Evaluation of post-operative development of mediastinitis in patients undergoing isolated coronary artery bypass grafting surgery: A single-center experience.

BACKGROUND: In this study, we aimed to evaluate mediastinitis cases developed after isolated coronary artery bypass graft surgery performed by median sternotomy to determine the causative microorganisms, risk factors, and clinical features. METHODS: Between March 2009 and December 2018, a total of 44 patients (32 males and 12 females; mean age 62.84±6.951 years; range, 46-78 years) who underwent isolated coronary artery bypass grafting surgery with median sternotomy and developed mediastinitis postoperatively were included in the studying our cardiovascular surgery (CVS) department. Patients demographic information, comorbidities, habits, pre-operative hospital stay, elective or emergency surgery, perioperative internal mammary artery use, perioperative blood or blood product, operation and cardiopulmonary bypass times, suitability of antibiotic prophylaxis, medical and surgical treatment, clinical data, and laboratory results were retrospectively analyzed. Purulent discharge cultures obtained directly from the mediastinal space and microbiological examination notes made from the material obtained from the surgical site or surgical repair were recorded. RESULTS: In isolated coronary artery bypass grafting surgery performed over a period of approximately 10 years, the rate of mediastinitis was 1%. There was no statistically significant difference between patients with and without mediastinitis in terms of age, sex, smoking habits, duration of operation and cardiopulmonary bypass, and intraoperative blood transfusion. The presence of diabetes mellitus and high mean body mass index was significantly higher in patients with mediastinitis compared to those without. Mediastinitis was diagnosed in 38 (86.3%) patients in the 1st month, 5 (11.3%) in the first 3 months, and 1 (2.2%) in the 1st year. Twenty-five (56.9%) Gram-positive bacteria, 13 (29.6%) Gram-negative bacteria, and 1 (2.3%) fungi were the microorganisms grown in purulent discharge cultures. Pathogen microorganisms could not be produced in 5 (11.4%) cases. The three most commonly isolated agents were methicillin-resistant coagulase-negative staphylococci (MRCNS) (50%), Escherichia coli (9.1%), and Klebsiella pneumoniae (6.8%). CONCLUSION: Attention should be paid to surgical site infection in patients undergoing CVS. Following discharge, follow-up is important and empirical treatment should be determined by considering the presence of MRCNS as the leading infectious agent in our hospital when infection occurs.

Evaluation of infections associated with implantable cardiac electronic devices: 10 years of experience in a single center.

PURPOSE: Cardiac implantable electronic device (CIED) is used increasingly in recent years. In this study, it is aimed to evaluate the frequency of CIED-associated infections in the cardiology clinic of our hospital in the last 10 years, the causative microorganisms by determining their risk factors and clinical characteristics. MATERIALS AND METHODS: 225 patients who underwent CIED implantation in our hospital's cardiology clinic between March 2009 and December 2019 were retrospectively identified. The patients were grouped as with and without CIED-associated infection. RESULTS: In a period of approximately 10 years, the rate of CIED infection was determined as 4.8%. 9 of the patients (81.8%) had CIED infection after the first implantation, and 2 of the patients (18.2%) after replacement. When the groups with and without CIED infection were compared; there was no significant difference in the group with CIED infection compared to the control group in terms of age, gender, type of the device inserted and the way of placing the device (implantation/replacement). Comparing risk factors between CIED infection and control group, there is no significant difference in terms of diabetes mellitus (DM), congestive heart failure, renal failure, hypertension, dyslipidemia, malignancy, immunosuppression. The use of anticoagulation was found statistically significant. CONCLUSIONS: CIED infections occur clinically with increased morbidity and mortality due to factors related to the patient and/or the type of device implanted. Knowing the patient's comorbid conditions well and taking precautions before CIED implantation can contribute to the reduction of the CIED infections.

Managing adult patients with infectious diseases in emergency departments: international ID-IRI study.

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.

The relationship between brucellosis and vitamin D.

INTRODUCTION: This study was aimed to determine the relationship between vitamin D and soluble vitamin D receptor (VDR) levels and brucellosis, a common infection in Turkey, in which the cellular immune system is important in the course of the disease. METHODOLOGY: Patients who had been followed up in the Department of Infectious Diseases and Clinical Microbiology of Cukurova University Medical Faculty, having been diagnosed with brucellosis and who had no brucellosis treatment before, were enrolled in the study along with healthy controls. The participants' vitamin D and soluble VDR values were recorded. Laboratory parameters of patients and controls, clinical findings, and disease course of brucellosis patients were also noted. RESULTS: The mean age of the 86 brucellosis patients, of whom 38 (44.2%) were males and 48 (55.8%) were females, was 40.9 ± 18.4 years. Complicated course of brucellosis rate was found to be 29.1%. Vitamin D and VDR levels were lower in brucellosis patients at the time of diagnosis compared to control group. For males, vitamin D and VDR levels were higher in the control group than in the patient group. In males, VDR levels were higher than in females. A significant difference was not found between clinical forms of the disease and vitamin D and VDR levels. CONCLUSIONS: Vitamin D and VDR levels were shown to be significantly lower in brucellosis patients before treatment compared to the control group. These results suggest that vitamin D could be involved in the pathogenesis of the disease.