scholarly journals Clinical Review of Microbial Corneal Ulcers Resulting in Enucleation and Evisceration in a Tertiary Eye Care Center in Hungary

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Gábor Tóth ◽  
Milán Tamás Pluzsik ◽  
Gábor László Sándor ◽  
Orsolya Németh ◽  
Olga Lukáts ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Cardiac Disease ◽  
Propionibacterium Acnes ◽  
Systemic Diseases ◽  
Infectious Keratitis ◽  
Tertiary Referral ◽  
Tertiary Referral Center

Purpose. To analyse the clinical and microbiological characteristics and preexisting ophthalmic and systemic conditions of infectious keratitis resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 12 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes undergoing surgery between 2007 and 2018 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, with infectious keratitis as the primary indication for enucleation or evisceration. For each subject, clinical history, B-scan ultrasound report, and microbiological analyses were reviewed. Results. There were 48 enucleated/eviscerated eyes from 47 patients (29 females (61.7%), age at the time of surgery 66.4 ± 18.5 years). Indication for surgery was hopeless, unmanageable keratitis (62.5%), and keratitis with endophthalmitis (37.5%). The most common preexisting ophthalmic conditions were previous cataract surgery (60.4%), previous therapeutic penetrating keratoplasty (PKP) (56.3%), corneal perforation (52.1%), glaucoma (41.7%), and long-term topical steroid usage (31.3%). In order to treat keratitis, before enucleation or evisceration, 20 eyes (41.7%) underwent PKP, 12 eyes (25.0%) amniotic membrane transplantation, 8 eyes (16.7%) conjunctival autograft transplantation, 6 eyes (12.5%) tarsorrhaphy, and 4 eyes (8.3%) vitrectomy to salvage the eye prior to the final treatment of enucleation or evisceration. The most frequent preexisting systemic diseases were hypertension (62.5%), cardiac disease (20.8%), diabetes mellitus (20.8%), and rheumatoid arthritis (14.6%). Staphylococcus aureus (17.0%) and Propionibacterium acnes (12.8%) were the most commonly isolated gram-positive bacteria, and Pseudomonas aeruginosa was the most frequently isolated gram-negative pathogen bacterium (10.6%). Six globes (12.5%) had positive fungal cultures (1 case of Candida albicans, Candida parapsilosis, Trichosporon inkin, Acremonium sp., Fusarium sp., and Penicillium sp.). Conclusions. Staphylococcus aureus, Propionibacterium acnes, and Pseudomonas aeruginosa keratitis with or without endophthalmitis represent the most common indication for ocular enucleation/evisceration in patients with microbial keratitis in a tertiary referral center in Hungary. The incidence of enucleation and evisceration related to mycotic keratitis does not seem to have increased within the last decade. Most frequent preexisting systemic diseases in cases of enucleation and evisceration are hypertension, cardiac disease, diabetes mellitus, and rheumatoid arthritis.

scholarly journals Visual Outcome, Microbiological Profile and Antibiotic Sensitivity of Infectious Keratitis in a Tertiary Referral Center

2020 ◽  
Author(s):  
Kristina Moore Stanfield ◽  
Bo Huang ◽  
Blake Matherne ◽  
Osasu Adah ◽  
Daniel McClung ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Contact Lens ◽  
Antibiotic Sensitivity ◽  
Empirical Therapy ◽  
Visual Outcome ◽  
Corneal Transplant ◽  
Infectious Keratitis ◽  
Tertiary Referral Center ◽  
Infection Source

Abstract Purpose:Treatment of infectious keratitis is chosen by identification of infection source with associated antibiotic susceptibilities. Because culturing corneas may take days to weeks to result, the mainstay of treatment is empirical therapy with broad-spectrum antimicrobials that are started before culture results return. We aim to record the microbiological profiles with associated antibiotic susceptibility patterns isolated from corneal cultures in patients with infectious keratitis, as well as visual outcomes over a 5-year period.Methods:A retrospective analysis of medical records of patients who presented to UMMC from 1/1/2014 to 12/31/2018 with keratitis or corneal ulcer were included in this study based off diagnosis codes.Results:Of 563 corneal infections analyzed, 202 (35.9%) had positive cultures. The most frequently isolated organism was Coagulative negative Staphylococcus/Staphylococcus epidermidis, followed by Pseudomonas aeruginosa, and Staphylococcus aureus. Pseudomonas aeruginosa was isolated in 37.2% contact lens wearers. We found that 93.3% of gram-positive cultured bacteria were susceptible to vancomycin with no resistance, and 81.8% of gram-negative bacteria were highly susceptible to tobramycin with no resistance. Regardless of treatment, 19.8% of patients needed some type of additional procedure, with the most common procedures being corneal transplant & evisceration. Conclusion:CNS, Pseudomonas aeruginosa, and Staphylococcus aureus were the most common microbes causing infectious keratitis. Pseudomonas aeruginosa remains the most commonly identified organism in contact lens wears. The empirical treatment of vancomycin and tobramycin used at our institution remains an excellent treatment for these microbes.

