Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter ...baumanii. Pairwise, retrospective exposed-unexposed study. Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia). Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy. Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously. Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure. We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
A living cell actively generates traction forces on its environment with its actin cytoskeleton. These forces deform the cell elastic substrate which, in turn, affects the traction forces exerted by ...the cell and can consequently modify the cell dynamics. By considering a cell constrained to move along a one-dimensional thin track, we take advantage of the problem geometry to explicitly derive the effective law that describes the non-local frictional contact between the cell and the deformable substrate. We then couple such a law with one of the simplest model of the active flow within the cell cytoskeleton. This offers a paradigm that does not invoke any local non-linear friction law to explain that the relation between the cell steady state velocity and the substrate elasticity is non linear as experimentally observed. Additionally, we present an experimental platform to test our theoretical predictions. While our efforts are still not conclusive in this respect as more cell types need to be investigated, our analysis of the coupling between the substrate displacement and the actin flow leads to friction coefficient estimates that are in-line with some previously reported results.
•Viscous friction couples an active gel, modeling the cell, and an elastic half-space.•We solve the integro-differential problem arising for traveling wave solutions.•Experiments verify the relation between actin velocity and substrate displacement.•A biphasic dependence on friction of steady-state velocity arises from this coupling.•This arises from nonlocal effects and without any nonlinear element in the model.
Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter ...baumanii.
Pairwise, retrospective exposed-unexposed study.
Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia).
Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy.
Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously.
Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure.
We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
Invasive candidiasis has emerged as an important nosocomial infection, causing significant morbidity and mortality especially among critically ill patients. The aim of our study was to determine ...specie distribution and resistance profiles of
Candida
species isolated from blood cultures.
Materials and Methods
We conducted a retrospective study of all episodes of candidemia diagnosed in our laboratory from January 2006 to May 2009. The susceptibility to antifungal agents of all
Candida
isolates was tested by using a Sensititre
®
YeastOne panel.
Results
A total of 130
Candida
isolates were recovered from blood cultures.
Candida tropicalis
was the most frequent specie (37.7%), followed by
C. albicans
(22.3%),
C. glabrata
(19.2%), and
C. parapsilosis
(12.2%). All the isolates were inhibited by ≤1 μg/ml of amphotericin B and ≤2 μg/ml of caspofungin. For fluconazole, 7.3% of clinical isolates were resistant. It was most active against
C. parapsilosis
(100% susceptible),
C. albicans
(95.8% susceptible), and
C. tropicalis
(94% susceptible). All of the fluconazole-susceptible isolates were susceptible to voriconazole, as were 83.3% of the fluconazole-susceptible-dose-dependent isolates. Among fluconazole-resistant isolates, 85.7% were susceptible to voriconazole.
Conclusions
In our institution,
C. tropicalis
was the most frequent specie isolated from the bloodstream. Caspofungin had an excellent in vitro activity against
Candida
isolates and was the drug of choice among fluconazole-resistant isolates.
HELLP syndrome is an acronym for Hemolysis, Elevated Liver enzymes and Low Platelets. It is generally considered in the literature as a particular clinical form of pre-eclampsia, a severe ...complication of the second half of pregnancy. However, this syndrome can occur in isolation in the absence of pre-eclampsia symptoms. Its pathophysiology remains still unclear. The clinical picture is often incomplete and fruste at first. To date, its diagnosis and management is still the subject of much controversy. Associated or not with a vascular and renal manifestations, the HELLP syndrome is a high-risk maternal disorder. The objective of this article is to review the pathophysiological and clinical data and current treatment.
In order to estimate the prevalence of hospital-acquired infection (HAI) and research factors associated with its occurrence, a one-day prevalence survey was conducted at the Habib Bourguiba ...University Hospital, Tunisia. We studied 280 patients who had been present in the same ward for at least 48
h, and who had occupied a hospital bed between 17 April 2002 (midnight) and 18 April 2002 (midnight). The overall prevalence of HAI was 17.9%. The most frequently infected sites were the lungs (32%), surgical wounds (28%) and the urinary tract (20%). Microbiological documentation was available in only 28% of HAIs, and the most frequently isolated organisms were Gram-negative rods (80.8%). Results of multiple logistic regression analysis indicated that HAI is linked to the medical category, the use of intravascular devices and antibiotic prophylaxis. This survey provided information on the prevalence of HAI in Tunisian hospitals, the breakdown of infections, and HAI predisposing factors.
Candida dubliniensis, a newly described fungal pathogen associated mainly to immunocompromised host's infection, is phenotypically closely related to C. albicans. In this study, we report for the ...first time, isolation and identification, in Tunisia, of 14 isolates of C. dubliniensis from 12 human immunodeficiency virus-negative patients hospitalised in the intensive care unit (ICU) at Habib Bourguiba Sfax Hospital. Our study was firstly based on the failure to grow at 45 °C. This presumptive identification was completed by other tests: chlamydospore production, culture on Candiselect4 (Bio-Rad) and the commercial test Bichro-Dubli fumouze®, which specifically identify C. dubliniensis. The confirmation of the discrimination between both species was performed by PCR, targeting the hyphal wall protein (HWP1) gene. The recovery of C. dublinensis by routine laboratory diagnosis is recommended for elucidating the epidemiology of this novel pathogen.
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