Risk factors and outcomes for bloodstream infections with extended-spectrum beta -lactamase-producing Klebsiella pneumoniae ; Findings of the nosocomial surveillance system in Hungary.

Risk factors for and outcomes of bloodstream infections (BSIs) caused by ESBL-producing and by ESBL-non-producing Klebsiella pneumoniae were compared in a four-year multicenter study in Hungary. One hundred ESBL-positive and one hundred ESBL-negative patients were included as cases and controls. Investigated risk factors were related to demographics, comorbid conditions, treatments, invasive procedures, surgery prior bacteremia, presence of additional nosocomial infections and preceding hospital admission within a year. Measured outcomes were crude mortality, mortality related to infection and delay in introducing appropriate therapy (DAT). Though some risk factors for infection (admission to intensive care units, having central venous and/or urinary catheter, mechanical ventilation) were shared by both groups, in other respects cases and controls were found to differ substantially. The 36 percent of patients with BSIs with ESBL-producing Klebsiella died versus 23 percent of controls (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.0-5.4; p = 0.02). The 18 percent of deaths in cases versus 9% in controls could be attributed to infection (OR: 5.0; 95% CI: 1.5-16.2; p = 0.006). Cases more often received previous antibiotic therapy than controls (OR: 2.7; 95% CI: 1.1-6.7; p = 0.02) and delay in the introduction of appropriate antibiotic treatment was observed in 44% of cases versus 19% of controls (OR: 3.4; 95% CI: 1.6-7.3; p = 0.001). The results demonstrate that BSIs caused by ESBL-producing K. pneumoniae are related to previous antibiotic therapy and are associated with a high rate of mortality that is often linked to delay in the introduction of appropriate antibiotic therapy. This confirms that besides infection control measures the early identification and antibiotic resistance profiling of the infecting pathogen is salient in the control of BSIs caused by ESBL-producing K. pneumoniae .

[Experience with the clinical use of beta-tri-calcium phosphate (Cerasorb) as a bone replacement graft material in human periodontal osseous defects]. / A beta tri-calcium phosphate (Cerasorb) klinikai alkalmazásával nyert tapasztalatok humán parodontális csonthiányok pótlásában.

Various bone replacement graft materials have been used in attempting to restore periodontal bone structure lost as a result of periodontal inflammation. The pure beta-tricalcium phosphate has been successfully used in oral surgery for replacing lost bone but the periodontal data available are very limited. The major objective of the present clinical trial is to evaluate the regenerative-reparative potential of beta-tricalcium phosphate (CERASORB) in the treatment of two-three-wall vertical periodontal bony defect. 21 patients with advanced intrabony defects were selected for this study. Parameters used for assessment: Bleeding on probing, Clinical Probing Depths (CPD), Clinical Attachment Loss (CAL), Clinical Gingival Recession (CGR) and Radiological evaluation on standardized periapical radiographs. Following local anesthesia, intracervicular incisions is placed and a full thickness mucoperiosteal flap is raised vestibularly and lingually. The granulation tissue was completely removed from the defects and the roots were thoroughly scaled and planed using hand and ultrasonic instruments. Osseous recontouring was not performed. Following defect debridement, the CERASORB bone-grafting material was carefully applied and gently condensed in the bone crater then the flaps were repositioned in a coronal position and closed with vertical or horizontal mattress sutures. Six months after surgery CPD, CAL and CGR parameters were also measured and compared to baseline data. Bone defects treated with beta-TCP bone grafting materials showed a great variation in healing tendency. The best radiological results (bone fill) were obtained in three wall defects. Even using the most thorough suturing technique substantial part of the bone grafting material was lost during the first post-surgical week. If no sequestration occurred substantial bone fill and clinical attachment gain occurred especially in the three wall defects one year after grafting. The use of biological barrier membranes are recommended.