scholarly journals Prevalence, clinical features and treatment pattern of patients with concurrent diagnoses of rheumatoid arthritis and psoriatic disease: results of a 14-year retrospective study in a tertiary referral center

2019 ◽  
Vol 10 ◽  
pp. 204062231984790
Author(s):  
Kai-Lung Chen ◽  
Hsien-Yi Chiu ◽  
Jui-Hsiang Lin ◽  
Jian-De Ye ◽  
Yi-Hsuan Cho ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Features ◽  
Age Of Onset ◽  
Medical Center ◽  
Skin Lesions ◽  
Tertiary Referral ◽  
Female Ratio ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Psoriatic Disease

Background: Multiple comorbidities, including rheumatoid arthritis (RA), have been reported to be associated with psoriasis. Objective: This study aimed to determine the prevalence and the clinical features of RA among patients with psoriasis in a tertiary referral center. Methods: Between January 2000 and December 2013, all patients coded with psoriatic disease (ICD-9 CM 696.0 OR ICD-9 CM696.1) and RA (ICD-9 CM 714.0) in a tertiary medical center were enrolled. Results: There were 10,844 patients and 9073 patients with psoriatic disease and RA identified by diagnostic codes, respectively. Among patients with psoriasis, 111 patients had claim-based diagnosis of RA (1.02%). By reviewing medical records and telephone interview or clinic visits, 25 of the 111 patients (0.23%) was identified unequivocally as having concurrent RA. Among them, 17 (68%) were female and 16 (64%) patients developed arthritis prior to the onset of psoriasis with a mean lag of 6.3 years (1–19 years); 8 (32%) had psoriasis skin lesions prior to the onset of arthritis with a mean lag of 6.9 years (3–20 years); 1 (4%) had skin lesions and arthritis in the same time; 17 (68%) patients also fulfilled the CASPAR classification criteria for psoriatic arthritis. The mean age of onset for arthritis was 49.6 years old. Conclusions: The prevalence of RA in psoriasis might be overestimated in some previous studies using claimed database. Patients with concurrent RA and psoriasis showed a comparable age of onset and male to female ratio, but had more axial involvements compared to patients without psoriasis.

scholarly journals Microbiological Study of Diabetic Foot Ulcer

2019 ◽  
Vol 10 (1) ◽  
pp. 50-55
Author(s):  
Mohammuddunnobi ◽  
Tasnuva Jahan ◽  
Abdullah Al Amin
Keyword(s):  
Diabetes Mellitus ◽  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Proteus Mirabilis ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Klebsiella Pneumonia ◽  
Coagulase Negative Staphylococci

Background: Diabetic foot is one of the most feared complications of diabetes and is the leading cause of hospitalization in diabetic patients. Limb-threatening diabetic infections are usually polymicrobial involving multiple aerobic and anaerobic organisms. Methodology: The present study was a cross sectional study, conducted in the department of surgery and microbiology at BIRDEM General Hospital, Dhaka, over a period of 9 months during January 2017- September' 2017. The study included a total of 77 adult patients of clinically diagnosed diabetic foot patients presenting to outpatient department and emergency ward. The standard case definition of diabetic foot is 'any pathology occurring in the foot of a patient suffering from diabetes mellitus or as a result of long term complication of diabetes mellitus'. Results: Majority 17(22.1%) patients had Klebsiella pneumonia, 14(18.2%) had Pseudomonas aeruginosa, 11(14.3%) had Staphylococcus aureus, 10(13.0%) had Escherichia coli, 6(7.8%) had Coagulase-negative staphylococci and 8(10.4%) had Providencia spp. In Escherichia coli 100% sensitivity to imipenem, 70% to amoxicillin-clavulanic acid, amikacin, piperacillin-tazobactam. In Coagulasenegative Staphylococci 83.3% sensitivity to tetracycline, 66.7% to ceftriaxone. In Proteus mirabilis 100% sensitivity to tetracycline, amikacin, ceftriaxone, imipenem, piperacillin-tazobactam. In Enterococcus spp.75.0% sensitivity to tetracycline. In Citrobacter spp. 100% sensitivity to imipenem. Conclusion: Common organism found in diabetic foot ulcer patients were Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci and Providencia spp. In tetracycline, amikacin, ceftriaxone, imipenem, piperacillin-tazobactam was 100% sensitive in Proteus mirabilis and only imipenem found in Escherichia coli and Citrobacter spp. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 50-55

