Is timely and appropriate antifungal drug enough for survival of adult cases with candidaemia? Five-year experience / ¿Es el uso oportuno y adecuado de antimicóticos suficiente para la supervivencia de casos de adultos con candidemia? Cinco años de experiencia

OBJECTIVE: Candidaemia is the fourth most common cause of nosocomial bloodstream infections. The objective of this paper was to evaluate the risk factors associated with mortality in patients with candidaemia with respect to Candida species and their susceptibilities, retrospectively. METHODS: All consecutive patients who developed candidaemia at an 800-bed training and research hospital were enrolled in this retrospective, observational, single centre study during the period June 2006 to December 2011. RESULTS: A total of 97 candidaemia episodes were identified in 97 patients during the study period with an overall incidence of four episodes/10 000 admissions in adults. Crude 30-day mortality rates among patients with candidaemia were 56% (55 of 97 cases). Urinary catheterization, immunosuppressive therapy, acute physiology and chronic health evaluation (APACHE) II score (>16) and hypoal-buminaemia were found to be independent risk factors for fatal candidaemia. CONCLUSIONS: Adult cases with candidaemia who have risk factors associated with mortality are more likely to have poor prognosis despite appropriate and timely initiated antifungal drug treatment. Empiric antifungal drug should be tailored according to the severity of the patients ' conditions and local antifungal susceptibility.

OBJETIVO: La candidemia es la cuarta causa más común de infecciones nosocomiales del flujo sanguíneo. El objetivo del presente trabajo fue evaluar los factores de riesgo asociados con la mortalidad en pacientes con candidemia con respecto a las especies de Candida y sus susceptibilidades, de manera retrospectiva. MÉTODOS: Todos los pacientes consecutivos que desarrollaron candidemia en un hospital de capacitación e investigación de 800 camas, fueron inscritos en este estudio retrospectivo, observacional, monocéntrico, durante el período de junio de 2006 a diciembre de 2011. RESULTADOS: Se identificaron un total de 97 episodios de candidemia en 97 pacientes durante el período de estudio con una incidencia general de cuatro episodios/10 000 ingresos en adultos. Las tasas brutas de mortalidad de 30 días entre los pacientes con candidemia fueron 56% (55 de 97 casos). Se halló que la cateterización urinaria, la terapia inmunosupresiva, y la puntuación (> 16) de la escala de Evaluación de la fisiología aguda y salud crónica (APACHE II) así como la hipoalbuminemia, constituyen factores de riesgo para una candidemia fatal. CONCLUSIONES: Los casos adultos con candidemia que tienen factores de riesgo asociados con mortalidad son más propensos a tener un pronóstico pobre a pesar del tratamiento apropiado y oportuno con medicamentos antimicóticos. Los antimicóticos empírico se deben adaptar según la severidad de las condiciones de los pacientes y la susceptibilidad antifúngica local.

Colistin against colistin-only-susceptible Acinetobacter baumannii-related infections: Monotherapy or combination therapy.

Purpose: To evaluate the outcomes of the patients who were infected with colistin-only-susceptible (COS) Acinetobacter baumannii and treated with either colistin monotherapy or colistin combined therapy. Materials and Methods: This retrospective case-control study was conducted in the training and research hospital with an 800 beds between August 2008 and December 2011. The patients, who were infected with COS A. baumannii and received either colistin monotherapy or colistin combined therapy, were included into the study. Results: In total, 51 patients fulfilling study criteria were evaluated. Colistin monotherapy was found effective as much as colistin combined therapy in terms of clinical and microbiological responses in patients with ventilator associated pneumonia (VAP) and also in patients with blood stream infections. Conclusion: Although there is no randomised controlled study yet, colistin monotherapy and colistin combined therapy are likely to achieve similar treatment responses rates. Heteroresistant strains can emerge in patients who receive colistin monotherapy.

Tuberculous meningitis: a report of 60 adult cases / Meningitis tuberculosa: reporte de 60 casos adultos

OBJECTIVE: This was to evaluate the history, clinical and laboratory findings, outcome and prognosis of patients with tuberculous meningitis (TBM). METHOD: Between 1998 and 2009, 60 patients with TBM were evaluated, retrospectively. RESULT: Overall, 60 patients were selected, of which 33 (55%) were male. The patients' ages ranged from 14 to 62 years. In the majority of the patients, disease was in an advanced stage on admission (66% in stage III according to the British Research Council neurological criteria). The rate of complications was highest among patients in stages II and III with an overall mortality rate of 6.6% (n= 2 of stage II patients and n= 2 of stage III patients). CONCLUSIONS: Earlier admission of the patients with TBM could provide better outcomes with regard to sequelae and mortality. Fatal cases presented with rapid deterioration and were refractory to treatment.

OBJETIVO: El propósito de este trabajo fue evaluar la historia, los hallazgos clínicos y de laboratorio, la evolución, y la prognosis de pacientes con meningitis tuberculosa (MTB). MÉTODO: Entre 1998 y 2009, se evaluaron 60 pacientes con TBM, retrospectivamente. RESULTADOS: En general, se seleccionaron 60pacientes, de los cuales 33 (55%) fueron varones. La edad de los pacientes osciló de 14 a 62 años. En la mayoría de los pacientes, la enfermedad se encontraba en etapa avanzada al momento del ingreso (66% en la etapa III de acuerdo con los criterios neurológicos del Consejo Británico de Investigación). La tasa de complicaciones fue más alta entre los pacientes en las etapas IIy III con una tasa de mortalidad general de 6.6% (n = 2 en los pacientes de etapa IIy n = 2 en los pacientes de etapa III). CONCLUSIONES: El ingreso temprano de los pacientes con MTB podría proporcionar mejores resultados con respecto a las secuelas y la mortalidad. Los casos fatales se presentaron con deterioro rápido y fueron refractarios al tratamiento.

Does antimicrobial use increase the rate of antimicrobial resistance: A one year experience.

Antimicrobial resistance has been a challenge in all countries. The aim of this study is to ascertain the risk factors that predispose patients to infections with extended spectrum beta lactamase (ESBL)-producing gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA). Patients who were treated in the secondary care hospital due to infections in 2009 and their isolates were evaluated retrospectively. In total, 174 patients and their 189 isolates, which contained 36 ESBL-producing gram-negative bacteria, 112 non-ESBL-producing gram-negative bacteria, and 41 gram-positive bacteria were evaluated retrospectively. Hospitalisation in the previous 3 months, comorbidity, and usage of amoxicillin-clavulanate in the previous 3 months were determined to be the risk factors associated with infections by the ESBL-producing gram-negative bacteria. Hospitalisation was found to be a risk factor for infection with MRSA. Hospitalisation and underlying conditions increase the colonisation with resistant bacteria and resistance rates in the patients, hospitals and communities. An infection control programme should be contemplated not only for hospitals, but also for the greater community.