Risk factors and clinical outcomes for intensive care unit patients with mul-tidrug-resistant Acinetobacter spp. bacteremia.

BACKGROUND: Multidrug-resistant (MDR) isolates of Acinetobacter spp. have been reported worldwide. This study aimed to analyze clinical features and outcomes of intensive care unit (ICU) patients with MDR Acinetobacter spp. bacteremia and to determine factors influencing survival by using 30-day mortality as the primary endpoint. METHODS: A case-control study included a total of 164 patients with MDR Acinetobacter spp. bacteremia hospitalized in ICUs in Vojvodina Province, Serbia, from January 2013 through March 2016. Medical records were reviewed, and patients' demographic and clinical characteristics were collected. Predictors of 30-day mortality were identified by logistic regression analysis.  Results: The overall 30-day mortality rate was 48.2 % (79 of 164 patients). Multivariate logistic regression analysis revealed that independent predictors of 30-day mortality were two or more co-morbidities, diabetes mellitus, and inappropriate use of antimicrobials.  Conclusion: Early implementation of appropriate antimicrobial therapy, particularly in critically ill ICU patients with MDR Acinetobacter spp. bacteremia, with two or more co-morbidities and diabetes mellitus, can be crucial for survival. HIPPOKRATIA 2020, 24(1): 21-26.

Treatment of Periodontal Disease with an Octenidine-based Antiseptic in HIV-positive Patients.

OBJECTIVE: To evaluate the effects of a periodontal therapy with subsequent application of an octenidine (OCT)-based antiseptic in HIV-positive patients receiving highly active antiretroviral therapy. METHODS: HIV-positive patients with a clinically diagnosed periodontal disease were randomly divided into two groups (n = 30/group). Both groups initially received a periodontal therapy. Patients in the OCT group additionally used an OCT-based mouthwash. Subgingival plaque samples and periodontal indices were analysed prior to treatment onset as well as one and 3 months post-treatment. RESULTS: Periodontal therapy has resulted in a significant decrease in the values of all periodontal indices one and 3 months following the therapy completion (P = 0.000). The effects of the two applied therapeutic protocols differed significantly in terms of the variation in the PBI (F = 4.617; P = 0.017) and the PD (F = 3.203; P = 0.044) value. In the patients in the OCT group, a more pronounced decrease in the PBI and PD was noted at 1-month follow-up as well as a greater increase in the PD value 3 months upon treatment completion. In the OCT group, no more atypical microorganisms were detectable 1 month post-treatment, while in the control group they were found in 34.5% of patients. CONCLUSIONS: The periodontal therapy bears good results in HIV-positive patients. Additional administration of OCT contributes to the significant decline in the PBI and DS values and eliminates atypical microorganisms within 1 month post-treatment. However, more favourable results were not noted in the OCT group at the 3-month assessment.

Different fatty acid composition of serum phospholipids of small and appropriate for gestational age preterm infants and of milk from their mothers.

BACKGROUND: Placental supply of fatty acids (FA) is essential for normal foetal development but in premature infants this supply is interrupted. To investigate the association of intrautrine growth restriction with serum phospholipid and breast milk FA composition, we compared preterm infants small for gestational age (SGA) and matched appropriate for gestational age (AGA), and their mothers' milk during the first 4 weeks of postnatal life. METHODS: Sera from 11 SGA and 12 AGA infants born 34-36 weeks of gestation were collected at birth, 14(th) and 28(th) day, and breast milk on 14(th) and 28(th) day after birth. FA composition was analyzed by gas chromatography. RESULTS: Preterm SGA infants had significantly lower oleic, total monounsaturated FA (MUFA), docosahexaenoic acid (DHA) and n-3 polyunsaturated FA (PUFA) and higher levels of stearic and linoleic acid at birth than AGA infants (p<0.05). DHA was significantly lower, whereas docosatetraenoic and docosapentaenoic acids were higher in SGA infants after 28 days. Mothers of AGA infants had markedly lower levels of MUFA and higher levels of total and n-6 PUFA in their breast milk. CONCLUSION: SGA infants have altered serum phospholipid FA composition at birth and during their first month of life, probably due to inadequate transplacental supply and activity of desaturase system. RESULTS on human milk suggest that pregnancies with AGA or SGA would later influence breast milk FA composition.