with sudden or insidious onset that causes heart lesions or aggravates the preexisting ones; during its course it can affect other organs, mortality being high. AIM: To identify non-HIV immunosuppressed patients with infective endocarditis, namely those with associated diabetes, hepatitis, cancer, or old age with multiple comorbidities, and to assess the nosocomial risk by Carmeli score. MATERIAL AND METHODS: This is a retrospective study using epidemiological, clinical, laboratory and treatment data from 56 patients admitted to and diagnosed with infective endocarditis at the lasi Infectious Diseases Hospital in the interval January 2008 - May 2012. To these patients we looked for non-HIV immunosuppressed character, having in their pathology association diabetes, chronic hepatitis, malignancy, or other comorbidities. RESULTS: From the infective endocarditis patients, 92.8% were found non-HIV immunosuppressed, 25% of them presenting renal failure, and 21.1% having diabetes. The most common Carmeli score obtained was score 2 in 57.1% of the cases. In these patients, the most frequent etiologic agent of infective endocarditis was Enterococcus faecalis (16%), followed by Staphylococcus aureus (10.7%). CONCLUSIONS: It was noted that in addition to endocardial damage due to the multiple etiologic agents involved, non-HIV immunosuppression in these patients plays an important role. The association of Carmeli score in patients diagnosed with infective endocarditis is significant, especially in case of adequate therapy initiation for a right treatment of this pathology.

Antibiotic therapy in severe sepsis in HIV-positive patients.

Severe sepsis has become one of the most frequent causes of hospitalization in intensive care units for patients diagnosed with HIV infection. The difficulty in setting a sepsis diagnosis in HIV-positive patients led to the systematic exclusion of these patients from studies on sepsis, which limited the understanding of its impact on the evolution of the disease. Our study aims to evaluate the etiology of sepsis in immunocompromised HIV-positive patients and the evolution after antibiotic therapy. 30 patients diagnosed with HIV infection and sepsis, admitted to our clinic between January 2008 and April 2012, were followed. Severity of illness, time since diagnosis, CD4 count, antiretroviral treatment, incidence of severe sepsis, and organ dysfunctions were registered. Patients were between 1 and 61 years of age, most of them were classified into stages B2, B3 and C3, requiring hospitalization for a period ranging from 14 to 28 days, with an average of 16.7 days and a median of 18 days, while 8 required monitoring in the intensive care unit. In about 40% of cases, the starting point was an infection of the lower respiratory tract, but also of the upper urinary tract and skin infections. Evolution and mortality in sepsis associated with HIV/AIDS infection depend on the presence of organ failure and are less influenced by the level of immunodepression, complex antibiotic therapy being the cornerstone in controlling patients.

[Epidemiology and clinical features in diabetic patients with invasive infections treated at the Clinical Hospital of Infectious Diseases of Iasi, Romania, between 2008-2010]. / Cercetari clinico-epidemiologice retrospective asupra infectiilor invazive la bolnavii diabetici în spitalul clinic de boli infectioase Iasi, în perioada 2008-2010.

UNLABELLED: Infections in the diabetic population can be severe and life threatning at least for two reasons: clinical signs are often torpid, masqued by chronical complications of diabetes leading to late recognition and medical adresability and also because of the inability to control established infection due to complex cell-mediated and humoral immunity deffects. The aim of the study was to evaluate the etiology, clinical features and outcome in diabetic patients with invazive disease. MATERIAL AND METHODS: A retrospective study was conducted between January 2008 and December 2010 at The Clinical Hospital of Infectious Diseases Iasi among 75 diabetic patients with sepsis of microbiologically confirmed etiology (positive cultures from normally sterile sites) and sepsis with clinically suspected etiology (positive cultures from pus). Cases with positive urocultures and coprocultures only, were excluded. RESULTS: From 75 diabetics, 56% were males, 90,7% being over 50 years. Severe cases of sepsis (33/75, 44%) were associated more often with insulin-treated diabetes than non-insulin treated group (40% vs. 4%, p<0,005) probably because of multiple comorbidities associated as suggested by a high Charlson score (6,09 vs. 4,09, p<0,05). There were 64 cases with confirmed etiology and 11 cases with clinically suspected etiology. Staphylococcus aureus and Escherichia coli were the most common agents isolated, being involved in 16 (21,3%) cases each, followed by coagulase negative Staphylococci (14/18,66%), Enterococcus spp.(6/8%), group B Streptococcus (3/4%), Streptococcus pneumoniae, Enterobacter spp., Salmonella spp. (2/2,66% each), Aerococcus viridans, Streptococcus equi, Klebsiella pneumoniae, Neisseria meningitidis, Sphyngomonas paucimobilis, Pseudomonas aeruginosa, Proteus mirabilis (1/1,33%). Multiple septic disseminations occured in 17(22,6%) cases and meningeal involvment was doccumented in 10(15,6%) cases. Meticillin resistance was noted in 53,3% for invasive isolates of S. aureus. Among 16 invazive strains of E. coli, 25% were resistant to 3rd generation cephalosporins, 17% to ciprofloxacin and 6,6% to aminoglycosides and colimycin. There were no E. coli strains resistant to imipenem, piperacillin-tazobactam and aztreonam. The mean mortality rate was 14,66%. CONCLUSIONS: The high level of resistance of S. aureus and E. coli to commonly used antibiotics and meningeal involvement imposes a multidisciplinary approach of the diabetic patient. Proper knowledge of the pathogers involved in the potential invazive diseases is an important tool for successful treatment with appropriate empirical broad-spectrum antimicrobial agents.

[Risk factors for Pseudomonas aeruginosa infections, resistant to carbapenem]. / Factori de risc pentru infectiile cu Pseudomonas aeruginosa rezistent la carbapeneme.

UNLABELLED: Since their introduction in clinical practice,carbapenems have been among the most powerful antibiotics for treating serious infections cased by Gram-negative nosocomial pathogens, including Pseudomonas aeruginosa. The emergence of betalactamases with carbapenem-hydrolyzing activity is of major clinical concern. Pseudomonas aeruginosa is a leading cause of nosocomial infection. RESULTS: Risk factors for colonization with carbapenems-resistant Pseudomonas in hospital are: history of P. aeruginosa infection or colonization within the previous year, (length of hospital stay, being bedridden or in the ICU, mechanical ventilation, malignant disease, and history of chronic obstructive pulmonary disease have all been identified as independent risk factors for MDR P. aeruginosa infection. Long-term-care facilities are also reservoirs of resistant bacteria. Risk factors for colonization of LTCF residents with resistant bacteria included age > 86 years, antibiotic treatment in the previous 3 months, indwelling devices, chronic obstructive pulmonary disease, physical disability, and the particular LTCF unit.