scholarly journals Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

2011 ◽  
Vol 5 (11) ◽  
pp. 809-814 ◽  
Author(s):  
Ali Faisal Saleem ◽  
Muhammad Shafaat Shah ◽  
Abdul Sattar Shaikh ◽  
Fatima Mir ◽  
Anita K M Zaidi
Keyword(s):  
Antimicrobial Agents ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Tertiary Care ◽  
Case Series ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Resistant Isolate ◽  
Acinetobacter Species ◽  
Tertiary Care Medical Center

Introduction: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration.  Methodology: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan. Results: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate. Conclusion: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.  

scholarly journals Clinical and Microbiological Aspects of β-Lactam Resistance in Staphylococcus lugdunensis

2016 ◽  
Vol 55 (2) ◽  
pp. 585-595 ◽  
Author(s):  
Ian H. McHardy ◽  
Jennifer Veltman ◽  
Janet Hindler ◽  
Katia Bruxvoort ◽  
Marissa M. Carvalho ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Tertiary Care ◽  
Disk Diffusion ◽  
Staphylococcus Lugdunensis ◽  
Disk Diffusion Test ◽  
Content Type ◽  
Tertiary Care Medical Center ◽  
Zone Edge

ABSTRACTAntimicrobial susceptibility results from broth microdilution MIC testing of 993Staphylococcus lugdunensisisolates recovered from patients at a tertiary care medical center from 2008 to 2015 were reviewed. Ninety-two oxacillin-susceptible isolates were selected to assess the accuracy of penicillin MIC testing, the penicillin disk diffusion test, and three β-lactamase tests, including the cefoxitin-induced nitrocefin test, penicillin cloverleaf assay, and penicillin disk zone edge test. The results of all phenotypic tests were compared to the results ofblaZPCR. The medical records of 62 patients from whomS. lugdunensiswas isolated, including 31 penicillin-susceptible and 31 penicillin-resistant strains, were retrospectively reviewed to evaluate the clinical significance ofS. lugdunensisisolation, the antimicrobial agents prescribed, if any, and the clinical outcome. MIC testing revealed that 517/993 (52.1%) isolates were susceptible to penicillin and 946/993 (95.3%) were susceptible to oxacillin. The induced nitrocefin test was 100% sensitive and specific for the detection of β-lactamase compared to theblaZPCR results, whereas the penicillin disk zone edge and cloverleaf tests showed sensitivities of 100% but specificities of only 9.1% and 89.1%, respectively. The penicillin MIC test had 100% categorical agreement withblaZPCR, while penicillin disk diffusion yielded one major error. Only 3/31 patients with penicillin-susceptible isolates were treated with a penicillin family antimicrobial. The majority of cases were treated with other β-lactams, trimethoprim-sulfamethoxazole, or vancomycin. These data indicate that nearly all isolates ofS. lugdunensisare susceptible to narrow-spectrum antimicrobial agents. Clinical laboratories in areas with resistance levels similar to those described here can help promote the use of these agents versus vancomycin by effectively designing their antimicrobial susceptibility reports to convey this message.

Risk Factors for Otolaryngological Foreign Bodies in Eastern Poland

2012 ◽  
Vol 147 (5) ◽  
pp. 889-893 ◽  
Author(s):  
Beata Rybojad ◽  
Artur Niedzielski ◽  
Grażyna Niedzielska ◽  
Paweł Rybojad
Keyword(s):  
Risk Factors ◽  
Foreign Body ◽  
Elementary Education ◽  
Urban Areas ◽  
Foreign Bodies ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Series ◽  
Psychomotor Development ◽  
Tertiary Care Medical Center