scholarly journals SURVEILLANCE OF BACTERIA METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AND PSEUDOMONAS AERUGINOSA IN PATIENTS ADMITTED TO ORTHOPEDIC DEPARTMENT IN A TERTIARY REFERRAL HOSPITAL

2018 ◽  
Vol 11 (6) ◽  
pp. 381
Author(s):  
Pulin Bihari Das ◽  
Monali Priyadarshini Mishra ◽  
Siba Narayan Rath
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Site Infections ◽  
Macconkey Agar ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Methicillin Resistant ◽  
Fungal Strains ◽  
Mrsa Strains

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged independently in diverse geographic zones and MRSA and Pseudomonas aeruginosa cause surgical site infections. Nosocomial surveillance in orthopedic surgery wards of the hospital for 16 months is presented.Methods: A total of 621 wound swabs were cultured on blood and MacConkey agar plates for bacteria and Sabouraud dextrose agar for fungi.Results: From 468 bacterial colonies, 98 MRSA and 74 P. aeruginosa strains and 41 fungal strains were isolated, and fungal strains were 13 strains of Aspergillus niger, and 28 strains of Candida albicans. P. aeruginosa and S. aureus strains were susceptible to antibiotics tobramycin, ciprofloxacin, piperacillin, vancomycin, levofloxacin, and amoxyclav. Similarly, A. niger and C. albicans were susceptible to antifungals, amphotericin B (AMB), liposomal AMB, itraconazole, voriconazole, posaconazole, and caspofungin.Conclusion: Isolated MRSA strains were resistant to presently used common antibiotics, which attribute to the leading causatives of post-operative infection in orthopedic wounds, specifically.

Current characteristics of infectious keratitis at a tertiary referral center in South Korea

2009 ◽  
Vol 53 (5) ◽  
pp. 549-551
Author(s):  
Sang Beom Han ◽  
Tae Hyoung Lim ◽  
Won Ryang Wee ◽  
Jin Hak Lee ◽  
Mee Kum Kim
Keyword(s):  
South Korea ◽  
Infectious Keratitis ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Current Characteristics

scholarly journals Descriptive study on the clinical profile and demography of patients with chronic folliculitis of leg attending a tertiary referral center

2020 ◽  
Vol 2 ◽  
pp. 104-109
Author(s):  
Thalekkara Madhavan Saranya ◽  
Sarita Sasidharanpillai ◽  
Kidangazhiathmana Ajithkumar
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Large Sample Size ◽  
Tertiary Referral ◽  
Female Ratio ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Duration Of Disease ◽  
Chi Square Analysis

Objectives: The objectives are as follows: (1) To document the clinical profile and demography of patients attending a tertiary referral institution with chronic folliculitis of leg and (2) to document the bacteriological profile of pustular lesions of chronic folliculitis. Materials and Methods: After obtaining clearance from institutional research and ethics committees, consecutive patients who attended our tertiary care center with clinically diagnosed chronic folliculitis of the leg from December 1, 2016, to November 30, 2017, were included in this cross-sectional study. The data regarding patient characteristics and clinical profile of disease were collected using a preset pro forma. Pus culture and sensitivity study was carried out in all patients who had pustules at presentation. The association between duration of disease and extent of disease and duration of disease and clinical grading was evaluated by Pearson’s Chi-square analysis. Results: The study population comprised 39 (78%) males and 11 (22%) females with male to female ratio of 3.5:1. Study participants ranged in age from 16 to 67 years. In 15/24 (62.5%) patients who manifested pustules, pus culture isolated pathogenic bacteria, Staphylococcus aureus, sensitive to cloxacillin in 14 (58.3%) and methicillin-resistant S. aureus in one (4.2%). Limitations: A study conducted in a tertiary referral center not reflecting the disease profile in the community was the major limitation. Conclusion: Staphylococcus aureus sensitive to common antibiotics like cloxacillin being the most common pathogen isolated from pustular lesions signifies the need for more prospective studies with a large sample size to evaluate the role of environmental factors and individual’s immune system in maintaining the inflammation in chronic folliculitis of the leg.

