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SUMMARY:The aim of this study was to explore the rate of device-associated nosocomial infections (DANIs) and the distributions of causative agents and patterns of antibiotic resistance in the medicalsurgical intensive care unit (ICU) over a 3-year period and to compare these rates with those reported by National Nosocomial Infections Surveillance System and International Nosocomial Infection Control Consortium. A total of 1,798 patients were hospitalized in our ICU for 13,942 days, of which 309 patients had DANIs, indicating an overall infection rate of 22.1 per 1,000 ICU-days. The central lineassociated bloodstream infection rate was 6.4 per 1,000 catheter-days, whereas the ventilator-associated pneumonia rate was 14.3 per 1,000 ventilator-days and the catheter-associated urinary tract infection rate was 4.3 per 1,000 catheter-days. Overall, 87.4z of all Staphylococcus aureus DANIs were caused by methicillin-resistant strains. With respect to Pseudomonas aeruginosa, 30.9z of the strains were resistant to ciprofloxacin, 23.3z to amikacin, 43.1z to ceftazidime, 19.1z to piperacillin-tazobactam, and 34.7z to imipenem. Furthermore, 1.9z of the Enterococcus spp. were resistant to vancomycin, and 51.1z of Enterobacteriaceae were resistant to ceftriaxone. DANI rates decreased over the 3-year study period, which was likely in response to the infection control measures implemented in our ICU.

BackgroundEpidural anesthesia is one of the best options for lower abdominal and lower limb surgery. However, there have been insufficient reports regarding the use of epidural anesthesia for pilonidal sinus surgery. The present study was performed to compare the clinical profiles of epidural block performed with 0.75% levobupivacaine and 0.75% ropivacaine in this procedure.MethodsThirty patients undergoing pilonidal sinus surgery were randomly allocated into two groups: one group received levobupivacaine and the other received ropivacaine at 0.75% in a volume of 10 ml. Arterial blood pressure, heart rate, oxygen saturation, the onset time of analgesia and duration of block, highest sensory block level, perioperative and postoperative side effects, and patients' and surgeons' satisfaction were recorded.ResultsHemodynamic stability was maintained in both groups throughout surgery. The onset time of analgesia (the time from epidural injection of local anesthetic to reach L2 sensorial block) was 6.26 ± 3.49 min in the levobupivacaine group and 4.06 ± 1.75 min in the ropivacaine group (P = 0.116). The duration of sensorial block (time for regression of sensory block to L2) was 297.73 ± 70.94 min in group L and 332.40 ± 102.22 min in group R (P = 0.110). Motor block was not seen in any of the patients in the study groups. Patients' and surgeons' satisfaction with the anesthetic technique were mostly excellent in both groups.ConclusionsIn patients undergoing pilonidal sinus surgery, both levobupivacaine and ropivacaine produce rapid and excellent epidural block without leading to motor block or significant side effects. Although not statistically significant, the onset time of anesthesia was shorter and the duration of effect was longer with ropivacaine than with levobupivacaine in this study.

Sevoflurane and propofol have no deleterious effects on homocysteine levels in patients with MTHFR deficiency. Avoidance of NO is the key point for anaesthetic consideration regarding these patients.

Purpose:The risk factors of colistin methanesulfonate (CMS) associated nephrotoxicity are important. Our study attempts look into the prevalence of CMS-associated nephrotoxicity in Intensive Care Units (ICUs), and related risk factors.Materials and Methods:The study was conducted between September 2010 and April 2012 on 55 patients who underwent CMS treatment. Nephrotoxicity risk was defined based on the Risk Injury Failure Loss End-stage kidney disease criteria.Results:Fifty-five patients included in the study. A total of 22 (40%) patients developed nephrotoxicity. The correlation was detected between nephrotoxicity and patients over 65 with a high Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score. APACHE II score was revealed an independent risk factor for nephrotoxicity.Conclusion:Advanced age and a high APACHE II score are significant risk factors in the development of nephrotoxicity at ICUs following CMS use. Patient selection and close monitoring are critical when starting CMS treatment.

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New-onset refractory status epilepticus (NORSE) is a definition used to describe clinical conditions with no history of seizures, no identifiable structural or etiological cause, and for which a diagnostic result cannot be reached by research. Its treatment is often done with intravenous anesthetic drugs and its mortality is quite high. In this article, a 33-year-old patient whose etiology could not be determined as a result of extensive research in our intensive care unit and who recovered completely is presented.

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