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WOS: 000329585200001, PubMed ID: 24118178, We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200mg/day, rifampicin 600mg/day and streptomycin 1g/day; doxycycline 200mg/day, rifampicin 600mg/day and gentamicin 5mg/kg; doxycycline 200mg/day and rifampicin 600mg/day; doxycycline 200mg/day and streptomycin 1g/day; and doxycycline 200mg/day, rifampicin 600mg/day and ciprofloxacin 1g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

The aim of this case report is to draw attention to the frequent occurrence of metoclopramide-induced movement disorders. We report a case of an acute dystonic reaction to metoclopramide in a patient treated for hepatitis A. Metoclopramide can cause severe adverse events, such as an acute dystonic reaction, and should be used with caution in patients with infectious diseases.

Summary Polysaccharide slime seems to be the most important factor by which coagulase negative staphylococci (CNS) strains adheres and colonises catheters. The aim of this study was to determine the prevalence of slime-producing CNS strains isolated from nasal samples of patients on haemodialysis and of healthy persons as a control. Nasal cultures were performed for 131 haemodialysis patients and 56 healthy persons. CNS strains were isolated from 86 of 131 patients (72.9%), and 46 of 56 healthy persons (82.1%). Twenty-four (27.9%) of the 86 CNS strains tested in the patient group and four (8.7%) of the 46 CNS strains in the control group were slime factor positive. There was a significant difference (p

Sporotrichosis is a cutaneous or systemic fungal infection caused by Sporothrix schenckii. The infection is characterized by nodular, pustular, or ulcerative lesions. Infection usually occurs after traumatic implantation of the fungus into the skin. We report a case presenting first cellulitis and later on as a non-healing ulcer which was diagnosed by punch biopsy as sporotrichosis and managed successfully with itraconazole. A 56-year-old woman admitted to our department with complaint acute onset of swelling of the right lower-extremity with erythema and warmth. The patient was diagnosed initially as celulitis and started on ampicillin-sulbactam. Diagnosis of sporotrichosis was made with histological examination skin biopsy and the patient was started on itraconazole. One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months the lesions had healed. This case shows that if a wound do not respond to antibiotics in cases with ulcer, some rare etiological agents should be considered. [Dis Mol Med 2016; 4(3.000): 34-36]

The study was designed to compare antibiotic use, cost and consumption before and after an initiation of an antibiotic-restriction policy in our hospital. The policy was applied in 2003, and the prescription of two groups of antibiotics (intravenously used and expensive antibiotics) was restricted. A prescription for the restricted antibiotics could be obtained with approval by an infectious disease specialist (IDS). All the hospitalized patients who received antibiotics were evaluated by a cross-sectional study with standard criteria. The annual cost and consumption of antibiotics were evaluated. After restriction, the rate of antibiotic use decreased from 52.7 to 36.7% (P0.001), and the appropriate use increased from 55.5 to 66.4% (P0.05). Appropriate use was higher for restricted antibiotics (88.4%) than for unrestricted ones (58.2%) (P0.001), and higher in the presence of ID consultation (97.5%) than in the absence of consultation (55.7%) (P0.001). Culture-based treatment was increased, and appropriate use in such cases (93.0%) was higher than empirical treatment (33.3%) (P0.001). After the restriction policy, consumption of antibiotics belonging to the restricted groups was decreased by 44.8%. Total expenditure of all antibiotics was decreased by 18.5%, and the savings were US$332,000 per year. This restriction policy was effective in promoting rational antibiotic prescription and lowering antibiotic cost and consumption in our hospital.

A 36-year-old, 7-week-gravida patient with catheter-related nosocomial infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) is presented in this paper. The patient was admitted to our hospital because of carbon monoxide intoxication. After 14 days, MRSA catheter-related bacteremia developed. The central venous catheter was immediately removed, and teicoplanin therapy was started. Because of persistent fever, leukocytosis, and high C-reactive protein values, endocarditis was suspected. A transesophageal echocardiogram revealed 19-mm vegetation on her mitral valve, confirming the diagnosis of endocarditis. Gentamicin and rifampicin were added to the therapy regimen, and the dose of teicoplanin was increased to 12 mg/kg-day. After 8 days, a splenic abscess was detected by ultrasonography. Vegetation excision, mitral valve replacement by open-heart surgery and splenectomy were performed in the same operation. Antibiotherapy was continued for 6 weeks after surgery, and the patient's condition improved. The development of endocarditis could be prevented by proper clinical practices.

Malaria is a rare but potentially serious complication of blood transfusion. In this report a transfusion-transmitted malaria case has been presented. A 47-years-old woman admitted to our clinic with the complaints of striking fever with chills, diarrhea and vomiting. She had history of an operation and transfusion before 10 days of admission. On physical examination jaundice, splenomegaly and abdominal tenderness were detected. Laboratory results revealed anemia, and elevated LDH and bilirubin levels. Examination of thin blood films yielded Plasmodium vivax trophozoites. Chloroquine was initiated for therapy and the patient was successfully treated. On the other hand, informations about her blood donor indicated that he had been in the military service in Southeast Anatolia of Turkey where malaria is endemic. All the efforts to reach the donor, for his diagnosis and treatment, were failed. Since our region (Northeast Anatolia) is not an endemic area for malaria and the patient had no travel history to an endemic area, it has been considered that the transmission route of malaria in this case was blood transfusion. In conclusion, as there are no available approved tests for malaria screening of donations, the transfusion-transmitted malaria can only be prevented by careful questioning of the donors.

