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Iliopoulou M, Skouras V, Psaroudaki Z, Makarona M, Vogiatzakis E, Tsorlini E, Katsifa E, Spyratos D, Siopi D, Kotsiou O, Xitsas S, Martsoukou M, Sigala I, Kalomenidis I. Bacteriology, antibiotic resistance and risk stratification of patients with culture-positive, community-acquired pleural infection. J Thorac Dis 2021; 13:521-532. [PMID: 33717525 PMCID: PMC7947506 DOI: 10.21037/jtd-20-2786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Community-acquired pleural infection (CAPI) is a growing health problem worldwide. Although most CAPI patients recover with antibiotics and pleural drainage, 20% require surgical intervention. The use of inappropriate antibiotics is a common cause of treatment failure. Awareness of the common causative bacteria along with their patterns of antibiotic resistance is critical in the selection of antibiotics in CAPI-patients. This study aimed to define CAPI bacteriology from the positive pleural fluid cultures, determine effective antibiotic regimens and investigate for associations between clinical features and risk for death or antibiotic-resistance, in order to advocate with more invasive techniques in the optimal timing. Methods We examined 158 patients with culture positive, CAPI collected both retrospectively (2012-2013) and prospectively (2014-2018). Culture-positive, CAPI patients hospitalized in six tertiary hospitals in Greece were prospectively recruited (N=113). Bacteriological data from retrospectively detected patients were also used (N=45). Logistic regression analysis was performed to identify clinical features related to mortality, presence of certain bacteria and antibiotic resistance. Results Streptococci, especially the non-pneumococcal ones, were the most common bacteria among the isolates, which were mostly sensitive to commonly used antibiotic combinations. RAPID score (i.e., clinical score for the stratification of mortality risk in patients with pleural infection; parameters: renal, age, purulence, infection source, and dietary factors), diabetes and CRP were independent predictors of mortality while several patient co-morbidities (e.g., diabetes, malignancy, chronic renal failure, etc.) were related to the presence of certain bacteria or antibiotic resistance. Conclusions The dominance of streptococci among pleural fluid isolates from culture-positive, CAPI patients was demonstrated. Common antibiotic regimens were found highly effective in CAPI treatment. The predictive strength of RAPID score for CAPI mortality was confirmed while additional risk factors for mortality and antibiotic resistance were detected.
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Affiliation(s)
| | - Vasileios Skouras
- Department of Pulmonary Medicine, 401 General Army Hospital, Athens, Greece
| | - Zoe Psaroudaki
- Department of Clinical Microbiology, "Evangelismos" Hospital, Athens, Greece
| | - Magda Makarona
- Microbiology Laboratory and National Reference Center for TB, Athens Chest Hospital "Sotiria", Athens, Greece
| | - Evangelos Vogiatzakis
- Microbiology Laboratory and National Reference Center for TB, Athens Chest Hospital "Sotiria", Athens, Greece
| | - Eleni Tsorlini
- Department of Microbiology, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Katsifa
- Department of Microbiology, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dionisios Spyratos
- Department of Pulmonary Medicine, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Siopi
- Department of Pulmonary Medicine, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ourania Kotsiou
- Department of Respiratory Medicine, University of Thessaly, Larissa, Greece
| | - Stelios Xitsas
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece
| | - Maria Martsoukou
- Department of Microbiology, "Sismanoglion" General Hospital, Athens, Greece
| | - Ioanna Sigala
- 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
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Sakellari I, Gavriilaki E, Kaliou M, Mallouri D, Batsis I, Yannaki E, Smias C, Sotiropoulos D, Tsorlini E, Anagnostopoulos A. Candida is an emerging pathogen beyond the neutropenic period of allogeneic hematopoietic cell transplantation. Clin Transplant 2017; 31. [PMID: 28224660 DOI: 10.1111/ctr.12921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ioanna Sakellari
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Eleni Gavriilaki
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Maria Kaliou
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Despina Mallouri
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioannis Batsis
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Christos Smias
- BMT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Eleni Tsorlini
- Microbiology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
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Kachrimanidou M, Tsorlini E, Katsifa E, Vlachou S, Kyriakidou S, Xanthopoulou K, Tsergouli K, Samourli T, Papa A. Prevalence and molecular epidemiology of methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital. Hippokratia 2014; 18:24-27. [PMID: 25125947 PMCID: PMC4103036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of health- and community-associated infections; its prevalence in Greece is among the highest in Europe. We investigated the prevalence and molecular epidemiology of MRSA in a tertiary Greek hospital. MATERIAL AND METHODS Spa typing and random polymorphic DNA analysis were used to investigate the molecular epidemiology of 28 MRSA isolates during May 2010 to May 2011 in a tertiary hospital in Northern Greece. RESULTS Nine spa types were detected; t003 was the predominant (32.1%) one, detected in various wards and throughout the study period, while t037 was recovered only from intensive care unit patients, and only in April 2011, suggestive of an epidemic. Additional rare types were detected for the first time in Greece. CONCLUSIONS Spa typing and random polymorphic DNA analysis gave an insight into the epidemiology of MRSA in a Northern Greece hospital. Concerning the distribution in the hospital, the predominant spa type t003 was present in various wards, and was constantly detected throughout the study period, very suggestive of an epidemic, while other types were detected only in specific wards. Our data underline the need for surveillance, typing and constant reassessment of existing strategies to control MRSA.
