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Ergönül Ö, Keske Ş, Ksinzik A, Güldan M, Özbek L, Azap A, Şimşek-Yavuz S, Can F, Sakarya S. The challenges in the monitoring of infectious diseases after the earthquake in Türkiye in 2023. THE LANCET. INFECTIOUS DISEASES 2023; 23:e482-e488. [PMID: 37419128 DOI: 10.1016/s1473-3099(23)00362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/09/2023]
Abstract
After the devastating earthquake in Türkiye and Syria in February, 2023, the long-term failure to meet the need for shelter, unfavourable living conditions in tent settlements, poor access to clean drinking water, water suitable for personal hygiene, and sanitary facilities, as well as interruptions in provision of primary health-care services, have emerged as the most important risk factors contributing to the spread of infectious diseases. 3 months after the earthquake, most of these problems persist in Türkiye. Data on the control of infectious diseases are scarce according to the reports prepared by medical specialist associations based on observations of health-care providers working in the region and statements made by the local health authorities. According to these unsystematised data, and considering the conditions in the region, faecal-oral transmissible gastrointestinal infections, as well as respiratory and vector-borne infections, are the main challenges. Vaccine-preventable diseases, such as measles, varicella, meningitis, and polio can be spread in temporary shelters due to interrupted vaccine services and crowded living conditions. In addition to controlling risk factors for infectious diseases, sharing data on the status and control of infectious diseases in the region with the community, health-care providers, and relevant expert groups should be a priority to improve the understanding of the effects of interventions and prepare for possible infectious disease outbreaks.
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Affiliation(s)
- Önder Ergönül
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye.
| | - Şiran Keske
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Apolina Ksinzik
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye; Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Mustafa Güldan
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Laşin Özbek
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Medical Faculty, Ankara, Türkiye
| | - Serap Şimşek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Medical Faculty, Istanbul, Türkiye
| | - Füsun Can
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Medical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Sibel Sakarya
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Public Health, Koç University School of Medicine, Istanbul, Türkiye
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Boral J, Pınarlık F, Ekinci G, Can F, Ergönül Ö. Does Emerging Carbapenem Resistance in Acinetobacter baumannii Increase the Case Fatality Rate? Systematic Review and Meta-Analysis. Infect Dis Rep 2023; 15:564-575. [PMID: 37888136 PMCID: PMC10606343 DOI: 10.3390/idr15050055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND In the era of rising carbapenem resistance, we aimed to investigate the change in mortality rate and positivity of carbapenemase genes in Acinetobacter baumannii. METHODS Preferred Reporting Items for Systematic Review (PRISMA) guidelines were adopted in this systematic review. Our literature search included the Cochrane Library, Pubmed, Scopus, Web of Science, Medline, Tubitak TR Dizin, and Harman databases for studies dating back from 2003 to 2023 reporting bloodstream A. baumannii infections in Türkiye. A simple linear regression model was used to determine the association between resistance, mortality, and time. RESULTS A total of 1717 studies were identified through a literature search, and 21 articles were selected based on the availability of the data regarding mortality and resistance rate (four articles) or the molecular epidemiology of carbapenem-resistant A. baumannii (17 articles) in Türkiye. From 2007 to 2018, the carbapenem resistance rate increased (p = 0.025). The OXA-23 and OXA-58 positivities were inversely correlated (p = 0.025). CONCLUSIONS Despite the emergence of carbapenem resistance, mortality did not increase in parallel, which may be due to improved medical advancements or the fitness cost of bacteria upon prolonged antimicrobial exposure. Therefore, we suggest further global research with the foresight to assess clonal relatedness that might affect the carbapenem resistance rate.
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Affiliation(s)
- Jale Boral
- Graduate School of Health Sciences, Koç University, Istanbul 34010, Türkiye; (J.B.)
- Koç University İşBank Center for Infectious Diseases, Koç University Hospital (KUISCID), Istanbul 34010, Türkiye;
| | - Fatihan Pınarlık
- Graduate School of Health Sciences, Koç University, Istanbul 34010, Türkiye; (J.B.)
- Koç University İşBank Center for Infectious Diseases, Koç University Hospital (KUISCID), Istanbul 34010, Türkiye;
| | - Güz Ekinci
- Graduate School of Health Sciences, Koç University, Istanbul 34010, Türkiye; (J.B.)
