Procalcitonin in diagnosing the diabetic foot infection

Diabetic foot infection is a debilitating disease that requires prompt diagnosis and treatment. In this study, we assessed inflammatory markers; serum Procalcitonin [PCT], c-reactive protein [CRP], erythrocyte sedimentation rate [ESR] and leukocyte counts in two groups of patients with infected and non-infected diabetic foot ulcer. A descriptive cross-sectional study was carried out on diabetic patients during 18 months in Firoozgar Hospital. Patients were divided in two groups according to Infectious Disease Society of America [IDSA] guideline for diagnosis and treatment of diabetic foot infections. Blood samples were drawn from venous lines for measurement of complete blood count [CBC], ESR, CRP, and PCT. Diagnostic values of serum PCT Levels were determined by immunoluminometric assay. SPSS version 15.0 software was used for analysis. Sixty adult patients were considered for this study. Thirty patients with infected ulcer with mean age of 57.5 +/- 2.09 years and 30 with non- infected ulcers with mean age of 61.1 +/- 1.9 years were evaluated. Patients with infected ulcers had significantly elevated levels of CRP, ESR and leukocyte counts in comparison with the non- infected ulcers. Serum PCT levels did not differ between the two groups. Our study suggests CRP, ESR and Leukocyte counts can be used to diagnose of infected ulcers. The role of PCT in localized infections should be determined in further studies

Ten-year experience of rhinocerebral zygomycosis in a teaching hospital in Tehran

Rhinocerebral zygomycosis is a rare, rapidly progressive and often fatal fungal infection occurring in several immunocompromised states. Prior investigators have reported an increasing incidence among Iranian population; therefore, we decided to present the clinical features and treatment outcome of a group of patients with rhinocerebral zygomycosis. Medical records of all cases with the diagnosis of rhinocerebral zygomycosis attending Rasoule- Akram Hospital, Tehran, Iran, were retrospectively reviewed from 1997 to 2007. Age, gender, predisposing illness, surgical procedures, and treatment outcomes were reviewed. Totally, 30 patients [17 males and 13 females] were reviewed with a mean age of 49.4 +/- 20.3 years. The lag time between onset of symptoms referable to zygomycosis and commencement of amphotericin B was 1 to 90 days with median of 10 days. An association between delayed treatment and mortality was found [p=0.01]. Visual loss was observed in 53.3%. The ethmoid [86.6%] and maxillary sinuses [66.6%] were most commonly involved. Eighteen patients had underlying diabetes mellitus [60%]. All patients received medical treatment, while 28 [93.3%] underwent surgical intervention. Twenty three patients [76.7%] had orbital involvement with a mortality rate of 43.5%. The overall mortality rate was 40% [12 cases]. Patients with higher doses of amphotericin B and multiple surgical intervention had lower mortality rate [p=0.00 and p=0.01, respectively]. Factors such as age, gender, predisposing diseases, orbital involvement, multi-sinus involvement, and white blood cell count had no impact on survival rate. Institution of aggressive surgical debridement of devitalized tissue and the timely initiation of systemic medical therapy is critical for good outcome

Comparing community acquired pneumonia between elderly population and others

To evaluate the manifestations and outcome of community acquired pneumonia in elderly population and compare it with other adults in two teaching hospitals. A prospective study including all patients over 14 years of age admitted to our hospitals with community acquired pneumonia, was carried out over a period of 12 months. All adult patients and over 65 years old [elderly patients] diagnosed with pneumonia were examined and followed by two of the authors distinctly. Analysis was performed, using chi square, in order to find correlations between signs and symptoms of pneumonia and age. Totally, 183 patients [103 elderly] were studied. The mean age of the participants [ +/- SD] was 59 +/- 24 years. The main manifestations of pneumonia in elderly patients were as follow: tachypnea [64%], cough [62%], and fever [34%], respectively. Our results showed that the frequency of fever [p=0.04], chest pain [p=0.001], and pleuritic pain [p=0.001] decrease with aging, however, mental status changes [p=0.015], and CHF [p=0.02] increase with aging. Thirty one patients [17%] died, of whom 29 were over 65 years of age [p=0.01]. The clinical presentations of pneumonia in the elderly population can be different from those in younger patients, therefore, it is important to be familiar with these differences to avoid unnecessary delays in prompt diagnosis

Bacteriological profile and antimicrobial resistance of blood culture isolates

Bloodstream infection [BSI] is an important cause of mortality and morbidity and among the most common health-care associated infections. In this study we described the frequency of occurrence and antimicrobial susceptibility patterns of nosocomial and community-acquired BSI isolates from a teaching hospital in Tehran, Iran. his cross-sectional study was conducted in 850-bed Rasul Akram university hospital from April 2006 to April 2007. All patients with a positive blood culture were enrolled. Antimicrobial susceptibility testing was performed with disk diffusion and E-test MIC. During the study period, 456 isolates were obtained from blood cultures, from a total of 8818 collected sets, among which 291 were felt to represent true bacteremia and 98 were nosocomial. Acinetobacter spp. were the most frequently isolated agents in the hospital and community acquired BSIs [32%], followed by Escherichia coli [13.7%] and Klebsiella spp. [12%]. The most effective antibiotics for gram-negative and gram-positive bacteria were ciprofloxacin [13% resistance rate] and vancomycin and oxacillin [with 13% resistance rate], respectively. Analysis of antibiotic resistance pattern showed that 20.43% of Acinetobacter spp. and 15.4% of Pseudomonas aeruginosa were multi drug resistant [MDR], while 48.7% of Kiebsiella spp were ESBL-producing isolates and 15% of Staphylococcus aureus were oxacillin-resistant. We did not observe any vancomycin-resistant strains among isolates of S. aureus. Rifampin and ciprofloxacin showed good activity against most of gram-positive and gram-negative organisms, respectively. Carbapenems [imipenem and meropenem] were highly active against strains of Enterobacteriaceae [E. coli, Klebsiella] that showed resistance to third generation of cephalosporines

Evaluation of diabetes mellitus in patients with sepsis

Diabetes mellitus is a prevalent disease worldwide and infection is a major problem in diabetics. This study investigated the frequency of diabetes mellitus and its associated factors in patients with sepsis. This is a descriptive cross-sectional study including 300 randomly selected cases admitted to Rasoul-e-Akram Hospital with the diagnosis of sepsis between March 2003 and February 2006. Of 300 septic patients, 158 [52.7%] had diabetes mellitus with the mean age [ +/- standard deviation] of 52.7 +/- 28.4 years. The most common site of infection was respiratory tract. Evaluation of the outcome of patients in two diabetic and non-diabetic groups demonstrated a statistical difference [p=0.001]. Mortality rate increased with aging, delay in therapy commencement and the number of SIRS criteria [p=0.001]. Evaluation of the mortality rate in 3 diabetic groups [blood glucose> 250, 180-250 and <180 mg/dl] demonstrated a statistical difference [P= 0.001]. Aging can increase the rate of sepsis and its associated mortality in both diabetic and non-diabetic patients. Mortality of sepsis is more in diabetics when compared with non-diabetics. Severity of disease [further SIRS criteria] increases mortality and tight control of blood glucose may be associated with better prognosis