Antibiotic management programme in a tertiary intensive care unit: effects of a carbapenem-restricted period on clinical and laboratory parameters and costs of infections

BACKGROUND

Carbapenems are antibiotics used for serious infections. The consumption of carbapenems has increased worldwide due to increasing microbial resistance.

AIM

To investigate the effects of a carbapenem-restricted antimicrobial stewardship programme (ASP) on changes in the resistance profiles of infectious agents, the amount of antibiotics used, length of stay in the intensive care unit (ICU), mortality, and costs.

METHODS

Patients hospitalized in ICU between July 1st, 2020 and May 1st, 2021 were divided into two periods: the carbapenem-non-restricted period (CNRP); and the carbapenem-restricted period (CRP) in which alternative antibiotics to carbapenems were preferred during infection. The defined daily dose (DDD) per 100 patient-day methodology was used to calculate the antibiotic consumption.

FINDINGS

Of the 572 patients included in the study, 62.2% were male, and mean age was 70.5 years. In the blood culture the most frequently Gram-negative agent was Acinetobacter baumannii (25%). A. baumannii bloodstream infections with multidrug-resistant and extensively drug resistant micro-organisms were significantly different between the two periods (CNRP: 95.6% (N = 22), CRP: 66.6% (N = 8); P = 0.04). There was a gradual decrease in the incidence density and rate of nosocomial infection (P = 0.06), and a significant decrease in meropenem consumption between the two periods (CNRP vs CRP: 21.19 vs 6.37 DDD per 100 patient-days respectively; P = 0.007). ASP yielded US$8,600 of antibiotic cost savings and a total of 14% patient cost savings (P < 0.05) per patient.

CONCLUSION

Combining an effective ASP with a comprehensive infection control programme may mitigate the emergence of antimicrobial-resistant bacteria.

The role of chest X-ray in coronavirus disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

OBJECTIVE

It is possible to diagnose coronavirus disease 2019 (COVID-19) faster and more accurately with chest X-ray (CXR) and chest computed tomography (CT) than with reverse transcriptase PCR (RT-PCR) tests. The aim of this study was to verify the possibility of reducing the use of CT in diagnosis and follow-up of COVID-19 infection by using CXR.

PATIENTS AND METHODS

A total of 326 COVID-19 patients who were hospitalized in Ankara City Hospital were included in this retrospective study.

RESULTS

A total of 326 patients were RT-PCR positive for COVID-19 infection; 178 were male (54.6%) and 148 were female (45.4%), with a median age of 45. Considering the results, the baseline CXR sensitivity in our experience was approximately 72%. The CXRs of 113 patients with abnormal CT were divided into 2 groups, the CXR normal and abnormal groups, and were then compared. In the 1st group with abnormal CXR, the mean age, the number of patients over 65 years old, and the comorbidity rate were higher. Additionally, it was determined that the number of patients requiring respiratory support and intensive care unit (ICU) admission in this 1st group was higher than in the 2nd group (with normal CXR). Most of the patients who died (91%, 10/11) were in Group 1. In the group with normal CXR, no patients in the critically ill category needed invasive or non-invasive mechanical ventilators.

CONCLUSIONS

CXR can help in detecting clinically moderate and severe cases of COVID-19. CXR can assist clinicians in patient management and treatment planning regarding the clinical course, respiratory support, ICU need, and mortality and can help them prepare for potential negative outcomes.

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission

OBJECTIVE

As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters.

PATIENTS AND METHODS

The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols.

RESULTS

2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses.

CONCLUSIONS

The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Neuropathic pain in pregnant Turkish women with lumbopelvic pain and its impact on health-related quality of life

Objectives

To investigate the prevalence of neuropathic pain in pregnant women and to state its influence on the functional status and health-related quality of life (HRQoL) in terms of physical, social, and emotional functioning.

