This retrospective cohort study aimed to compare primary and secondary outcomes of patients undergoing radical cystectomy according to two different perioperative antimicrobial therapy protocols in ...2016.
In this single-center, retrospective cohort study, we investigated data of 104 patients undergoing radical cystectomy due to bladder cancer from January 1, 2016, to December 31, 2016. According to perioperative antimicrobial prophylaxis, patients were divided into two groups: 48 patients received piperacillin/tazobactam 3x4.5 g intravenously (IV) combined with metronidazole 3x500 mg IV, and 56 patients received ceftriaxone 1x2 g IV combined with metronidazole 3x500 mg IV. All patients received the first dose of antibiotics 24 hours prior to the operative procedure, and it continued over the next 48 hours after the procedure. We analyzed and compared data from various primary and secondary outcomes for both groups of patients.
In the group of patients receiving the combination of the piperacillin/tazobactam with metronidazole, the length of postoperative hospitalization was shorter (14 vs. 16 days, Z=2.24957 p=0.02383), leukocyte blood count on the first postoperative day was lower (9.80 vs. 11.15, p=0.01384), and hospital-acquired pneumonia was less common (2.08% vs. 12.5%, p=0.04688) than in the group receiving a combination of ceftriaxone and metronidazole.
In radical cystectomy, perioperative antimicrobial prophylaxis protocol using piperacillin/tazobactam combined with metronidazole proved to be more effective than the combination of ceftriaxone with metronidazole.
•Burkholderia gladioli was identified as a cause of healthcare-associated bacteremia.•The investigation traced to the contaminated multidose vials with saline solution.•Isolates from blood and saline ...showed the same susceptibility patterns.•Pulsed-field gel electrophoresis (PFGE) was used to genotype the strains.•PFGE profile of all B. gladioli isolates demonstrated clonal relatedness.
Burkholderia gladioli has been associated with infections in patients with cystic fibrosis, chronic granulomatous disease, and other immunocompromising conditions. The aim of this study was to better depict the outbreak of healthcare-associated bacteremia caused by B. gladioli due to exposure to contaminated multidose vials with saline solutions.
An environmental and epidemiologic investigation was conducted by the Infection Prevention and Control Team (IPCT) to identify the source of the outbreak in three Croatian hospitals.
During a 3-month period, 13 B. gladioli bacteremia episodes were identified in 10 patients in three Croatian hospitals. At the time of the outbreak, all three hospitals used saline products from the same manufacturer. Two 100-ml multidose vials with saline solutions and needleless dispensing pins were positive for B. gladioli. All 13 bacteremia isolates and two isolates from the saline showed the same antimicrobial susceptibility patterns and pulsed-field gel electrophoresis profile, demonstrating clonal relatedness.
When an environmental pathogen causes an outbreak, contamination of intravenous products must be considered. Close communication between the local IPCT and the National Hospital Infection Control Advisory Committee is essential to conduct a prompt and thorough investigation and find the source of the outbreak.
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Right-sided infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) is strongly associated with intravenous drug abuse, congenital heart disease, or previous medical ...treatment and is rare in healthy patients without a history of drug abuse. Here, we present a case of an 18-year-old male with no drug abuse history and no medical burden who was diagnosed with MRSA tricuspid valve endocarditis. Due to initial symptoms which indicated community-acquired pneumonia and radiological finding of interstitial lesions, empiric therapy with ceftriaxone and azithromycin was started. After the detection of Gram-positive cocci in clusters in several blood culture sets, endocarditis was suspected, and flucloxacillin was added to the initial therapy. As soon as methicillin resistance was detected, the treatment was switched to vancomycin. Transesophageal echocardiography established the diagnosis of right-sided infective endocarditis. A toxicological analysis of hair was carried out, and no presence of narcotic drugs was found. After six weeks of therapy, the patient was fully recovered. Exceptionally, tricuspid valve endocarditis can be diagnosed in previously healthy people who are not drug addicts. As the clinical presentation commonly resembles a respiratory infection, a misdiagnosis is possible. Although MRSA rarely causes community-acquired infections in Europe, clinicians should be aware of this possibility.
