Cost analysis of ventilator-associated pneumonia in Turkish medical-surgical intensive care units.

A study was carried out to assess treatment success and the overall costs of patients with ventilator-associated pneumonia (VAP). In a prospective case control study, data were collected from 25 intensive care unit (ICU) beds. A total of 162 ICU patients who required mechanical ventilation were assessed. Of these, 81 patients were diagnosed with VAP and the other 81 were controls (without VAP). Risk of mortality was analyzed and total cost of care was recorded. Age, sex and underlying disease were similar between the groups. The mean length of stay (LOS) in the ICUs in the VAP cases (15.7±9.1 days) exceeded that of the controls (4.9±4.9 days) (p 0.0001), and the additional LOS attributable to VAP was estimated at 10.8 days. In the VAP group, 25 patients had early-onset VAP, and the other 56 patients had late-onset VAP. Mortality rates were higher in VAP patients (32%) than controls (19.7%) p 0.05). Total costs were USD 8602.7±5045.5 in the VAP group and USD 2621.9±2053.3 in controls. The additional cost for VAP was found to be USD 5980 per patient. These data suggest that morbidity, mortality, ICU length of stay and costs increase with VAP. The additional costs for VAP are especially based on the use of novel and expensive antibiotics, other drugs, and medical material.

[Comparison of the serological tests used for the laboratory diagnosis of brucellosis]. / Brusellozisin laboratuvar tanisinda kullanilan serolojik testlerin karsilastirilmasi.

Brucellosis which is an important public health problem is a zoonotic disease that causes economic loss, and seen all over the world as well as in our country. The aim of this study was to compare the results of Rose Bengal test, standard tube agglutination test (STA), Coombs tube agglutination test, Rivanol tube agglutination test and ELISA (IgA, IgG and IgM) method, in patients who were suspected to have brucellosis. Blood and serum samples collected from 77 patients were included to the study. Blood cultures were performed from all of the patients and Brucella spp were isolated in 35 (45.4%) of them. At least one of the serological tests for Brucella was found positive in 62 samples (80.5%). When culture positivity accepted as the gold standard, the sensitivities of the tests were calculated as follows; 100% for Rose Bengal, 94.3% for STA, 97.1% for ELISA IgG, 94.3 for ELISA IgA and 71.4 for ELISA IgM. No prezone phenomenon was observed in the samples. Brucella Coombs tube agglutination test did not increase the chance of diagnosis of brucellosis, unlike the results of previous studies. We found that Rose Bengal and STA tests were still efficient methods for brucellosis serodiagnosis. The results of rivanol tube agglutination test were similar to STA test, and this test can be used especially in patients with brucellosis relapse. ELISA test detecting IgA and IgG antibody titers together found to be effective methods increasing the chance of brucellosis diagnosis, and could be helpful for follow up of brucellosis.

A case of right-side infective endocarditis with ventricular septal defect.

A 28-year-old woman previously known to have a ventricular septal defect presented with fever, headache, abdominal pain and nausea. Positive blood culture of methicillin-sensitive Staphylococcus aureus and the detection of vegetation attached to the right ventricular wall near the ostium of the ventricular septal defect confirmed diagnosis of infective endocarditis. After four weeks' treatment with proper antibiotics the patient recovered.