- Koç University İşBank Center for Infectious Diseases, Koç University Hospital (KUISCID), Istanbul 34010, Türkiye;
| | - Füsun Can
- Koç University İşBank Center for Infectious Diseases, Koç University Hospital (KUISCID), Istanbul 34010, Türkiye;
- Department of Medical Microbiology, School of Medicine, Koç University, Istanbul 34010, Türkiye
| | - Önder Ergönül
- Koç University İşBank Center for Infectious Diseases, Koç University Hospital (KUISCID), Istanbul 34010, Türkiye;
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul 34010, Türkiye
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Jazeer M, Pakkiyaretnam M. Infective Endocarditis Following Post-COVID Organizing Pneumonia Complicated by Multiple Splenic Abscesses and Glomerular Nephritis. Cureus 2023; 15:e45860. [PMID: 37881375 PMCID: PMC10597532 DOI: 10.7759/cureus.45860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
The association of glomerular nephritis and infective endocarditis with liver abscesses is a clinically complex entity that often makes the diagnosis challenging. Here, we report a case of a 50-year-old woman who presented with a febrile illness of two weeks' duration along with myalgia and malaise of four days' duration. She had a background history of well-controlled type 2 diabetes mellitus for five years with a past history of ischemic heart disease diagnosed five years ago. At the time of presentation, she was on long-term steroids for post-coronavirus disease (COVID) organizing pneumonia diagnosed three months back. With serial investigations, she was found to have subacute bacterial endocarditis with multiple liver and splenic abscesses. She was managed with antibiotics as per local protocols after which she made a successful recovery of her clinical status. The uniqueness of this case is the development of rare complications of subacute bacterial endocarditis in the background of immunosuppression.
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Affiliation(s)
- Mohamed Jazeer
- Internal Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
- Internal Medicine, Srijayawardanapura University, Batticaloa, LKA
| | - Mayurathan Pakkiyaretnam
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
- Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
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Mączyńska B, Frej-Mądrzak M, Sarowska J, Woronowicz K, Choroszy-Król I, Jama-Kmiecik A. Evolution of Antibiotic Resistance in Escherichia coli and Klebsiella pneumoniae Clinical Isolates in a Multi-Profile Hospital over 5 Years (2017-2021). J Clin Med 2023; 12:jcm12062414. [PMID: 36983414 PMCID: PMC10058544 DOI: 10.3390/jcm12062414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
In recent years, we have witnessed a growing drug resistance among bacteria, which is associated with the use and availability of an increasing number of broad-spectrum antimicrobial agents, as well as with their irrational and excessive use. The present study aims to analyze changes in the drug resistance of Gram-negative Enterobacterales: Escherichia coli and Klebsiella pneumoniae, isolated from infections in a multi-profile hospital over five years (from 2017 to 2021). Among the practical outcomes of the evaluation of these data will be the possibility of determining changes in susceptibility to the antibiotics used in the hospital. In turn, this will help propose new therapeutic options, especially for empirical therapy that is necessary in severe infections. The analysis of the use of individual groups of antibiotics allowed for identification of the causes of the increasing resistance of Gram-negative bacilli. The highest number of infections whose etiological agent was K. pneumoniae ESBL(+) and E. coli ESBL(+) was observed in 2018. In the analyzed five-year period, the number of multi-resistant (MDR) K. pneumoniae strains increased successively, which seems to be related to the growing use, especially in the pandemic period, of broad-spectrum antibiotics, mainly penicillins with inhibitors, third-generation cephalosporins, and carbapenems.
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Affiliation(s)
- Beata Mączyńska
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Medical University, 50-367 Wroclaw, Poland
- Department of Hygiene and Epidemiology, Lower Silesian T. Marciniak Specialist Hospital-Center for Emergency Medicine, 54-049 Wrocław, Poland
| | - Magdalena Frej-Mądrzak
- Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland
| | - Jolanta Sarowska
- Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland
| | | | - Irena Choroszy-Król
- Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland
| | - Agnieszka Jama-Kmiecik
- Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland
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Boral J, Genç Z, Pınarlık F, Ekinci G, Kuskucu MA, İrkören P, Kapmaz M, Tekin S, Çakar N, Şentürk E, Yurdakul F, Dikenelli B, Can F, Ergonul O. The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit. Sci Rep 2022; 12:20808. [PMID: 36460749 PMCID: PMC9716169 DOI: 10.1038/s41598-022-25493-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p = 0.835). Univariate analysis revealed the association of mechanical ventilation (p = 0.002) and bacterial growth in tracheal aspirate (p = 0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak.