Methods

A total of 90 pregnant women with lumbopelvic pain (LPP) and non-pregnant and healthy controls were included. The presence of neuropathic pain was determined using the Leeds assessment of neuropathic symptoms and signs (LANNS) questionnaire. The HRQoL was assessed using the Nottingham Health Profile (NHP), and the functional status was evaluated using the Oswestry Disability Index (ODI). The severity of pain was measured using a visual analog scale.

Results

The LANNS score was ≥12 in 34 pregnant women (37.8%). The prevalence of neuropathic pain was higher in pregnant women with LPP (odds ratio=6.22; 95% confidence interval=2.68-14.44) (p<0.001) than in controls. The LANNS score was found to be correlated with the physical mobility subgroup in the NHP at high levels (p=0.002, r=0.32) and with the ODI and pain subgroup in the NHP at moderate levels (p=0.013, r=0.26 and p=0.038, r=0.22, respectively).

Conclusion

The present study is the first to demonstrate that neuropathic pain is associated with pregnancy-related LPP and strongly correlated with functional impairment and deterioration in the HRQoL. A better understanding of neuropathic pain mechanisms in pregnancy-related LPP will help us find more effective treatment strategies.

The relationship between vitamin D, vertebral deformity and quality of life in psoriatic arthritis

OBJECTIVE

The aim of this study is to investigate the relation between vitamin D levels, vertebral deformities, functional status, quality of life, acute phase reactants and enthesopathy in patients with psoriatic arthritis (PsA).

PATIENTS AND METHODS

Fifty-two patients with PsA and 52 controls were enrolled to the study. Routine blood tests and serums 25-(OH)D3 were measured. The thoracic and lumbar vertebrae deformities identified in the radiographies were evaluated by a radiologist. Psoriatic Arthritis Quality of Life (PSAQoL) was used for evaluating quality of life and disease activity parameters for PsA were assessed. In PsA patients, correlations was performed between the 25(OH)-D3 levels and PGE (patient global assessment), PHGE (Physician global assessment), tender JC (joint count), HAQ-S (Health Assessment Questionnaire for the Spondyloarthropathies), PSAQoL, MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and BASDAI(Bath Ankylosing Spondylitis Disease Activity Index) values.

RESULTS

The results showed that 25(OH)-D3 levels was not correlated with these values. (p>0.05 for r = -0.171, r = -0.167, r=-0.069, r=-0.236, r=-0.062, r= -0.058 and r = -0.106 respectively). It was determined that the PSAQoL score had a positive and statistically significant correlation with the DGD, swollen JC, CRP, HGD, tender JC, VAS-pain, HAQ-S, MASES and BASDAI values in PsA patients. (p>0.05 for r=0.291, r=0.324, r=0.346, r=0.312; and p=0.001 for r=0.472, r=0.380, r=0.565, r=0.696, r=0.359, r=0.633, respectively) Statistical analyses demonstrated that PsA patients with vertebral deformities had higher numbers of tender joints, more prolonged periods of morning stiffness, higher DAS28-ESR (Disease Activity Score) scores, and higher levels of vitamin D (p<0.05, p<0.05, p=0.05 and p<0.05, respectively). The multiple logistic regression analysis indicated that the only factor which had an effect on the development of vertebral deformities was the use of steroids.

CONCLUSIONS

This result has demonstrated that psoriatic arthritis has a considerable effect on patient quality of life. Most significant factors that affecting quality of life were physical pain and disability while vertebral deformities and 25-(OH)D3 had no significant effect.

Comorbidities in Turkish patients with rheumatoid arthritis: association with the health-related quality of life in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning

AIMS

The aim of our study was to investigate the comorbidities in Turkish RA patients and evaluate the impact of comorbidities on health-related quality of life (HRQoL) in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning.

METHODS

In a cross-sectional setting, a total of 160 RA patients who were admitted to our outpatient clinic between December 2013 and February 2014 were consecutively enrolled in the study. Comorbidities were recorded. Disease activity was measured by using Disease Activity Score-28 (DAS28). Stanford Health Assessment Questionnaire (HAQ) was used for determining functional status, Nottingham Health Profile (NHP) for HRQoL, and modified Sharp Score for radiological damage.