Estrogen deficiency is a major contributor to the pathogenesis of urinary tract infections (UTI) in postmenopausal women. After menopause, the vaginal pH increases, lactobacilli disappear from the vaginal flora, and the vagina is predominantly colonized by Enterobacteriaceae, especially Escherichia coli. To better understand the associations between post-menopausal vaginal flora and the development of UTI, we conducted a prospective study among 87 postmenopausal women ages between 50-65 years. Vaginal samples were collected from lateral vaginal wall of women to perform a smear on a glass slide and placed on appropriate media. The smear was then stained with Gram stain. Urine samples were collected and cultured by standard bacteriologic techniques. Vaginal lactobacilli were present in 55.2%, and vaginal Enterobacteriaceae were present in 40.2% of the subjects. Heavy growth of lactobacilli was associated with a lower frequency of vaginal colonization with Enterobacteriaceae members (p0.001), Streptococcus sp. (p0.05) and Pseudomonas sp. (p0.05). The most commonly isolated microorganism was E. coli. The frequency of asymptomatic bacteriuria and symptomatic UTI among postmenopausal women were found 17.5% (15/87) and 11.5% (10/87), respectively. As a result, Enterobacteriaceae colonization of the vagina in postmenopausal women increases the prevalence of asymptomatic bacteriuria and symptomatic UTI (p0.01 and p0.05, respectively).

To examine the bacterial isolates from the burn patients and to compare the antibiograms of the predominant bacteria isolated from 51 patients who were hospitalized at least 3 weeks or more over a period of 7 months, a prospective study was undertaken. Periodic swabs were taken from burn wound, nasal, axillary, inguinal, and umbilical region of the patients on admission and on 7th, 14th, and 21st days of hospitalization. Mean hospital stay was 36.5 days. A total of 1098 microbial isolates were detected during the study period. Coagulase-negative staphylococci (CNS, 63.0%) and Staphylococcus aureus (19.7%) were the most prevalent isolates in admission cultures. During the next weeks, these bacteria were superceded by mainly Pseudomonas aeruginosa. Between admission and 21st day, the rates of methicillin resistance of staphylococci strains increased steadily. There was no vancomycin resistance in any staphylococci strains, although nine of the S. aureus isolates (2.7%) were resistant to teicoplanin. There were no strains producing inducible beta lactamase (IBL) among P. aeruginosa strains. One extended-spectrum beta-lactamase (ESBL)-producing strain was recovered on admission, although strains producing IBL and ESBL were detected at rates of 79.6 and 57.1%, respectively, on the 21st day. The nature of microbial wound colonization, flora changes, and antimicrobial sensitivity profiles should be taken into consideration in using empirical antimicrobial therapy of burned patients.

Nasal carriage of Staphylococcus aureus plays a key role in the epidemiology and pathogenesis of infection, and is a major risk factor for the development of both community-acquired and nosocomial infections. The objective of this study was to investigate the carriage rate of S. aureus in hospital personnel and normal population groups, and to compare the resistance rates of the isolated strains to certain antibiotics. The nasal carriage rates of S.aureus were found to be 27.5% in 262 hospital personnel, and 24.0% in 75 normal healthy subjects (p0.05). While methicillin resistant S. aureus rate was 9.7% in hospital personnel, no methicillin resistant strain was detected in the control group (p0.05). According to the in-vitro sensitivity test results, resistance rates of meticillin sensitive S. aureus (MSSA) strains isolated from hospital personnel to fusidic acid, erythromycin and clindamycin were as 11%, 18% and 12%, respectively. There were no resistant strains to these antibiotics among MSSA, isolated from normal subjects. In conclusion, the colonization of the resistant strains rather than the frequency of S. aureus colonization is more important in the hospital personnel.

Hospital-acquired infections are the ones that develop within hospital stay or appear after discharge. These infections are associated with an increased rate of morbidity and mortality, longer hospital stay and higher hospital costs and Hospital Infections Control Committees have been founded to prevent it. In this review, we intended to investigate the role of the surgeon in this committee.

We review, in detail, 2 cases of anthrax during pregnancy, its maternal and perinatal complications, and its management. Patient 1 was a 33-year-old woman at 32 weeks of gestation. She had a submandibular eschar; extensive edema on her face, neck, and upper thorax that inhibited respiratory function; and fever. The patient was treated with penicillin G and prednisolone after the diagnosis of anthrax. She recovered within 10 days but delivered a preterm baby. Patient 2 was a 29-year-old woman at 33 weeks of gestation. Her anthrax lesion was on her right elbow, and therapy consisted of procaine penicillin. She also delivered a preterm baby. These 2 cases show that anthrax during pregnancy can be successfully managed, but preterm delivery could be a complication.

Women colonized with group B Streptococcus (GBS) during pregnancy are at an increased risk of premature delivery and GBS amniotic infection can result in intrauterine death. GBS also infects the newborn. The vaginal flora of a healthy woman is composed of Doderlein bacilli. Bacterial vaginosis (BV) is a clinical condition caused by the replacement of these bacilli with high concentrations of aerobic and anaerobic bacteria. GBS inhibits Lactobacillus species in vitro. The main goal of this study was to assess differences in the vaginal flora of pregnant women and provide a detailed evaluation of vaginal swab for the presence of GBS and other organisms. From January 2002 to February 2003 150 healthy pregnant women were included in the study. Their mean ± S.D. age was 26.1 ± 6.7 years (range 17—45 years) and pregnancy duration was 31.4 ± 5.3 weeks (range 22—40 weeks). Vaginal fluid samples were collected with cotton swabs. The swabs were Gram-stained and placed on appropriate media. Slides were then assessed according to the criteria of Nugent et al. (excerpt)

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.