Clinical and microbiological efficacy and toxicity of colistin in patients infected with multidrug-resistant gram-negative pathogens.

Polymyxins have recently again become important because of multidrug-resistant (MDR) gram-negative pathogens. The aim of this study was to evaluate the clinical and microbiological efficacy and toxicity of different dosages of colistin in patients infected with MDR microorganisms that were sensitive only to colistin. The study was conducted in the 1,200-bed Ankara Numune Training and Research Hospital. Patients with normal renal function who received colistin for 48 h or more were retrospectively evaluated. Clinical response was defined as resolution of fever and clinical and laboratory findings. Microbiological response was defined as bacteriological eradication from the infection site. Nephrotoxicity was defined as at least two consecutive serum creatinine measurements with an increase of 0.5 mg/dl from baseline at least 24 h apart after 2 or more days of colistin therapy. Twenty-four patients were included in the study: total clinical response was obtained in 17 of 24 (70.8 %) patients and microbiological response in 15 of 24 (62.5 %) patients. Patients were grouped according to colistin dosage of 3 × 1 million units (MU) versus 3 × 2 MU. Clinical response rates were 69.2 % and 72.7 %, respectively (p = 0.65). Microbiological response rate was similar (p = 0.62). Nephrotoxicity was revealed in 1 of 13 patients (7.7 %) for the 3 × 1 MU group and 2 of 11 patients (18.2 %) in the 3 × 2 MU group (p = 0.57). The nephrotoxicity rate was greater with higher dosages of colistin, but the difference was not statistically significant. Renal function of patients receiving higher dosages of colistin should be more closely monitored.

[Phenotypic and genotypic traits of vancomycin-resistant enterococci in a public hospital: the first vanB-positive Enterococcus faecium isolates]. / Bir Devlet Hastanesinde Vankomisine Dirençli Enterokok Suslarinin Fenotipik ve Genotipik Olarak Degerlendirilmesi: Ilk vanB-Pozitif Enterococcus faecium Izolatlari

Thirty eight vancomycin resistant enterococci (VRE) were isolated in one year surveillance study for hospital infection control programme in a state hospital in Ankara, Turkey. All isolates were identified as Enterococcus faecium by VITEK2 system (bioMerieux, France). Vancomycin and teicoplanin resistant 30 strains were defined as vanA phenotype while vancomycin-resistant teicoplanin-susceptible eight strains were defined as vanB phenotype. vanA genes were found in 30 strains while vanB genes were found in five strains by using PCR method. Those five strains were the first vanB positive E.faecium strains in our country. VRE strains revealed six different band patterns by PFGE, while six isolates could not be classified. All isolates with vanB type resistance were found in the same cluster. Source of vanB positive strains was considered as the hemodialysis unit. When the previous national reports related to vancomycin-resistant enterococci were considered, this was the first report of vanB positive E.faecium isolates in our country. This emphasized that both the diversity of VRE and the isolation rate was increasing. In order to eliminate the spread of VRE, effective surveillance studies should be performed and protective measures should be established promptly.

Effect of Nutritional Support Containing Arginine, Glutamine and ß-hydroxy-ß-methylbutyrate on the Protein Balance in Patients with Major Burns.

OBJECTIVE: To evaluate the effect of a supplementary nutritional product containing arginine, glutamine and ß-hydroxy-ß-methylbutyrate (HMB) on the nutritional parameters of patients with major burns. METHODS: In a total of 40 patients with major burns treated in the Burns Unit, standard nutritional support was administered to 20 patients, and the study product was added to the standard nutritional support of the remaining 20 patients. The biochemical laboratory test results and burn severity were recorded on the first day of treatment and on Days 14 and 28. The 40 patients were divided as the study and the control group, and their results were compared. RESULTS: An increase in the albumin, prealbumin and total protein values in the group administered with the study product was found to be statistically significant compared to the control group (p=0.021, p=0.02, p<0.001, respectively). The decreases in haemoglobin and C-reactive protein (CRP) were at the levels expected in burn trauma. CONCLUSION: The results obtained in this study demonstrated that the addition of arginine, glutamine and HMB to the nutrition of patients with burns had a positive effect on the protein balance.

Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients.

BACKGROUND/AIM: The aim of this study was to investigate the epidemiologic characteristics, the causative microorganisms and their antimicrobial susceptibility patterns, and the prognostic risk factors for mortality in critically ill patients with ventilator-associated pneumonia (VAP). MATERIALS AND METHODS: In this retrospective observational study, all the critically ill patients with VAP hospitalized in a medical/surgical intensive care unit (ICU) between January 2010 and June 2015 were evaluated. Patients' demographic features and microbiological data were reviewed. RESULTS: A total of 417 patients were clinically diagnosed with VAP; 51.1% of them were male and the average age was found as 69.9 ± 15.9 years. VAP was detected at approximately 25.0 ± 18.0 days of ICU stay and 17.9 ± 12.6 days after intubation. Acinetobacter baumannii (69.5%) was isolated as the most frequent VAP agent, and the most effective antibiotic was colistin. The crude mortality rate was detected as 39.8% among the patients. The presence of dyspnea at admission, coronary heart disease as a comorbidity, unconsciousness at admission, steroid usage, and prolonged hospital stay were observed as independent risk factors in multivariate analysis (P < 0.01). CONCLUSION: According to the etiological microorganisms and antimicrobial susceptibility patterns, colistin was found to be the most reliable antibiotic for empirical antimicrobial therapy.