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Affiliation(s)
- M Kachrimanidou
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece ; Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - E Tsorlini
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - E Katsifa
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - S Vlachou
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - S Kyriakidou
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - K Xanthopoulou
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | - K Tsergouli
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | - T Samourli
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - A Papa
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
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Pitsiou G, Kachrimanidou M, Papa A, Kioumis I, Paspala A, Boutou A, Vlachou S, Tsorlini E, Argyropoulou-Pataka P. Lemierre's syndrome presenting to the ED: rapidly fatal sepsis caused by methicillin-susceptible Staphylococcus aureus Staphylococcus protein A type t044. Am J Emerg Med 2012; 31:268.e5-7. [PMID: 22795989 DOI: 10.1016/j.ajem.2012.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022] Open
Abstract
We describe the case of a fatal septic illness in a previously healthy young man caused by community-acquired methicillin-susceptible Staphylococcus aureus of Staphylococcus protein A (spa) type t044. The patient developed a devastating Lemierre-like syndrome with extensive thrombosis of inferior vena cava and iliac veins with multiple metastatic septic emboli of the lungs. He presented to the emergency department with rapidly progressing sepsis followed by multiple organ dysfunction syndrome. Recognition of such virulent community-acquired strains is of great importance because they could prove to be emerging pathogens for life-threatening diseases.
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Affiliation(s)
- Georgia Pitsiou
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G.H. G. Papanikolaou, Exohi, Thessaloniki, 57010, Greece.
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Christoforidis E, Vasiliadis K, Blouhos K, Tsalis K, Tsorlini E, Tsachalis T, Betsis D. Feasibility of therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones in nonagenarians: a single unit audit. J Gastrointestin Liver Dis 2008; 17:427-432. [PMID: 19104704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Little information is available on short and long-term outcome of therapeutic endoscopic retrograde colangiopancreatography (ERCP) for choledocholithiasis in nonagenarians (>=90 years). The aim of this study was to evaluate retrospectively the feasibility of therapeutic ERCP in nonagenarians with choledocholithiasis, as compared with patients aged between 75 and 89 years. PATIENTS AND METHODS During a 9-year period, therapeutic ERCP was performed for choledocholithiasis in 33 nonagenarian patients (group A) and 272 patients aged 75 to 89 years (group B). Clinical features, endoscopic findings, interventions, early and long-term results of therapeutic ERCP for a mean follow-up of 36 months were assessed and compared between the two groups. RESULTS Group A patients had a higher incidence of acute cholangitis, concomitant diseases and gallbladder stones, as compared to group B patients. Furthermore, they required an emergency procedure, multiple sessions, stent insertion, and needle knife fistulotomy significantly more frequently (p<0.001). Group B patients underwent significantly more endoscopic manipulations and had a longer procedure time than group A patients. Complete bile duct stone clearance was achieved in 24.2% of group A patients and in 90.8% of group B patients (p<0.001). No ERCP related deaths occurred in group A patients. Cholecystectomy was not routinely performed in Group A patients having gallbladder stones. The rate of early and late complications was not significantly different between the two age groups. CONCLUSION Therapeutic ERCP and biliary stenting have proved to be a feasible treatment option for the management of choledocholithiasis in nonagenarians.
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Affiliation(s)
- Emmanuel Christoforidis
- 4th Surgical Department, Endoscopy Unit, Aristotle University of Thessaloniki, Dorileou 3 Kalamaria 55 133, Thessaloniki, Greece
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Christoforidis E, Vasiliadis K, Goulimaris I, Tsalis K, Kanellos I, Papachilea T, Tsorlini E, Betsis D. A single center experience in minimally invasive treatment of postcholecystectomy bile leak, complicated with biloma formation. J Surg Res 2007; 141:171-5. [PMID: 17499275 DOI: 10.1016/j.jss.2006.07.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/23/2006] [Accepted: 07/11/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bilomas are localized collections of bile occurring usually post-operatively from an injured cystic or bile duct. Our study aims to evaluate the efficacy of minimal access endoscopic and percutaneous modalities in treating symptomatic bile leak and biloma formation. PATIENTS AND METHODS Sixteen patients with biloma after open or laparoscopic cholecystectomy underwent assessment of the site and extent of the bile leak via endoscopic retrograde cholangiography (ERC). Endoscopic sphincterotomy was performed in all patients who were managed non-operatively, any retained duct stones were removed, and an endoprosthesis was inserted in a selected basis. Percutaneous drainage of the bile collection, under ultrasound or computed tomography guidance, followed ERC. RESULTS ERC supplemented by computed tomography or ultrasound guided percutaneous biloma drainage was successful in 15 patients. One patient having major ductal injury was treated surgically. Thirteen patients had leakage from the cystic duct, one from the right hepatic duct, and one from an aberrant right hepatic duct. Bile duct stones were removed from seven patients an endoprosthesis was inserted in six and a nasobilary catheter in one. Bilomas resolved and bile leakage was treated successfully in all 15 patients with no further complications. CONCLUSION ERC accurately diagnoses the cause of postcholecystectomy bile leakage and biloma formation. Furthermore, endoscopic sphincterotomy and selective stent insertion in coordination with percutaneous drainage procedures represents in the majority of cases the corner stone of a definitive treatment.
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