Burkholderia gladioli has been associated with infections in patients with cystic fibrosis, chronic granulomatous disease and other immunocompromising conditions. The aim of this study was to better ...depict the outbreak of healthcare-associated bacteremia caused by Burkholderia gladioli due to contaminated multi-dose vials with saline solutions.
An environmental and epidemiological investigation was conducted by the Infection Prevention and Control Team (IPCT) in order to identify the source of the outbreak in three Croatian hospitals.
During a three-month period, a total of thirteen B. gladioli bacteremia episodes were identified in ten patients in three Croatian hospitals. At the time of the outbreak, all three hospitals used saline products from the same manufacturer. Two 100 ml multi-dose vials with saline solutions and needleless dispensing pins were B. gladioli positive. All thirteen bacteremia isolates, as well as two isolates from the saline, showed the same antimicrobial susceptibility patterns and pulsed-field gel electrophoresis profile demonstrating clonal relatedness.
When an environmental pathogen causes an outbreak, contamination of intravenous products must be considered. Close communication between local IPCT and the National Hospital Infection Control Advisory Committee is essential to conduct a prompt and thorough investigation and find the source of the outbreak.
Research on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population ...and may increase the risk of developing a subsequent major depression. This study was aimed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms.
A randomized controlled study design with a one-year follow-up was used. Fifty patients with mild to moderate depressive symptoms (74% female, aged 57 +/- 9 yrs, diabetes duration of 10 +/- 8 yrs, BMI 31 +/- 6 kg/m2, HbA1C 7.7% +/- 1.4, 53% insulin treated) were randomly assigned to either an intervention or a control group. The intervention group underwent four psycho-educational sessions aimed at enabling self-management of depressive symptoms. The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual. Both groups were contacted by phone in 2-3-month intervals, and re-assessed for depression after 6 and 12 months. Changes in depressive symptoms and glycaemic control were considered primary outcomes. Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups.
Both the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale (Friedman ANOVA chi2 = 10.8 p = .004 and chi2 = 7.3 p = 0.03, respectively). The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups (chi2 = 11.6 p = 0.003 and chi2 = 17.1 p = 0.0002, respectively). Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up (all p > 0.05).
Psycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms, but its effects are comparable with the non-specific support given to the subjects in the control group.
Current Controlled Trials ISRCTN58745372.
Cilj: Nedavna istraživanja prezentirala su korinebakterije kao uzročnike oportunističkih infekcija. Corynebacterium striatum pojavljuje se kao značajan uzročnik kod imunokompromitiranih i ...imunokompetentnih bolesnika.
Metode: U ovom radu je prikazan slučaj odraslog pacijenta oboljelog od COVID-19 bolesti s infekcijom krvotoka uzrokovanom C. striatum. Uz to, predstavljeni su klinički slučajevi infekcija krvotoka uzrokovanih Corynebacterium spp., uglavnom C. striatum.
Rezultati: Prikazujemo 43-godišnjeg pacijenta hospitaliziranog zbog bilateralne pneumonije uzrokovane virusom SARS-CoV-2. Tijekom liječenja primijenjen je postupak izvantjelesne membranske oksigenacije (engl. extracorporeal membrane oxygenation, ECMO). C. striatum izoliran je u sedam setova hemokultura uzorkovanih tijekom sedam uzastopnih dana. Na temelju identifikacije pomoću MALDI-ToF-a, započeta je empirijska terapija vankomicinom. Identifikacija je potvrđena sekvenciranjem gena 16S ribosomske RNA. Centralni venski kateter je zamijenjen, ali je C. striatum kontinuirano izoliran u hemokulturama sljedećih dana. Iako je preporučena zamjena ECMO kanile, postupak nije izveden zbog teškog stanja pacijenta. Vankomicinu je dodan fosfomicin kao „terapija spasa” kako bi se reorganizirala struktura biofilma te omogućila bolja penetracija i učinkovitost vankomicina što je rezultiralo sterilnim hemokulturama u narednim danima.