MAJOR RESULTS

Comorbidities were reported in 107 patients (66.88 %). The most common was peptic ulcer (31.25%). This was followed by osteoporosis (21.25%), dyslipidemia (15.63%), depression (15%), hypertension (13.75%), diabetes mellitus (13.13%), thyroid disorders (%8.13), lung diseases (%6.88), cardiovascular diseases (6.25%), and cancers [(1 breast cancer, 1 malign melanoma, 3 lung carcinoma), 3.13%], respectively. Patients with comorbidities scored significantly higher in DAS28, HAQ, pain, energy and physical mobility subgroups of NHP (p<0.05). It was not recorded any statistical significant difference in modified Sharp scores and sleep, social isolation and emotional reactions subgroups of NHP between the patient groups with and without comorbidities (p>0.05).

CONCLUSIONS

Comorbid conditions of RA are common and associated with more active and severe disease and functional impairment. Comorbidities should be detected and treated earlier to reduce its negative impact on outcome in RA.

The effects of periodontal therapy on gingival crevicular fluid matrix metalloproteinase-8, interleukin-6 and prostaglandin E2 levels in patients with rheumatoid arthritis

OBJECTIVE

The aim of this study was to evaluate the effects of non-surgical periodontal therapy on gingival crevicular fluid levels of matrix metalloproteinase-8 (MMP-8), interleukin-6 (IL-6) and prostaglandin E2 (PGE2 ) in patients with rheumatoid arthritis (RA) with periodontal disease.

MATERIAL AND METHODS

Twenty-seven patients with gingivitis and periodontitis with RA, 26 patients with gingivitis and periodontitis that were systemically healthy and 13 periodontally and systemically healthy volunteers (control group) were included in this study. RA activity was assessed by disease activity score test. The clinical periodontal parameters, fasting venous blood and gingival crevicular fluid samples were obtained and gingival crevicular fluid MMP-8, IL-6 and PGE2 levels were evaluated at baseline and at 3 mo follow-up after non-surgical periodontal treatment.

RESULTS

Gingival crevicular fluid MMP-8, PGE2 and IL-6 levels were higher in all groups than the control group. Following periodontal therapy, there were significant decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels from patients with RA with periodontitis (p < 0.05). Plaque index, gingival index and bleeding on probing were significantly correlated with IL-6 and PGE2 at baseline and at 3 mo follow-up after non-surgical periodontal treatment.

CONCLUSION

Non-surgical periodontal therapy of patients with RA with periodontitis may provide beneficial effects on local inflammatory control via decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels.

On the Severity of Carpal Tunnel Syndrome: Diabetes or Metabolic Syndrome

Background and Purpose

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Although its etiology is unknown, certain conditions are commonly associated with CTS, such as obesity, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, and sarcoidosis. We aimed to determine the association between metabolic syndrome and CTS, and we compared the severity of CTS between patients with diabetes (and no concomitant metabolic syndrome) and patients with metabolic syndrome.

Methods

Two hundred patients with a clinically and electrophysiological confirmed diagnosis of CTS were included in the study. Their demographic characteristics and severity of CTS were analyzed according to the presence or the absence of metabolic syndrome. Differences in the electrophysiological findings were evaluated between the following four groups: 1) metabolic syndrome alone (n=52), 2) diabetes alone (n=20), 3) combined metabolic syndrome and diabetes (n=44), and 4) no metabolic syndrome or diabetes (n=84).

Results

CTS was more severe in the patients with metabolic syndrome than those without this syndrome. The electrophysiological findings were worse in patients with metabolic syndrome alone than in those with diabetes alone and those without diabetes and metabolic syndrome.

Conclusions

CTS appears to be more severe in patients with metabolic syndrome than patients with diabetes. Diabetes is one of the well-known risk factors for CTS, but other components of metabolic syndrome may have a greater effect on the severity of CTS.

[Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning]

OBJECTIVE

To determine the impact of postpolio-syndrome on quality of life in polio survivors.

METHODS

Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing.

RESULTS

Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups.

CONCLUSIONS

Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

Brucellosis in spondyloarthritis mimicking an exacerbation

Spondyloarthritis are a group of chronic inflammatory diseases that affect the axial skeleton, entheses and peripheral joints and may have extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Brucellosis is a systemic infectious disease, endemic in Middle East, Latin America, and Mediterranean countries, which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Some hallmarks of Brucellosis may mimic a spondyloarthritis flare. In this paper, authors present a clinical case of brucellosis occurring in a patient with spondyloarthritis. Clinical symptoms initially mimicked exacerbation of spondyloarthritis.

Comparison of clinical and electrophysiological findings in patients with suspected radiculopathies

Cervical and lumbar roots may be irritated or compressed due to the pathological conditions such as disc herniations, degenerative foraminal stenosis, trauma and tumors. Electrophysiologic tests are frequently used in conjunction with imaging modalities for evaluation of low back and neck pain radiating to extremities, primarily for the purpose of establishing the presence or absence of a radiculopathy. In this study, we aimed to evalulate the relationship between clinic and electroneuromyographic (ENMG) findings in patients with suspected radiculopathies. Forty one patients with radicular complaints in the upper extremities and 51 patients with radicular complaints in the lower extremities were included in this study. McNemar test and Kappa coefficients between the two methods were applied to each group of patients, in order to test the significance of the difference between the two diagnostic procedures' ability on finding out the pathology. The McNemar test identified a significant difference between the two diagnostic approaches both for cervical and lumbar radiculopathies (p<0.001). The Kappa coefficients between the two methods were determined as 0.08 and 0.07, respectively. This means, efficacy of anamnesis and neurological examination for the prediction of electrodiagnostic tests was found to be limited. Normal neurological examination results in a patient with suspected radiculopathy can not eliminate abnormal electrodiagnostic test results; likewise, abnormal findings in the neurological examination would not mean finding pathologies in the electrodiagnostic tests. For more accurate approach to a patient, neurological examination and electrodiagnostic tests must be used and interpreted together.

Fatigue in rheumatoid arthritis: association with severity of pain, disease activity and functional status

OBJECTIVE

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis causing progressive joint destruction and disability. Major patient complaints are pain, disability and fatigue. The aim of this study is to assess fatigue and its association with disease-specific variables (severity of pain, disease activity, and functional status) in patients with RA.

PATIENTS AND METHODS

A total of 160 RA patients were included in the study. Fatigue was measured by using Fatigue Symptom Inventory (FSI). The quadrivariate Disease Activity Score-28 (DAS28) was used for evaluating disease activity and Health Assessment Questionnaire (HAQ) for determining functional status. Severity of pain was measured by using 10 cm Visual Analog Scale-Pain (VAS-pain).

RESULTS

Intensity items of FSI (most fatigue, least fatigue, average fatigue, current fatigue) were strongly correlated with DAS28, HAQ, and VAS pain (p=0.000). When the correlation coefficients were analyzed, current fatigue showed the highest correlation with VAS-pain (r: 0.96). This was followed by DAS28 and HAQ, respectively (r: 0.77 and 0.70) (p=0.000). Duration items of FSI (number of days fatigued, amount of time fatigued) were significantly correlated with DAS28, HAQ, and VAS pain (p=0.000). Also there were significant positive correlations between interference scale of FSI and DAS28, HAQ, and VAS-pain (r: 0.68, 0.61 and 0.67, respectively) (p=0.000). None of FSI subgroups showed statistically significant correlation with di­sease duration.

CONCLUSIONS

Fatigue is strongly associated with severity of pain, disease activity and functional status. Fatigue should be included in clinical practice and clinical trials as a RA outcome measure.

