Rare complication spontaneous pneumothorax and pneumomediastinum in COVID-19 patients: A single center experience.

INTRODUCTION: We aimed to describe the clinical characteristics and outcomes of patients with spontaneous pneumothorax (SPT) and pneumomediastinum (SPM) due to COVID-19 pneumonia. METHODOLOGY: This retrospective study evaluated inpatients at a COVID-19 pandemic hospital. Between March 11, 2020 and March 31, 2021, patients who developed complications of spontaneous pneumothorax (SPT) and pneumomediastinum (SPM) with a confirmed diagnosis of SARS-CoV-2 by polymerase chain reaction (PCR) method were included. RESULTS: Of the 6,528 hospitalized patients, nine developed complications of SPT and SPM, with an incidence of 0.14%. Four of these patients developed SPT, one developed SPM, one developed SPT + SPM + emphysema, and three developed SPT + SPM. The mean age of the patients was 67.67 ± 13.41 years and the median was 68 (45-88) years. All patients were male. Six patients died, one of whom died of myocardial infarction from uncomplicated causes. CONCLUSIONS: Studies with more cases are needed to evaluate the causality between COVID-19 and pneumothorax (PT) and pneumomediastinum (PM). However, it should be kept in mind that PT and PM may lead to this clinic when sudden respiratory distress occurs in these patients and rapid diagnosis and treatment should be planned. As observed in this study, PT and PM are important factors in the development of mortality in COVID-19 patients.

Risk factors for community-onset urinary tract infections caused by extended-spectrum ß-lactamase-producing Escherichia coli

Background/aim: Community-onset urinary tract infections(UTIs) caused by extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli have increased in many parts of the world. This study aimed to determine the prevalence and risk factors for community-onset UTI caused by ESBL-producing E. coli. Materials and methods: This prospective cohort study was conducted between January 2012 and March 2014 in cases of community-onset UTI caused by E. coli. Patients with UTI due to ESBL-producing E. coli and patients with UTI due to non-ESBL-producing E. coliwere compared to identify risk factors for ESBL-producing E. coli in the community. Results: A total of 305 patients (116 males [46.4%]; mean age: 57.76 ± 18.06 years) were included in the study. Among these patients, 154 (50.5%) were infected with ESBL-producing E. coli. In multivariate analysis, the healthcare-associated UTI (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.02­3.18; P = 0.041), upper urinary tract infection (OR: 3.05; 95% CI: 1.76­5.29; P < 0.0001), use of antibiotics in the preceding 6 months (OR: 2.28; 95% CI: 1.21­4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73­9.35; P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli. Conclusion: The increasing prevalence ofESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially in patients with two or more of the risk factors. A better understanding of the epidemiology and risk factors associated with community-onset UTIs due to ESBL-producing E. coli may have significant implications in decision-making for empirical antimicrobial treatment.

Spondylodiscitis: a common complication of brucellosis.

INTRODUCTION: Brucellar spondylodiscitis is a frequent and serious complication of brucellosis. The aim of this study is to describe the brucellosis patients with spondylodiscitis and the predictive factors related to spondylodiscitis in brucellosis. METHODOLOGY: Laboratory-confirmed brucellosis patients from a low- to medium-endemic region were enrolled in the study and distributed into two groups. Group I consisted of patients with spondylodiscitis and Group II patients had no complications. Both groups were compared for predictive factors of spondylodiscitis. RESULTS: A total of 219 patients with active brucellosis were included in the study. We determined at least one complication in 91 (41.6%) patients. The most frequent complication was spondylodiscitis [n = 59 patients (26.9 %)]. In univariate analysis, age, time from symptom onset to diagnosis, presence of low back pain, increased levels of erythrocyte sedimentation rate, and alkaline phosphatases were the most significant predictive factors for spondylodiscitis among brucellosis cases. Presence of headache and thrombocytopenia were less frequent in patients with spondylodiscitis when compared to patients without complications (p = 0.024, p = 0.006 respectively). In multivariate analysis, old age (odds ratio [OR] 1,063; 95% confidence interval [CI] 1.026-1.101; p < 0.001), prolonged time between symptoms onset before diagnosis (OR 1.008; 95% CI 1.001-1.016; p = 0.031), and presence of low back pain (OR 12.886; 95% CI 3.978-41.739; p < 0.001) were indepedently associated with an increased risk of spondylodiscitis. CONCLUSIONS: Spondylodiscitis is the most frequent complication of systemic brucellosis. Patients with low back pain, older age, and longer duration of symptoms should be considered as candidates of potential spondylodiscitis in brucellosis.