Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey.

We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum ß-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.

Effects of a major earthquake on blood donor types and infectious diseases marker rates.

This observational study attempted to identify the effect of a natural disaster on the safety of blood supply and donor types with the influx of donors after a severe earthquake. Blood donation rate, blood discard rate and safety of blood donations responding to the earthquake, as projected from the infectious disease marker rate, were evaluated in blood donated immediately before (1 July-17 August) and after 17 August 1999 (17 August-21 August). These were compared with the results from the corresponding periods in 1998 and 2000 for donations at a university medical centre and two regional blood centres. 8055 units of allogeneic blood were collected at two regional blood centres, and 450 units were collected at a university medical centre during 4 days. Viral marker rates were nearly the same at the former but were slightly lower at the latter. The blood discard rate was nearly twice the comparative periods at the former, but it remained unchanged at the latter. Voluntary donors replaced the replacement donors during 4 days. This analysis highlights the size of the pool of potential donors that are available as a national resource that can be motivated to give blood with the right motivation.

Detection and evaluation of salivary antibodies to Helicobacter pylori in dyspeptic patients.

Helicobacter pylori infection is one of the most prevalent infections in humans. The high prevalence and the association with peptic ulceration and gastric cancer require simple and non-invasive methods for the diagnosis of the infection. Detection of salivary anti-H. pylori IgG antibodies has advantages compared with those on serum. In this study, salivary immunoglobulin G response to H. pylori was evaluated in 100 consecutive dyspeptic patients by enzyme-linked immunosorbent assay (ELISA), in comparison with culture and histopathologic examination of gastric biopsy specimens obtained at endoscopic procedures and assessed the accuracy of salivary diagnosis of the infection. The overall sensitivity and specificity of the test were 87 and 73%, respectively. These results suggest that saliva testing for H. pylori antibodies could be used reliably for screening dyspeptic patients in general practice, especially in children in whom venesection is more difficult.

Usefulness of 99mTc-ciprofloxacin (infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy.

UNLABELLED: 99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections. METHODS: Fifty-six sites with suspected bone or joint infection were examined with 99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370-400 MBq infecton or 185-200 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies. RESULTS: There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With 99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients. CONCLUSION: Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy.

Aminoglycoside resistance mechanisms in Enterobacteriaceae and Pseudomonas spp. from two Danish hospitals: correlation with type of aminoglycoside used.

Sixty-two aminoglycoside-resistant Gram-negative enteric bacteria were isolated over a 3-year period from two hospitals (Bispebjerg and Esbjerg) among a total of almost 270,000 isolates. These hospitals were selected because of their different aminoglycoside policies during the years investigated. At Bispebjerg Hospital the principal aminoglycoside used was tobramycin, while gentamicin was the first choice at Esbjerg Hospital. Escherichia coli was the most frequently found aminoglycoside-resistant species. Among the 61 aminoglycoside-resistant strains studied, resistance was due to aminoglycoside-modifying enzymes in all except two Xanthomonas maltophilia strains. The ANT(2") enzyme occurred significantly more often at Esbjerg Hospital (p = 0.001), while enzymes of the AAC(3) or AAC(6') moieties were more common, but not significantly so, at Bispebjerg Hospital. The phenotypic pattern of aminoglycoside resistance, as determined by disc diffusion, correlated 100% with the ANT(2") and AAC(3)-V (the two most common enzymes among the isolates) genotype of the organisms as established using DNA probes. Median minimum inhibitory concentrations (MICs) (mg/l) for clinically utilized aminoglycosides were: amikacin (1.6), gentamicin (25.0), kanamycin (50.0), netilmicin (1.6-25.0) and tobramycin (12.5-50.0). Isolates from Bispebjerg Hospital revealed significantly higher MICs for netilmicin and tobramycin (p < 0.01) as compared to isolates from Esbjerg Hospital.