Objective To identify the sociodemographic characteristics and risk factors associated with suspected foreign bodies in the ear, nose, throat, airway, and esophagus among Polish children. Study Design Case series with chart review. Setting Tertiary care medical center. Subjects and Methods A retrospective analysis of the medical records of patients hospitalized for a suspected foreign body (FB) between 1998 and 2008 was conducted. Data regarding place of residence, presence of siblings, parents’ educational status, seasonality, psychomotor development, age, and sex were collected and statistically analyzed. Results Of the 1011 patients with suspected foreign body insertion, 849 (84%) had a positive diagnosis. Of the confirmed foreign bodies, 96 were found in the tracheobronchial tree, 142 were found in the esophagus, and 611 were located in the external auditory canals, nasopharyngeal passage, tonsils, auricles, or lips. Sociodemographically, 596 of the children came from urban areas, with a preponderance of males (55%). Objects were removed more frequently in summer and autumn (60%). Children with siblings (53%) predominated. The majority of patients (52%) had parents with an elementary education. Food was the most frequent foreign body in children under 3 years of age. Patients with delayed psychomotor development constituted 1.6% of the analyzed population. Conclusions Being male, 1 to 3 years of age, belonging to an urban family with siblings, and having parents with an elementary education increased the risk of foreign body insertion. Training caregivers about proper nutrition and safety rules when playing with children can reduce the risk of accidents related to foreign body insertion.

Octreotide Acetate in Refractory Bone Marrow Transplant-Associated Diarrhea

1996 ◽  
Vol 30 (4) ◽  
pp. 331-336 ◽  
Author(s):  
Michael A Crouch ◽  
Maryann S Restino ◽  
Julia M Cruz ◽  
James J Perry ◽  
David D Hurd
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Series ◽  
Complete Response ◽  
Marrow Transplant ◽  
Stool Frequency ◽  
Octreotide Acetate ◽  
Tertiary Care Medical Center

OBJECTIVE To evaluate the effectiveness of octreotide acetate in the treatment of refractory bone marrow transplant—associated diarrhea. DESIGN Case series encompassing 30 months. SETTING A 12-bed bone marrow transplant unit at a tertiary care medical center. PARTICIPANTS Twenty-four patients with bone marrow transplant—associated diarrhea who did not improve with supportive or attapulgite therapy. INTERVENTIONS Patients received subcutaneous octreotide acetate at doses ranging from 50 to 250 μg 2 to 3 times daily. Concurrent treatment with antimotility or antisecretory agents did not occur. MAIN OUTCOME MEASURES The number of bowel movements and stool volumes were recorded daily. Complete response to octreotide therapy was defined as a reduction of both stool output and stool frequency by more than 50% within 72 hours. Partial response was defined as a reduction of either stool output or stool frequency by more than 50% within 72 hours. Treatment failure occurred if neither of the two parameters decreased by 50% within the designated time period. RESULTS Twenty-eight treatment challenges were initiated in the 24 patients evaluated. Diarrhea completely or partially subsided in 23 of 28 challenges (82.1%) within 72 hours. Stool output decreased from 1143 ± 595 at baseline to 252 ± 356 mL/d within 72 hours (p < 0.005). Stool frequency decreased from a baseline of 7.5 ± 3.4 to 2.7 ± 2.2 stools per day within 72 hours (p < 0.005). Adverse effects associated with octreotide were pain or burning at the injection site (24.1%), abdominal pain (13.8%), and increased stool output (6.9%). CONCLUSIONS These data suggest octreotide acetate significantly reduces stool output and frequency in patients with refractory bone marrow transplant—associated diarrhea. Additional research is necessary before this agent can be recommended for routine use in this patient population.

scholarly journals Ability of an Antibiogram to Predict Pseudomonas aeruginosa Susceptibility to Targeted Antimicrobials Based on Hospital Day of Isolation

2012 ◽  
Vol 33 (6) ◽  
pp. 589-593 ◽  
Author(s):  
Deverick J. Anderson ◽  
Becky Miller ◽  
Ruchit Marfatia ◽  
Richard Drew
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Tertiary Care ◽  
Logistic Regression Models ◽  
Tertiary Care Medical Center ◽  
Clinical Culture ◽  
Duration Of Hospitalization ◽  
Hospital Wards ◽  
Culture Positive