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Affiliation(s)
- Jale Boral
- grid.15876.3d0000000106887552Graduate School of Health Sciences, Koç University, Istanbul, Turkey ,grid.15876.3d0000000106887552Koç University İşBank Center for Infectious Diseases, Koç University Hospital, Maltepe Mahallesi, Davutpaşa Caddesi, No:4 Topkapı, 34010 Istanbul, Turkey
| | - Zeliha Genç
- grid.15876.3d0000000106887552Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Fatihan Pınarlık
- grid.15876.3d0000000106887552Graduate School of Health Sciences, Koç University, Istanbul, Turkey ,grid.15876.3d0000000106887552Koç University İşBank Center for Infectious Diseases, Koç University Hospital, Maltepe Mahallesi, Davutpaşa Caddesi, No:4 Topkapı, 34010 Istanbul, Turkey
| | - Güz Ekinci
- grid.15876.3d0000000106887552Graduate School of Health Sciences, Koç University, Istanbul, Turkey ,grid.15876.3d0000000106887552Koç University İşBank Center for Infectious Diseases, Koç University Hospital, Maltepe Mahallesi, Davutpaşa Caddesi, No:4 Topkapı, 34010 Istanbul, Turkey
| | - Mert A. Kuskucu
- grid.15876.3d0000000106887552Koç University İşBank Center for Infectious Diseases, Koç University Hospital, Maltepe Mahallesi, Davutpaşa Caddesi, No:4 Topkapı, 34010 Istanbul, Turkey ,grid.506076.20000 0004 1797 5496Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Pelin İrkören
- grid.15876.3d0000000106887552Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Mahir Kapmaz
- grid.15876.3d0000000106887552Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Süda Tekin
- grid.15876.3d0000000106887552Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Nahit Çakar
- grid.15876.3d0000000106887552Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | - Evren Şentürk
- grid.15876.3d0000000106887552Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | - Fatma Yurdakul
- grid.15876.3d0000000106887552Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | - Bilge Dikenelli
- grid.15876.3d0000000106887552Clinical Microbiology Laboratory, Koç University Hospital, Istanbul, Turkey
| | - Fusun Can
- grid.15876.3d0000000106887552Graduate School of Health Sciences, Koç University, Istanbul, Turkey ,grid.15876.3d0000000106887552Koç University İşBank Center for Infectious Diseases, Koç University Hospital, Maltepe Mahallesi, Davutpaşa Caddesi, No:4 Topkapı, 34010 Istanbul, Turkey
| | - Onder Ergonul
- grid.15876.3d0000000106887552Koç University İşBank Center for Infectious Diseases, Koç University Hospital, Maltepe Mahallesi, Davutpaşa Caddesi, No:4 Topkapı, 34010 Istanbul, Turkey ,grid.15876.3d0000000106887552Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
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Florea DA, Grumezescu V, Bîrcă AC, Vasile BȘ, Mușat M, Chircov C, Stan MS, Grumezescu AM, Andronescu E, Chifiriuc MC. Design, Characterization, and Antibacterial Performance of MAPLE-Deposited Coatings of Magnesium Phosphate-Containing Silver Nanoparticles in Biocompatible Concentrations. Int J Mol Sci 2022; 23:ijms23147910. [PMID: 35887261 PMCID: PMC9321465 DOI: 10.3390/ijms23147910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/21/2023] Open
Abstract
Bone disorders and traumas represent a common type of healthcare emergency affecting men and women worldwide. Since most of these diseases imply surgery, frequently complicated by exogenous or endogenous infections, there is an acute need for improving their therapeutic approaches, particularly in clinical conditions requiring orthopedic implants. Various biomaterials have been investigated in the last decades for their potential to increase bone regeneration and prevent orthopedic infections. The present study aimed to develop a series of MAPLE-deposited coatings composed of magnesium phosphate (Mg3(PO4)2) and silver nanoparticles (AgNPs) designed to ensure osteoblast proliferation and anti-infective properties simultaneously. Mg3(PO4)2 and AgNPs were obtained through the cooling bath reaction and chemical reduction, respectively, and then characterized through X-ray Diffraction (XRD), Transmission Electron Microscopy (TEM), and Selected Area Electron Diffraction (SAED). Subsequently, the obtained coatings were evaluated by Infrared Microscopy (IRM), Fourier-Transform Infrared Spectroscopy (FT-IR), and Scanning Electron Microscopy (SEM). Their biological properties show that the proposed composite coatings exhibit well-balanced biocompatibility and antibacterial activity, promoting osteoblasts viability and proliferation and inhibiting the adherence and growth of Staphylococcus aureus and Pseudomonas aeruginosa, two of the most important agents of orthopedic implant-associated infections.
