The aim of this study was to compare the responses of colistin treatment alone vs. a combination of colistin and rifampicin in the treatment of ventilator-associated pneumonia (VAP) caused by a carbapenem-resistant A. baumannii strain. Forty-three patients were randomly assigned to one of two treatment groups. Although clinical (P = 0·654), laboratory (P = 0·645), radiological (P = 0·290) and microbiological (P = 0·597) response rates were better in the combination group, these differences were not significant. However, time to microbiological clearance (3·1 ± 0·5 days, P = 0·029) was significantly shorter in the combination group. The VAP-related mortality rates were 63·6% (14/22) and 38·1% (8/21) for the colistin and the combination groups (P = 0·171), respectively. Our results suggest that the combination of colistin with rifampicin may improve clinical and microbiological outcomes of VAP patients infected with A. baumannii.

The aims of this study were to evaluate the kinetics of platelet counts and mean platelet volume (MPV) in adults with sepsis and to determine whether the responses are infection-specific. This retrospective cohort study included patients admitted to a tertiary-care teaching hospital with microbiologically proven nosocomial sepsis between January 2006 and January 2011. Platelet counts and MPV measurements were examined daily for 5 days after the onset of sepsis. During the study period, 151 of the 214 sepsis episodes were associated with thrombocytopenia. Gram-positive microorganisms were the most frequently isolated. The decrease in platelet counts was statistically significant for the first 3 days of sepsis in Gram-positive septic patients, for 4 days in Gram-negative septic patients and for all 5 days in fungal septic patients (p < 0.001). The increase in MPV values was statistically significant for the first 3 days of sepsis in Gram-positive septic patients and for all 5 days in the other groups (p < 0.001). We conclude that fungal sepsis has a stronger association with thrombocytopenia and increased MPV.

Akduman, Deniz; Kim, Lynn E.; Parks, Rodney L.; L'Ecuyer, Paul B.; Mutha, Sunita; Jeffe, Donna B.; Evanoff, Bradley A.; and Fraser, Victoria J., "Use of personal protective equipment and operating room behaviors in four surgical subspecialties: personal protective equipment and behaviors in surgery".

BackgroundInitial antimicrobial therapy (AB) is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation (MV) are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia (VAP) and hospital acquired pneumonia (HAP).MethodsWe retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test.ResultsSixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP (OR = 2.35 (95% CI, 1.05-5.22; p = 0.037) and APACHE II score at onset of HAP (OR = 1.06 (95% CI, 1.01-1.12); p = 0.018). In VAP patients; antibiotic usage in the previous three months (OR = 3.16 (95% CI, 1.27-7.81); p = 0.013) and admission to a surgical unit (OR = 2.9 (95% CI, 1.17-7.19); p = 0.022) were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP.ConclusionOur data suggests that the risk factors for inadequate initial AB are indirectly associated with the acquisition of resistant bacteria for both VAP and HAP. Although we could not find a positive correlation between adequate initial AB and survival; empirical AB with a broad spectrum should be initiated promptly to improve secondary outcomes.

No abstract

The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients.

The performance of a strand displacement amplification assay (the BDProbeTec-SDA assay) in detecting Neisseria gonorrhoeae in urine specimens was evaluated. When performed under stringent quality control conditions, the BDProbeTec-SDA assay is a sensitive, specific, and efficient method for the screening of large numbers of noninvasively obtained specimens. Because the predictive value of an assay is a function of the prevalence of the disease, culture confirmation is needed for samples with positive results from populations in which the prevalence of a disease is low or in situations in which false-positive results may have important medical, psychosocial, or medicolegal consequences. Genitourinary tract infections due to Chlamydia trachomatisand Neisseria gonorrhoeae are major causes of morbidity in sexually active individuals (7). Approximately 3 million new cases of C. trachomatis infection and 650,000 new cases of N. gonorrhoeae infection occur annually in the United States Asymptomatic infections in both men and women, along with coinfections and overlapping symptoms, can make specific clinical diagnosis difficult. Failure to provide effective treatment can lead to epididymitis in men and pelvic inflammatory disease and its sequelae of infertility, ectopic pregnancy, and chronic pelvic pain in women (12). There also is some evidence that gonococcal infections may facilitate the transmission of human immunodeficiency virus (6). As a result, prevention and control efforts increasingly are being focused on early diagnosis and treatment, especially in high-risk adolescents and young adults Յ24 years of age.The reference standard for detection of N. gonorrhoeae has been isolation by culture (1, 5), which has a high specificity and which can be used for susceptibility testing (1). Disadvantages include stringent transport and storage requirements and a bacterial growth time of 2 days or more. In addition, detection by culture usually involves an invasive procedure: a pelvic examination for women and insertion of an urethral swab for men.For a variety of specimens to be tested for N. gonorrhoeae or C. trachomatis including urethral and endocervical swab and urine specimens, nucleic acid detection assays such as PCR, ligase chain reaction, and transcription-mediated amplification possess higher sensitivities than older methods (2-4, 8-11, 13). However, each of these tests has limitations including variable sensitivities to inhibitors; limited throughput; high labor costs; and requirements for separate sample preparation, amplification, and detection areas and dedicated equipment. Thus, there is a need for a more user-friendly, sensitive, and specific diagnostic system which can test for C. trachomatis and N. gonorrhoeae simultaneously in large numbers of noninvasively obtained specimens.The BDProbeTec-SDA system (Becton Dickinson Microbiology Systems, Sparks, Md.) is a new semiautomated system which uses strand displacement amplification for the simultaneous detection of C. trachomatis and N. gonorrhoeae. Products...

Thrombocyte and Erythrocyte Indices in Sepsis and Disseminated Intravascular CoagulationSepsis is the inflammatory response against infection. The existence of DIC during sepsis indicates a poor prognosis and coagulation abnormalities and thrombocytopenia may exist. The aim of this study was to investigate platelet and erythrocyte indices in sepsis patients with DIC and without DIC. In both groups coagulation tests, platelet count and indices, erythrocyte count and indices were retrospectively analysed. In the sepsis plus DIC patients the prothrombin time and D-dimer values were found significantly higher and fibrinogen, platelet and plateletcrit were found significantly lower than in the sepsis without DIC group. The analysis of mean platelet volume, platelet distribution width, erythrocyte count and indices revealed no significant differences between the two groups. These results showed us that the depression of bone marrow in septic patients with DIC and without DIC did not differ. The activation of the coagulation system might probably be the cause of thrombocyte depletion in DIC.