RESUMEN
Background and objectives: acinetobacter baumannii [A. baumannii] septicemia is an important cause of morbidity and mortality in neonates hospitalized in neonatal intensive care units [NICUs]. The difficulty of treating A. baumannii nosocomial infection is associated with the high resistance to a wide range of antimicrobial agents. We aimed to find the role of A. baumannii as a nosocomial pathogen causing neonatal septicemia with special concern on risk factors for their acquisition and metallobetalactamases [MBLs] production, aiming to implement infection control program and treat infections
Material and Methods: this study was conducted over 22 month period and included 272 neonates with suspected septicemia admitted to NICU, Mansoura University Children's Hospital. Blood samples were cultured from all cases. A. baumannii identification, susceptibility testing and MBL production using double-disc synergy test [DDST] and combined-disc test [CDT] were performed. Multiplex polymerase chain reaction [PCR] assay was done to detect and differentiate the five families of acquired MBL genes IMP, VIM, SPM, GIM and SIM in a single reaction
Results: A. baumannii was detected in 23/272 [8.45%]. Associated risk factors included low birth weight, the use of central venous catheters, mechanical ventilation and prior antibiotics use. Case fatality rate was 6/23[26.1%]. Resistance to imipenem was 8/23 [34.78%]. Resistance to other antimicrobials was 7[30.4%] meropenem, 12[52.17%] piperacillintazobactam, 11[47.8%] tobramycin, 18[78.26%] ceftazidime and 13[56.52%] ciprofloxacin. Of 8 imipenem-resistant isolated clinical strains 3[37.5%] and 2 [25%] were positive for MBL production by DDST and CDT respectively. PCR analysis revealed the presence of blaVIM gene in 1 [12.5%] isolate and blaIMP gene in 3 [37.5%] isolates. No imipenem-resistant A. baumannii isolates that harbored bla SPM, SIM or bla GIM were detected. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for DDST were 75% , 100% , 88% , 100% and 80% respectively and for CDT, they were 50% , 100% , 75% , 100% and 66.7% respectively. Interestingly, 1 [6.7%] imipenem sensitive isolate was positive MBL producer as harboring blaIMP gene by PCR
Conclusion: MBL producing A. baumannii prevalence is considerable and alarming in NICU and is associated with significant infant fatality. We recommend the consistent and constant surveillance of such strains for the amendment of empirical antimicrobial therapy and probably the reduction of mortality rates for neonates infected with MBL- producing isolates and avoiding the intra-hospital dissemination of such strains
RESUMEN
Introduction: iliac angioplasty represents an important skill for the cardiovascular interventionist to master, not only to relieve patients lower extremity symptoms, but also to preserve vascular access for what may be lifesaving cardiovascular therapies such as coronary angioplasty or intra aortic balloon counter pulsation
Aim of the work: to evaluate the preliminary results of angioplasty in management of chronic iliac occlusive disease in Nasr City Insurance Hospital in 32 months
Patients and methods: a prospective study was done in 9-patients presented to Nasr City Insurance Hospital during the period between Nov. 2000 to May 2003 complaining of intermittent claudication [77.8%], rest pain [33.3%] and/or peripheral ulcer and gangrene [66.6%]. Angioplasty was an intermediate stage before surgery in 5-patients [55.6%] changing surgery from a major one [from the aorta] to a simpler one from the femoral artery] to a diffusely diseased peripheral vessels
Results: a successful angioplasty was done for all cases [7-right and 2-left iliac arteries]. PTA was enough with good results in 6-patients. PTA balloon dilatations and stenting was done for 3-patients. We considered our angioplasty procedure is technically successful if the residual stenosis is lower than 30% of the reference diameter. Follow up: Post intervention period passed smoothly in 7patients hut unfortunately, 2 patients died during follow up. NO mortality was related to the procedure. Patient [No.1] died 23 days after angioplasty due to septicemia and secondary infection after fern-pop. Bypass. The second patients [No.4] died 6-days after angioplasty due to AMI
Conclusion: angioplasty has the following advantages: -Lower initial procedure related morbidity and mortality. -No need for general an aesthesia. -Shorter hospital stay, and less trauma