Investigating the in vitro synergistic activities of several antibiotic combinationsagainst carbapenem-resistant Acinetobacter baumannii isolates.

BACKGROUND/AIM: Acinetobacter baumannii (A. baumannii) is one of the most common healthcare-associated infectious agents worldwide. The aim of this study was to investigate the in vitro synergistic activities of several antibiotic combinations against carbapenem-resistant (CR) A. baumannii isolates. MATERIALS AND METHODS: Eighteen CR A. baumannii strains were isolated from the patients who were hospitalized in the intensive care unit between June 2012 and August 2012. The in vitro effects of single and binary combinations of meropenem (MEM), colistin (CST), tigecycline (TGC), and sulbactam (SUL) on these isolates were determined using the Epsilometer test (E-test) method. RESULTS: All 18 isolates were resistant to MEM and SUL and susceptible to CST. TGC was detected as susceptible in two of the isolates and intermediate susceptibility results were observed in the remaining isolates. With MEM-CST and MEM-TGC combinations, synergism was determined against all isolates. The synergistic and/or additive effect ratios were detected in MEM-SUL, CST-SUL, TGC-SUL, and CST-TGC combinations as 16.7%, 38.9%, 16.7%, and 5.6%, respectively. CONCLUSION: Among the tested antimicrobial combinations, the in vitro combination of MEM with TGC or CST was most effective against the CR A. baumannii strains.

Emergence of multidrug resistant isolates and mortality predictors in patients with solid tumors or hematological malignancies.

INTRODUCTION: Infections are an important preventable cause of death in cancer patients. The aim of this study was to clarify the epidemiologic characteristics and resistance patterns of causative isolates and mortality predictors in infections of cancer patients. METHODOLOGY: Patients with sterile site infections were evaluated in a retrospective cohort study. Etiological agents, antimicrobial resistance patterns of the isolates, and possible risk factors for mortality were recorded. Survivors and non-survivors on day 30 after each infection onset were compared to identify the predictors of mortality. RESULTS: A total of 205 infection episodes of 132 patients were included in this study. Of them, 75% had hematologic malignancies and 25% had solid tumors. Febrile neutropenia was diagnosed in 61.5%. Bloodstream infections were the most frequent infection (78%). The majority of the pathogens were Enterobacteriaceae (44.3%) and nonfermentative isolates (17.6%). Multidrug-resistant (MDR) infections were responsible for 40% of the episodes. The mortality rate was 23.4%. Inadequate initial antibiotic treatment (OR = 4.04, 95% CI = 1.80-9.05, p = 0.001), prolonged neutropenia (> 7 days) before infection (OR = 3.61, 95% CI = 1.48-8.80, p = 0.005), infection due to Klebsiella species (OR = 3.75, 95% CI = 1.31-10.7, p = 0.013), and Acinetobacter baumannii (OR = 5.00, 95% CI = 1.38-18.2, p = 0.014) were independent predictors of mortality. CONCLUSIONS: Gram-negative isolates were found to be the predominant pathogens with higher mortality rates. Local epidemiological data should be taken into account when administering empirical therapy since the inadequacy of initial antibiotherapy is associated with a poor outcome.

Two cases of acute hepatitis after a serial knife stabbing.

Three persons became victims of a serial knife stabbing in a fight. Three months later, one of the victims presented with acute hepatitis. On the fifth day of his admission to the hospital, another victim of this serial stabbing presented to our clinic with acute hepatitis B infection. The patients told that the first victim stabbed in this fight was their relative and he was a carrier of hepatitis B virus for a long time. They said that the carier of hepatitis B was stabbed first and then, with the same knife, the first and second patients were stabbed, respectively. After 8 months, the index case (first victim) was admitted to our clinic with elevation of liver enzymes. HBsAg and HBeAg were positive. HBV DNA was 2 × 10 (9) copy/mL. Histopathologic examination of liver biopsy showed chronic hepatitis with histologic activity index of 6/18 and grade I fibrosis.

A cluster of Klebsiella pneumoniae bacteremia in a radiation oncology ward.

BACKGROUND: We report an outbreak of genetically related strains of Klebsiella pneumoniae bloodstream infection. METHODS: The practices that were possibly related to the outbreak were investigated through direct observation and interviews with staff by infection control team. Cultures of potential environmental sources of bacteria were obtained. RESULTS: Six patients receiving intravenous medications in saline solution developed fever and shaking chills 1.5 to 4 hours after the infusion was initiated. Cultures of the blood from 4 patients yielded K. pneumoniae. Molecular characterization of K. pneumoniae done by pulsed-field gel electrophoresis revealed the same strain. CONCLUSION: Although a definite source for the outbreak could not be identified, probably environmental contamination, lack of adherence to hand hygiene practices, contamination, and cross contamination led to this outbreak.