Health-related quality of life in rheumatoid arthritis: comparison of RAQoL with other scales in terms of disease activity, severity of pain, and functional status

Quality of life (QoL) is the gratification taken from life, happiness, and the way human beings perceive their situation within the system of culture and values. Rheumatoid arthritis (RA) is among the main conditions in which QoL is decreased. The aim of this study was to evaluate QoL and related variables in patients with RA. A total of 153 RA patients were included in the study. All patients were evaluated by the rheumatoid arthritis quality of life (RAQoL), Nottingham health profile (NHP), and the health assessment questionnaire (HAQ) scales. Disease activity score 28 (DAS28) was used for measuring disease activity, while the modified Sharp score developed by Van der Heijde was used for evaluating the radiological damage, and visual analog scale-pain (VAS-pain) was used to determine the level of pain. RAQoL had linear relations at high levels with VAS-pain, HAQ, DAS28, and the modified Sharp score (r values 0.86, 0.82, 0.82, and 0.38, respectively) and at a moderate level with disease duration (r 0.18). VAS-pain showed the highest correlation with the pain subgroup of NHP (r 0.91) and the second highest correlation was with RAQoL (r 0.86). As a result, it is concluded that in RA patients RAQoL is an important scale reflecting QoL related with pain, disease activity, functional status, and radiological progression. In our study pain ranked first among the variables that influenced QoL, and this was followed by disease activity and functional status.

The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial

AIM

To investigate the effects of balance training, using force platform biofeedback, on motor recovery, mobility and activity level of hemiparetic patients with stroke.

METHODS

In this randomized, controlled, assessor-blinded trial 41 inpatients [mean (+/-SD) age of 60.9 (+/-11.7) years] with hemiparesis after stroke (median time since stroke 6 months) were randomly assigned to an experimental or a control group. The control group (n=19) participated in a conventional stroke inpatient rehabilitation program, whereas the experimental group (n=22) received 15 sessions of balance training (using force platform biofeedback) in addition to the conventional program. Main outcome measures were motor recovery of the lower extremity (Brunnstrom staging), mobility (Rivermead Mobility Index, RMI) and activity level (Functional Independence Measure, FIM) that performed one week before and after the experimental treatment program.

RESULTS

Both groups were similar in terms of baseline clinical characteristics. Motor recovery, mobility and activity level improved significantly in both groups (P<0.05). Between-group difference of mean change score was not significant for the Brunnstrom stages (0.23 vs 0.26), RMI (2.9 vs 2.2) and FIM score (10.7 vs 11.5).

CONCLUSION

In our group of stroke patients, balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery, mobility and activity level.

The effects of balance training on gait late after stroke: a randomized controlled trial

OBJECTIVE

To investigate the effects of balance training, using force platform biofeedback, on quantitative gait characteristics of hemiparetic patients late after stroke.

DESIGN

Randomized, controlled, assessor-blinded trial.

SETTING

Rehabilitation ward and gait laboratory of a university hospital.

SUBJECTS

Forty-one patients (mean (standard deviation; SD) age of 60.9 (11.7) years) with hemiparesis late after stroke (median time since stroke six months) were randomly assigned to an experimental or a control group.

INTERVENTIONS

The control group (n = 19) participated in a conventional stroke inpatient rehabilitation programme, whereas the experimental group (n = 22) received 15 sessions of balance training (using force platform biofeedback) in addition to the conventional programme.

MAIN OUTCOME MEASURES

Selected paretic side time-distance, kinematic and kinetic gait parameters in sagittal, frontal and transverse planes were measured using a three-dimensional computerized gait analysis system, one week before and after the experimental treatment programme.

RESULTS

The control group did not show any statistically significant difference regarding gait characteristics. Pelvic excursion in frontal plane improved significantly (P = 0.021) in the experimental group. The difference between before-after change scores of the groups was significant for pelvic excursion in frontal plane (P = 0.039) and vertical ground reaction force (P = 0.030) in favour of experimental group.

CONCLUSION

Balance training using force platform biofeedback in addition to a conventional inpatient stroke rehabilitation programme is beneficial in improving postural control and weight-bearing on the paretic side while walking late after stroke.