scholarly journals SEPSE EM UNIDADE DE TERAPIA INTENSIVA EM UM HOSPITAL PÚBLICO: ESTUDO DA PREVALÊNCIA, CRITÉRIOS DIAGNÓSTICOS, FATORES DE RISCO E MORTALIDADE

2018 ◽  
Author(s):  
Matheus Da Silva Ribeiro ◽  
Henrique Fernandes de Moura Pires
Keyword(s):  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Social Science ◽  
Pseudomonas Spp ◽  
Terapia Intensiva ◽  
Klebsiella Spp ◽  
E 32

A sepse é uma condição clínica resultante de uma desregulada resposta inflamatória a uma infecção, sendo a principal causa de morte em UTIs, com mortalidade alcançando 67,4% no Brasil. Os patógenos mais envolvidos são: bacilos gram-negativos (Klebsiella spp. e Pseudomonas aeruginosa) e cocos gram-positivos (principalmente Staphylococci), sendo que, a depender da bactéria, o prognóstico dos pacientes é alterado. Os principais fatores de risco para a doença são a presença de comorbidades, como diabetes mellitus, população idosa e o longo tempo de internação. Em relação aos critérios e definições para sepse, estes sofreram consideráveis revisões, sendo que a última foi em 2016 com a publicação do “Sepsis 3”. Segundo o Instituto Latino Americano da Sepse (ILAS), os novos conceitos não se aplicam à realidade brasileira, que possui baixa sensibilidade diagnóstica. A partir disso, o trabalho teve como objetivo investigar as características clínicas e diagnósticas, microbiológicas e epidemiológicas de pacientes com o diagnóstico de sepse internados na UTI do Hospital Regional da Asa Norte (HRAN). Os critérios de inclusão foram: pacientes admitidos na UTI do HRAN, internados por 24 horas ou mais com diagnóstico de sepse em 2017. Foram excluídos: pacientes sem diagnóstico de sepse. Os dados foram tabulados no programa Excel e analisados no Statistical Package of Social Science (SPSS) versão 20.0. Os resultados foram apresentados de forma descritiva adotando-se números absolutos e porcentagens. No estudo, 81 pacientes preencheram os critérios de inclusão. Na amostra, 49 pacientes eram do sexo masculino (60,49%) e 32 do sexo feminino (39,50%). A média de idade foi de 56 anos. A mortalidade foi de 58,02% (47 óbitos), sendo que, dentre os óbitos, 65,95% eram do sexo masculino e 34,04% do sexo feminino. Em relação ao foco infeccioso, os 3 sítios mais incidentes foram: respiratório (45,67%), abdominal (24,69%) e urinário (8,64%). Em relação à identificação do patógeno, 75,30% tiveram diagnóstico etiológico indeterminado, e, dentre as bactérias identificadas, Pseudomonas spp. (6,17%), Klebsiella spp. (3,70%) e Staphylococcus aureus (2,47%) foram as mais incidentes. Em relação a comorbidades, as mais prevalentes foram a Hipertensão Arterial Sistêmica (43,20%), Diabetes Mellitus (33,33%) e Doença Renal Crônica (6,172%). Em relação à análise estatística do impacto da idade na mortalidade, foi evidenciado em nosso estudo que os idosos morrem significativamente mais por sepse que os não idosos. Quando se avalia a chance de sobreviver é 3,08 vezes maior nos mais jovens ou a razão de prevalência é de 0,63, ou seja, ser mais jovem atua como um fator de proteção, sendo o valor de p = 0,016. Com o estudo, pôde-se observar que a sepse ainda apresenta alta mortalidade em UTI, o que corrobora com outros estudos acerca do tema, além da identificação de fatores de risco (como idade e comorbidades), que estão associados a mau prognóstico. Os focos infecciosos mais incidente foram congruentes com a literatura: pulmonar, abdominal e urinário

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