ABSTRACT
Background: Surveillance of health care-associated infections (HCAIs) is an integral part of infection control programmes, especially in intensive care units (ICUs). Device-associated infections (DAIs) are a major threat to patient safety.
Aim: To measure DAI rates in ICUs.
Methods: Central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) were assessed in the ICUs of 4 tertiary-care teaching hospitals in Tehran, Islamic Republic of Iran.
Results: The incidence rate of CLABSI, VAP and CAUTI was 10.20, 21.08 and 7.42 per 1000 device-days, respectively. The utilization ratio for central lines, ventilators and urinary catheters was 0.62, 0.47, and 0.84, respectively. The most common organisms were Acinetobacter (33.5%) and Klebsiella (19.0%). Sixty to eighty percent of Enterobacteriaceae were extended-spectrum beta-lactamase producing. About half of Pseudomonas aeruginosa isolates were resistant to piperacillin/ tazobactam and carbapenem. Acinetobacter resistance rate to ampicillin/sulbactam and carbapenem was 7080%. The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus was 84.6% and 83.3%, respectively.
Conclusions: This study showed high incidence rates of DAIs and resistant organisms, and appropriate interventions are necessary to reduce these rates
ABSTRACT
Pancreatic tuberculosis is extremely rare and its clinical and radiological findings are similar to those of pancreatic malignancy. The diagnosis of pancreatic tuberculosis is not usually made prior to surgery. Here, we report a case of pancreatic tuberculosis, presented with abdominal pain and weight loss. Abdominal computed tomography [CT] showed a 62 mm x 32 mm septate solid-cystic mass in the pancreatic head area with extension into the hilum of the liver. There was no evidence of inflammation or pancreatitis. Endoscopic ultrasound-fine needle aspiration [EUS-FNA] could not yield the diagnosis. Exploratory laparotomy and further pathological evaluation suggested pancreatic tuberculosis. Response to antituberculosis treatment confirmed the diagnosis. Finally, previous case reports and case studies of pancreatic tuberculosis in the literature are fully investigated
Subject(s)
Humans , Female , Adult , Pancreas , Tomography , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Review Literature as Topic , ImmunocompetenceABSTRACT
Background: Amphotericin B Deoxycholate [ABD] has been the best therapeutic agent for treatment of most systemic fungal infections. However, untoward adverse effects like nephrotoxicity may limit its appropriate therapeutic use. We studied administration of fat emulsion early after infusion of ABD to evaluate its effects on ABD-associated nephrotoxicity
Methods: This study was a randomized clinical trial. Patients with fungal infections admitted in Amir-Alam and Imam-Khomeini University Hospitals, Tehran, Iran, entered the study during 1390- 1391. The patients were randomized to intervention and control groups. In both groups, patients received 1mg/kg/day ABD in dextrose 5%. In intervention arm, the patients additionally received intralipid 10% daily that was started as soon as possible within one hour after infusion of ABD. ABD-associated nephrotoxicity [a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl], daily serum creatinine changes during first two weeks of treatment and some other relevant indices of renal function were compared between groups. ABD-related hypokalemia was also compared as an additional target
Results: Thirty one patients entered the study. ABD-associated nephrotoxicity and values of other relevant indices of renal function were not different between intervention and control groups [P>0.05]. Daily changes in serum creatinine level within first two weeks of treatment in both groups were not also statistically different [P=0.62]. Furthermore, ABD-related hypokalemia was not significantly different between groups [P=0.47]
Conclusion: Administration of intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity. Moreover, it does not have any significant effect on ABD-related hypokalemia
ABSTRACT
Vancomycin-resistant enterococci [VRE] have emerged worldwide and have become an increasing problem in clinical settings. Acquired glycopeptide resistance in Enterococcus species is due to the acquisition of van A, van B, van D, van C and van E genes, resulting in the production of peptidoglycan precursors with reduced affinity for glycopeptide antibiotics. The origin of these van genes is still unknown, but recent studies have indicated that van B resistance in enterococci might arise from gene transfer from the human bowel flora. In this study, we investigated the presence of Enterococcus-associated van A, van B, van C, van D, van E genes in the feces of hospitalized patients. To determine the prevalence of vancomycin-resistant enterococci [VRE] fecal colonization of hospitalized patients, 422 Enterococcus spp. isolated from stool of patients in Amiralam hospital. Disk diffusion method was used to detect resistance to vancomycin. The MICs of vancomycin were determined by the agar dilution method. The presence of van A, B, C, D and E genes were assassed by PCR analysis. PCR was positive for van A for 6 out of 10 [60%] and van B for 4 out of 10 [40%] of VRE strains. Among the van positive enterococci, two [20%] specimens contained both van A and van B gene, whereas no van C, D and E positive enterococcal isolates were identified from these specimens. The MIC of VRE isolates were between 512- 1024 micro g/ml. Our results showed that most glycopeptide resistant Enterococcus isolated from stool of hospitalized patients carried van A and van B. It is also possible that frequency of infections caused by glycopeptide-resistant enterococci will increase in our geographical area