Five-year period evaluation of isolated agents and their resistance profiles in intensive care unit patients with malignancy.

INTRODUCTION: Patients treated in the intensive care unit (ICU) are usually patients who deteriorated health condition and could have longer hospital stay compared to other patients. Hospital infections are more common in ICU patients. The aim of this study was to evaluate the bacteria and treatment resistance profiles isolated from clinical specimens sent for hospital infections in ICU patients between January 1, 2014 and December 31, 2018. METHODOLOGY: Bacteria isolated from various clinical samples sent for hospital infections in hospitalized patients in the Anesthesia and Reanimation Intensive Care Unit were retrospectively analyzed. RESULTS: Culture positivity was detected in 547 of the sent clinical samples. Eighty Gram-positive bacteria, 389 Gram-negative bacteria and 78 fungi infection were identified in a total of 547 positive cultures. In Gram-positive bacteria, 4 MRSA, 6 VRE and 30 MRCoNS were identified as resistant strains. In Gram-negative bacteria, Acinetobacter spp. was the most culture positive strain with the number of 223. Carbapenem resistance was found in 258 of the Gram-negative bacteria and ESBL positivity was found in 44 of the Gram-negative bacteria strains. CONCLUSIONS: Gram-negative bacteria were the most frequently isolated strain in samples. Recently, colistin resistance has been increasing in Acinetobacter spp. and the increase in carbapenemase enzyme in Escherichia coli, Pseudomonas and Klebsiella species has increased resistance to carbapenems. Knowing the microorganisms that grow in ICUs and their antibiotic resistance patterns may help to prevent contamination of resistant microorganisms by both appropriate empirical antibiotic treatment and more isolation as well as general hygiene standard precautions.

Effect of Concurrent Lidocaine, Remifentanil and Methylprednisolone Use on the Clinical Effect of Sugammadex under General Anaesthesia in Rats.

OBJECTIVE: In an in vitro study, lidocaine, remifentanil and methylprednisolone produced inclusion complexes with sugammadex, which lead to a decrease in free and active concentrations of sugammadex. When used concurrently with these drugs, it is likely that the time for sugammadex to reverse a neuromuscular blockade is going to be prolonged due to a synergistic pharmacokinetic or pharmacodynamic interaction. The aim of the present study was to investigate whether concurrent use of sugammadex with remifentanil, lidocaine and methylprednisolone led to a decrease in the neuromuscular blockade reversal effect of sugammadex produced with neuromuscular blockade agent (NMBA) rocuronium. METHODS: The present study included 42 male Wistar rats. They were randomised into 7 groups, with 6 rats per group. The first group was the control group, the second group received remifentanil and methylprednisolone, the third lidocaine and methylprednisolone, the fourth remifentanil, the fifth lidocaine, the sixth methylprednisolone and the seventh lidocaine and remifentanil. All groups were administered 3.2 mg kg-1 rocuronium for neuromuscular blockade after the administration of study drugs. When the train of four (TOF) value was 0, all groups were administered 16 mg kg-1 sugammadex for the reversal of neuromuscular blockade. With a TOF Watch SX device, the time to TOF ≥0.9 was recorded. RESULTS: When the control group was compared with Groups 3, 4, 5, 6 and 7, no statistically significant difference was found. However, in Group 2, time to TOF ≥0.9 was prolonged significantly when compared with the control group. CONCLUSION: We suggest that remifentanil and methylprednisolone used concurrently with sugammadex lead to a decrease in sugammadex reversal effect by giving rise to decrease in its free and active concentrations probably via displacement in rats.

Sudden Appearance of Water in Flowmeter During Air/Oxygen and Sevoflurane Anaesthesia.

Endotracheal intubation was performed, and a water bubbling sound was heard from the anaesthesia device immediately after the release of gases to administer the O2-air-sevoflurane mixture. The flowmeter on the anaesthesia device was then found to be filled with water. The breakdown of the dryer in the medical air compressor system was determined as the source of the problem, since a greasy fluid mixture was released from the air-wall outlets in all rooms. Consequently, the anaesthesia team should keep in mind that problems as seen in the current case might emerge and should be alert.

Effects of Systemic Disorders on Postoperative Complications After Simultaneous Bilateral Total Knee Replacement.

OBJECTIVE: The aim of the present study was to retrospectively evaluate the association between accompanying systemic disorders and major complications developing in the early postoperative period in patients who underwent simultaneous bilateral total knee arthroplasty with combined spinal and epidural anaesthesia. METHODS: In the present study, the medical records of a total of 456 patients were analyzed. Preoperative data, including the American Society of Anesthesiologists physical status and presence of coronary artery disease (CAD), chronic pulmonary disease, diabetes mellitus (DM), hypertension and renal insufficiency were recorded. Furthermore, the data related to major complications, such as cardiac complications, respiratory complications, acute myocardial infarction (AMI), thromboembolism, cerebrovascular accident (CVA), confusion, acute renal failure (ARF), shock and cardiopulmonary arrest were recorded. RESULTS: We found that the frequency of complications markedly increased in the presence of concurrent DM and hypertension, or DM, hypertension and CAD, or DM and CAD. Further, 0.2% of the patients developed AMI, 3.3% developed cardiac complications, 2.2% developed respiratory complications, 0.9% developed thromboembolism, 0.2% developed CVA, 2% developed confusion and 0.4% developed cardiac arrest and shock in the first week after the operation. The frequency of cardiac and pulmonary complications and confusion was higher in patients aged above 65 years compared to patients below 65 years. CONCLUSION: We observed that the frequency of cardiac and pulmonary complications and confusion in the early postoperative period was markedly higher in patients aged above 65 years and in patients with concurrent DM and cardiovascular comorbidities.