Objective.To determine the utility of an antibiogram in predicting the susceptibility of Pseudomonas aeruginosa isolates to targeted antimicrobial agents based on the day of hospitalization the specimen was collected.Design.Single-center retrospective cohort study.Setting.A 750-bed tertiary care medical center.Patients and Methods.Isolates from consecutive patients with at least 1 clinical culture positive for P. aeruginosa from January 1, 2000, to June 30, 2007, were included. A study antibiogram was created by determining the overall percentages of P. aeruginosa isolates susceptible to amikacin, ceftazidime, ciprofloxacin, gentamicin, imipenem-cilastin, piperacillin-tazobactam, and tobramycin during the study period. Individual logistic regression models were created to determine the day of infection after which the study antibiogram no longer predicted susceptibility to each antibiotic.Results.A total of 3,393 isolates were included. The antibiogram became unreliable as a predictor of susceptibility to ceftazidime, imipenem-cilastin, piperacillin-tazobactam, and tobramycin after day 10 and ciprofloxacin after day 15 but longer for gentamicin (day 21) and amikacin (day 28). Time to unreliability of the antibiogram varied for antibiotics based on location of isolation. For example, the time to unreliability of the antibiogram for ceftazidime was 5 days (95% confidence interval [CI], <1–8) in the intensive care unit (ICU) and 12 days (95% CI, 7–21) in non-ICU hospital wards (P = .003).Conclusions.The ability of the antibiogram to predict susceptibility of P. aeruginosa decreases as duration of hospitalization increases.

Changes in Pharyngeal Baseline Impedance in Patients With Laryngopharyngeal Reflux

2020 ◽  
Vol 163 (3) ◽  
pp. 563-568
Author(s):  
Jeon Gang Doo ◽  
Su Il Kim ◽  
Jung Min Park ◽  
Oh Eun Kwon ◽  
Young Chan Lee ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Series ◽  
Healthy Controls ◽  
Retrospective Case ◽  
Tertiary Care Medical Center ◽  
Intraluminal Impedance ◽  
Reflux Event

Objective Few studies have investigated pharyngeal intraluminal baseline impedance (BI) levels in patients with laryngopharyngeal reflux (LPR). The aim of this study was to compare intraluminal BI levels between patients with LPR and healthy controls. Study Design Retrospective case series. Setting Tertiary care medical center. Subjects and Methods We conducted a retrospective analysis of 24-hour multichannel intraluminal impedance (MII)–pH monitoring results from patients with suspected LPR complaining of reflux symptoms. Patients with suspected LPR were divided into 2 groups according to the 24-hour MII-pH monitoring (LPR group: patients with symptoms with reflux events ≥1, symptom but no reflux [SNR] group: patients with symptoms but no reflux event). Healthy controls were recruited and also underwent 24-hour MII-pH monitoring. We compared the esophageal and pharyngeal BI levels and ratios between 3 groups. Results Pharyngeal BI levels in the LPR group were significantly higher than in the healthy controls. In addition, the pharyngeal BI levels in the SNR group were significantly higher than in the healthy controls. All ratios of pharyngeal to distal esophageal BI levels in the LPR and SNR group were significantly higher than in the healthy controls. However, there were no significant differences in esophageal BI levels and ratios between the 3 groups. Conclusion We found that the pharyngeal BI levels were higher in patients with LPR than in healthy controls. In addition, the pharyngeal BI levels measured by 24-hour MII-pH monitoring in patients with LPR symptoms, but without a reflux episode, were higher than in the healthy controls.

The Epidemiology of Invasive Pulmonary Aspergillosis at a Large Teaching Hospital

2001 ◽  
Vol 22 (6) ◽  
pp. 370-374 ◽  
Author(s):  
Clare F. Pegues ◽  
Eric S. Daar ◽  
A. Rekha Murthy
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Solid Organ ◽  
Discharge Diagnosis ◽  
Retrospective Case ◽  
Pulmonary Aspergillosis ◽  
Chi Square ◽  
Tertiary Care Medical Center