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Affiliation(s)
- Denisa Alexandra Florea
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
| | - Valentina Grumezescu
- National Institute for Lasers, Plasma and Radiation Physics, 409 Atomistilor Street, 077125 Magurele, Romania;
| | - Alexandra Cătălina Bîrcă
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
| | - Bogdan Ștefan Vasile
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
| | - Mihaela Mușat
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
| | - Cristina Chircov
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
| | - Miruna S. Stan
- Research Institute of the University of Bucharest (ICUB), University of Bucharest, 050657 Bucharest, Romania;
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
- Research Institute of the University of Bucharest (ICUB), University of Bucharest, 050657 Bucharest, Romania;
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania;
| | - Ecaterina Andronescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (D.A.F.); (A.C.B.); (B.Ș.V.); (M.M.); (C.C.); (A.M.G.)
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania;
- Correspondence:
| | - Mariana Carmen Chifiriuc
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania;
- Department of Microbiology, Faculty of Biology, University of Bucharest, Aleea Portocalelor Str. 1-3, District 5, 060101 Bucharest, Romania
- The Romanian Academy, Calea Victoriei 25, District 1, 010071 Bucharest, Romania
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Yesil C, Yalcin AN, Ogunc D, Ongut G, Ozhak B, Colak D, Er H, Sarıtas ZE. Use of colistin with rifampicin, trimethoprim-sulfamethoxazole and teicoplanin in acinetobacter mouse infection model. Future Microbiol 2022; 17:665-671. [DOI: 10.2217/fmb-2021-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Infections with multidrug-resistant Gram-negative bacteria such as Acinetobacter baumannii are major cause of morbidity and mortality. Colistin is used commonly to treat these infections. In this study, we evaluated the efficacy of different colistin combinations in a A. baumannii infection mouse model. Materials & methods: An A. baumannii mouse infection model was developed in 150 experimental animals. Treatment groups were as follows: colistin, colistin + rifampicin, colistin + trimethoprim/sulfamethoxazole, colistin + teicoplanin and a control group. The outcome was bacterial burden in the lung and liver tissues. The treatment groups were subdivided into 24-, 48- and 72-h groups. Results: Colistin and combinations reduce the A. baumannii burden significantly in lung and liver tissues compared with the control group. Compared with colistin alone colistin + rifampicin and colistin + TMP-SMX provided significantly better reduction in the bacterial burden. Conclusion: These results may suggest that rifampicin and TMP-SMX combination with colistin may have a potential role in the treatment of A. baumannii infections.
