Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases.

BACKGROUND AND OBJECTIVE: Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms. METHODS: The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia. RESULTS: Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49-4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75-13.64; P < 0.001), APACHE II score ≥ 20 (OR, 2.12; 95% CI: 1.28-3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00-2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11-5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)-46/123 (37.4%), P = 0.037 and 62/93 (66.7%)-65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains. CONCLUSION: Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.

Impact of a basic nutrition course for residents at a faculty hospital. Did it make a difference in demand for nutrition consultations?

BACKGROUND/AIMS: To assess whether a basic nutrition course for residents at a faculty hospital improves their knowledge of nutrition and increases the number of consultation requests for nutrition by alerting participants to the high prevalence of undernutrition in hospitals. METHODS: The residents from 34 departments of basic, internal and surgical sciences were recruited to take a 1-day course. Questionnaires, designed to assess knowledge of nutrition, were completed at the beginning and at the end of the course. The results of the questionnaires and the number of consultation demands for nutrition before and after the course were compared. RESULTS: The results of 161 participants were evaluated. The mean (+/-SE) numbers of correct answers given to the first and second questionnaires were 14.9 +/- 0.22 and 18.7 +/- 0.21, respectively (p < 0.01). When the number of requests for nutrition consultation during 7-month periods (just before and after the course) were compared, the mean number of requests in each month during these periods were found to be 1.81 +/- 0.58 and 4.06 +/- 1.20, respectively (p < 0.01). CONCLUSIONS: A short course of basic nutrition for residents improves their basic knowledge and leads to an increase in the number of consultation requests for nutritional support.

A rare complication of trigeminal nerve stimulation during radiofrequency thermocoagulation: sudden ST segment elevation.

Coronary vasospasm resulting from a sudden autonomic response associated with an intracranial procedure was encountered during percutaneous radiofrequency trigeminal rhizotomy. Although it is very rare, careful monitoring and readiness for the occurrence of such a potentially lethal situation with necessary medications may prevent a fatal outcome.