[ prospective study of 34 cases of hospital and community-acquired klebsiella pneumoniae bacteremia]

This prospective study attempted to determine the epidemiology, clinical manifestations and prognosis of patients with hospital and community-acquired bacteremia of Klebsiella pneumoniae. From July 1, 2004, to March 31, 2005, we prospectively studied 34 episodes of klebsiella pneumoniae bacteremia in 34 patients, treated in Imam Reza Hospital, Mashhad-IRAN. The disease was nosocomially acquired in 58.8% and community acquired in 41.2%. The different types of infection were sepsis [44.1%], burn wounds [26.5%], pneumonia [1 1.8%] endocarditis [2.9%], urinary tract infection [2.9%], and hepatic abscesses [2.9%]. Bum which was found in 9 [45%] patients, was the most common underlying disease, followed by renal failure in 3 [15%], Diabetes mellitus in 2 [10%], leukemia in 2 [10%], and intravenous drug abuse in 1 [5%]. The most frequent clinical findings in adult patients were fever [100%], leukocytosis [75%], thrombocytopenia [45%], jaundice [40%], cough [30%], tachycardia [30%], tachypnea [25%], rigors [25%], Hemoptysis [15%] and anemia [11.1%]. Carbenicillin and ciprofloxacin were the most active antibiotics. We observed that nosocomial infections are more prevalent than community aquired. Sepsis without focous, burn and neonatal infections were some of the most significant diseases in this study

[Epidemiologic study of virus genotypes in chronic hepatitis C]

Hepatitis C is an emerging infection in Iran especially due to unsafe sharing between IVDUs. HCV genotype has an important rolexCn clinical decision - making and drug therapy protocols. Up to now data is restricted and controversial in Iranian patients especialy in Mashhad. This descriptive study was done in the hospitals belonging to Mashhad University of Medical Sciences during the years 1382 - 83. We included 63 patients that hepatitis C was confirmed in them by routine HCV RNA PCR method. The test was done in a single lab all by one person by primer-specific method. Genotype of the virus was analyzed against risk factors in patients. Personal and laboratory data collected in a questionare were analyzed by qualitive statistics. Relative frequency of different genotypes and subtypes were: 3 [52.3%], 1[30.1%], 2[15.9%] and mixed [1.6%]. The relative frequency of genotypes was significantly different in hemophilic patients from others [80% from genotype 1]. Relative frequency of Genotype 3 in thalasemics, hemodialysis patients, IVDUs and Blood donors was 66.7%, 66.6%, 55. 44% and 46.18% respectively. According to genotyping results about 2/3 of patients are categorized in 'easy - to - treat' group, but no discriminative factor could be estimated to differentiate this group of patients that need shorter courses of therapy with lower doses. So genotyping is still necessary for clinical decision making

[Native Tricuspid valve endocarditis in the absence of intravenous drug use]

We presented two non-addicted patients with Tricuspid valve endocarditis. The first patient was a 38-year-old diabetic female with; fever chills, anemia, and microscopic hematuria and pyuria that occurred during several weeks. The plain radiography of chest was normal and high resolution computed tomography [HRCT] of chest, was done because of predominant pulmonary symptoms and signs that revealed consolidation and cystic formation in the left parynchyma. Based on these findings in HRCT we decided to start anti-tuberculosis treatment, but no significant response was seen. Tran's Thoracic Echocardiography [TTE] was done and revealed large vegetation of Tricuspid valve. The second patient was a 45 -year-old man who admitted with acute fever and left lower lobe infiltrate and systolic murmur. TTE was normal but Trans Esophageal Echocardiography showed large vegetation on the Tricuspid valve. Staphylococcus aurous grew in 2/3 blood cultures. We suggest that right-sided endocarditis must be considered in any patient with fever and recurrent pulmonary symptoms and signs, with or without abnormal chest X- ray, heart murmur or intravenous drug addiction

[Evaluation of antibiotics use in medical emergency, pediatric emergency, infectious diseases and surgical wards of imam reza general hospital, 2002, mashhad, iran]

The most serious result of inappropriate usage of antibiotics is increased prevalence and emergence ofmultidrug resistant organisms. We studied antibiotic prescribing for hospitalized patients in Infectious diseases, Medical emergency, Pediatric emergency and General Surgery wards of Imam Reza hospital for 4 months. We completed 535 questionnaire forms and evaluated them. Inappropriate usage of antibiotics was 100%, 66.2%, 84.96%, 50.77% in general surgery, infectious diseases. Medical emergency and pediatric emergency wards, respectively. The most common error in antibiotic prescribing in surgery ward was related to the time of prophylactic antibiotic use preoperatively. However, the most common error in antibiotic usage in medical wards except pediatric emergency ward was improper dosage of antibiotics, and in pediatric emergency ward was inappropriate choosing of antibiotics. In our study, inappropriate use of antibiotics was in unacceptably high and much higher than most other countries