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Affiliation(s)
| | - Ata N Yalcin
- Akdeniz University Medical School, Department of Infectious Diseases & Clinical Microbiology, Antalya, Turkey
| | - Dilara Ogunc
- Akdeniz University Medical School, Department of Medical Microbiology, Antalya, Turkey
| | - Gozde Ongut
- Akdeniz University Medical School, Department of Medical Microbiology, Antalya, Turkey
| | - Betül Ozhak
- Akdeniz University Medical School, Department of Medical Microbiology, Antalya, Turkey
| | - Dilek Colak
- Akdeniz University Medical School, Department of Medical Microbiology, Antalya, Turkey
| | - Halil Er
- University of Health Sciences, Antalya Training & Research Hospital, Department of Medical Microbiology, Antalya, Turkey
| | - Zubeyde E Sarıtas
- University of Health Sciences, Antalya Training & Research Hospital, Department of Medical Microbiology, Antalya, Turkey
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Evaluation of the Efficacy of Colistin Therapy with or without Loading Dose in the Treatment of Multi Drug Resistant Gram-negative Bacterial Infections. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1058903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Aydin M, Şaylan B, Ekiz İşcanlı İG. Factors associated with mortality in younger and older (≥75 years) hospitalized patients with community-acquired pneumonia. Ann Saudi Med 2022; 42:45-51. [PMID: 35112586 PMCID: PMC8812156 DOI: 10.5144/0256-4947.2022.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pneumonia is among the most serious infections in the elderly. The evaluation of prognosis and predicting the outcome is essential in managing the treatment of patients with pneumonia. OBJECTIVE Evaluate factors that might affect the mortality of elderly patients hospitalized for community-acquired pneumonia (CAP) in two age groups. DESIGN Medical record review. SETTINGS Tertiary care hospital. PATIENTS AND METHODS The study included CAP patients who were hospitalized during the period from January 2017 and December 2019. The CURB-65 scale was chosen to assess the severity of pneumonia on admission. Multivariate analyses were conducted separately for patients younger than 75 years and 75 years or older. MAIN OUTCOME MEASURES 30-day mortality, factors associated with mortality. SAMPLE SIZE AND CHARACTERISTICS 1603 patients with a median age of 74, including 918 women (57%). RESULTS The 30-day mortality rate was 6.5%. Patients with carbapenem-resistant gram-negative bacteria had lower survival rates (P<.0001). In the multivariate analysis, age, lung cancer, CURB-65, carbapenem resistance, and duration of hospital stay were associated with mortality in patients aged 75 years or older. Lung cancer, malignant disease, carbapenem resistance, duration of hospital stay and procalcitonin level were associated with mortality under the age of 75. Of 640 sputum cultures tested, P aeruginosa (42%) was the most common pathogen. CONCLUSION The risk factors that affected mortality differed among patients aged 75 years or older versus younger patients. Our findings are important in determining factors associated with mortality in managing the treatment and follow up of hospitalized CAP patients younger or 75 years of age or older. LIMITATIONS Single-center, retrospective. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mehtap Aydin
- From the Department of Infectious Disease and Clinical Microbiology, Umraniye Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Bengü Şaylan
- From the Department of Pulmonology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - İnşa Gül Ekiz İşcanlı
- From the Department of Respiratory Intensive Care Unit, Sultan Abdulhamid Han Training and Research Hospital, University of Health Science, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW Gram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. RECENT FINDINGS New rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened (≤7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined. SUMMARY RDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.
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11
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The protective role of fosfomycin in lung injury due to oxidative stress and inflammation caused by sepsis. Life Sci 2021; 279:119662. [PMID: 34081989 DOI: 10.1016/j.lfs.2021.119662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/02/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
AIM Early and prompt treatment of sepsis by effective antibiotics against susceptible organisms may be lifesaving. However, increased antibiotic resistance and side effects of chemotherapeutic agents limiting their tolerability result in a restricted use of medications. This has led to an increased search for solution oriented novel treatments and therapeutic targets, as well as investigations on the pathogenesis and physiology of sepsis. In this study, we aimed to examine the antioxidant and anti-inflammatory effects of fosfomycin in sepsis resulting from other causes. MAIN METHODS Sprague Dawley rats were assigned into three groups. Randomly selected control rats received intraperitoneal saline solution only. Only caecal puncture and ligation were carried out in the caecal ligation and puncture (CLP) group, while in the CLP + fosfomycin group (CLP + FOS), together with sepsis due to caecal puncture and ligation, 500 mg/kg of FOS was administered intraperitoneally (i.p.). KEY FINDINGS As compared to the control group, elevated TBARS and TNF-α levels as well as increased expression of NF-kB/p65 and TLR-4 and reduced -SH levels were found in the lung tissue of CLP rats. On the other hand, TBARS and TNF-α levels were reduced and NF-kB/p65 and TLR-4 expressions were decreased together with increase in total -SH levels among CLP + FOS (500 mg/kg i.p.) rats. SIGNIFICANCE FOS treatment may represent a promising agent in terms of reducing the sepsis-related lung injury due to its antimicrobial effects as well as its antioxidant and anti-inflammatory properties.
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