AbstractObjective:To characterize the epidemiology of invasive pulmonary aspergillosis (IPA).Design:A retrospective case series.Setting:An 850-bed, academic, tertiary-care medical center.Participants:Adult inpatients, between January 1, 1990, and December 31, 1998, with either a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis.Methods:We reviewed medical records and categorized case-patients as definitive or probable and acquisition of IPA as nosocomial, indeterminate, or community using standard definitions. To determine the rate of aspergillus respiratory colonization, we identified all inpatients who had a respiratory culture positive for Aspergillus species without a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis. Three study intervals were defined: interval 1,1990 to 1992; interval 2,1993 to 1995; and interval 3,1996 to 1998. Carpeting in rooms for patients following heart-lung and liver transplant was removed and ceiling tiles were replaced during interval 1; a major earthquake occurred during interval 2.Results:72 case-patients and 433 patients with respiratory colonization were identified. Acquisition was nosocomial for 18 (25.0%), indeterminate for 9 (12.5%), and community-acquired for 45 (62.5%) case-patients. Seventeen (23.6%) of the 72 case-patients had prior transplants, including 15 solid organ and 2 bone marrow. The IPA rate per 100 solid organ transplants (SOTs) decreased from 2.45 during interval 1 to 0.93 during interval 2 and to 0.52 during interval 3 (chi-square for trend, 5.44; P<.05). The hospitalwide IPA rate remained stable at 0.03 per 1,000 patient days.Conclusions:The SOT IPA rate decreased after intervals 1 and 2, although the hospitalwide IPA rate remained stable during the study period. Post-earthquake hospital demolition and construction occurring after interval 2 was not associated with an increase in the rate of IPA at our institution.

scholarly journals High antibiotic resistance and mortality with Acinetobacter species in a tertiary hospital, Nepal

2021 ◽  
Vol 11 (1) ◽  
pp. 13-17
Author(s):  
M. Mahto ◽  
M. Chaudhary ◽  
A. Shah ◽  
K. L. Show ◽  
F. L. Moses ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Significant Proportion ◽  
Polymyxin B ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Cross Sectional ◽  
Acinetobacter Species

SETTING: Nepal Mediciti Hospital, Bhainsepati, Lalitpur, NepalOBJECTIVES: To determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with Acinetobacter isolates between September 2018 and September 2019.DESIGN: This was a hospital laboratory-based, cross-sectional studyRESULTS: Acinetobacter spp. (n = 364) were more common in respiratory (n = 172, 47.3%) and invasive samples such as blood, body fluids (n = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (n = 110, 30.2%) and XDR (MDR plus carbapenem) (n = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (n = 319). Infected patients were more likely to be aged >40 years (n = 196, 61.4%) or inpatients (n = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (n = 59, 18.5%).CONCLUSION: A significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases.

scholarly journals Auricular complications following temporal bone resection for temporal bone malignancies: a clinical consideration

2020 ◽  
Author(s):  
Noritaka Komune ◽  
Satoshi Matsuo ◽  
Ryo Shimamoto ◽  
Kou Ikemura ◽  
Joe Iwanaga ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Medical Center ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Case Series ◽  
Bone Resection ◽  
En Bloc ◽  
Tertiary Care Medical Center ◽  
Vascular Insufficiency ◽  
Temporal Bone Resection

Abstract: Objective: Sacrificing the auricle has severe postoperative impacts on patients with temporal bone malignancy who have undergone en bloc temporal bone resection. The auricular complications following en bloc temporal bone resection remain unclear. Therefore, this study aimed to examine auricular complications following en bloc temporal bone resection and reveal the associated risk factors. Study Design: Case series with chart review. Setting: Single tertiary care medical center Participants: Our study includes all cases who underwent en bloc temporal bone resection with preserved auricle for temporal bone malignancy from January 1993 to July 2020. The resulting dataset contained 64 patients during the review period. Main outcome measures: We examined the relationship of auricular complications with surgical procedures and patient profiles. Results: Three of 64 cases (4.7%) showed postoperative auricular complication. The cause in all three cases was venous congestion. Postoperative bloodletting to relieve the congestion effectively salvaged the auricle in two of these cases. Insufficient bloodletting to relieve the auricular congestion in the remaining case led to auricular necrosis. Pre-/infra-auricular lymph node dissection is correlated with auricular complications with statistical significance. Conclusions: Temporal bone resection causes auricular congestion due to vascular insufficiency, particularly insufficient venous outflow. An immediate and continuous application of bloodletting can improve venous drainage after temporal bone resection to prevent auricle necrosis.

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