Zaključak: Tijekom posljednjih desetljeća u literaturi je opisano mnogo primjera infekcija krvotoka uzrokovanih kontaminantima kože. Iako se centralni venski kateter najčešće opisuje kao put ulaska mikrobiote kože u krvotok, ne smiju se zanemariti ni drugi kateteri, poput pleuralnog katetera i ECMO sustava. Poznato je kako bakterijske stanice često stvaraju biofilm na površini različitih medicinskih uređaja, kao što su središnji venski kateteri, endoskopi i urinarni kateteri. Fosfomicin ima potencijal prodrijeti u biofilm, transformirati strukturu biofilma i potencijalno povećati koncentraciju drugih antimikrobnih sredstava u biofilmu.
Prema dosadašnjim istraživanjima neracionalna primjena antimikrobne terapije značajan je problem u bolničkim i vanbolničkim ustanovama. Studije su pokazale da se približno 50 % antimikrobnih lijekova ...koristi nepotrebno i suboptimalno s obzirom na indikaciju, vrstu antimikrobnog lijeka, te duljinu primjene. Dosadašnja istraživanja su pokazala uzlazni trend prevalencije Clostridium diffi cile pseudomembranoznog kolitisa, bakterijskih patogena rezistentnih na fl uorokinolone i vankomicin rezistentnih enterokoka. Porast multirezistencije gram negativnih bakterija i na karbapeneme opasnost je za sigurnost bolesnika te ostavlja ograničene terapijske mogućnosti zadnje linije obrane poput primjene toksičnog polimiksinskog ntibiotika kolistina. U skladu s time mogućnosti optimalnog infektivnog liječenja već sada postaju ograničavajuće. Prema dosadašnjim radovima uvođenje bolničkog programa praćenja i rukovođenja antimikrobnom terapijom pokazalo se dobrim sredstvom optimalizacije antimikrobne terapije u 81 % studija. Primjena ovoga programa dovela je do značajnog poboljšanja mikrobiološkog ishoda, smanjenja stope antimikrobne rezistencije i nuspojava te kliničkog ishoda poput smanjenja stope mortaliteta i duljine boravka u bolnici. Stoga su Centres for Disease Control and Prevention, Atlanta, USA (CDC) i European Centre for Disease Prevention and Control (ECDC) suglasne da bi zdravstvene ustanove trebale implementirati multidisciplinarni Bolnički program praćenja i rukovođenja antimikrobnom terapijom (engl. Antimicrobic Stewardship
Programs - ASP) u svakodnevnu kliničku praksu. Primjena navedenog programa započeta je 1. 12. 2016. g. u Klinici za kardiovaskularne bolesti Magdalena u sklopu Internacionalne kanadske akreditacije (Accreditation Canada International).
Objective： The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to ...relevant specialist. Methods： Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index （PDI）, risk of malignancy index （RMI） and body mass index （BMI） were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. Results： The study included 689 women （112 malignant, 544 benignant, and 33 borderline tumors）. Malignant and borderline tumors were more frequent in postmenopausal women （P=0.000）. Women who had benignant tumors had the lowest BMI （P=0.000）. There were significant （P〈0.05） differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen （CEA） levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors （P=0.000）. Women with malignant tumors had highest values of RMI and PDI （P=0.000）. Conclusions： Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.
While the survival rates for patients with end-stage heart failure have dramatically improved with newer generations of left ventricular assist devices, LVAD-specific infections are important cause ...of morbidity, mortality, and hospital readmissions in these patients.
We performed a retrospective analysis of all driveline infections in patients who had undergone LVAD implantation at a single cardiosurgical center. Between June 2013 and March 2017, 51 patients underwent implantation of LVAD. Among these, 12 received Heart Ware LVAD,34 Heart Mate II LVAD, and 5 Heart Mate III LVAD. The end goal for LVAD therapy was destination therapy in three patients and bridge-to-transplantation in 48 patients.
One month, six months, and one-year survival rates were 90%, 85%, and 81%, respectively. Five patients developed driveline infections. Median time from LVAD implantation to driveline infections was 126 days. One of these patients underwent heart transplantation. Two patients were treated with antibiotics and surgical driveline repositioning with extensive debridement of the wound. Two patients with a chronic infection were treated conservatively with regular wound cleaning.
Driveline infections remain a serious therapeutic challenge. With the development of surgical techniques and new devices, it is possible to reduce morbidity and increase survival rate in patients with implanted LVAD.
Driveline, Infections, LVAD.
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