Assessment of bloodstream infections and risk factors in an intensive care unit.

BACKGROUND/AIM: Nosocomial bloodstream infection (BSI) increases mortality rates, duration of stay in hospital, and treatment costs. This study was conducted to determine the rate and the risk factors of BSIs among intensive care unit patients. MATERIALS AND METHODS: Sixty-four patients with BSIs (patient group) and 79 patients without a nosocomial infection (control group) were enrolled in the study. Centers for Disease Control and Prevention criteria were used for diagnosing BSIs. Potential risk factors were evaluated by multivariate logistic regression model. RESULTS: The BSI development rate was 15.7% (64/407), with an incidence rate of 18.2/1000 patient days. Distribution of pathogens among BSI patients were as follows: gram-positive cocci, 42.18% (27/64); gram-negative cocci, 34.3% (22/64); and Candida spp., 23.4% (15/64). Risk factors were determined as intubation, arterial catheter, tracheostomy, duration of intubation, duration of catheter use, duration of nasogastric catheter, underlying diseases of chronic renal failure and diabetes mellitus, implemented treatments of sedation and enteral nutrition, and APACHE II score. CONCLUSION: : BSIs are the leading cause of mortality and morbidity in intensive care unit patients. Determination of the local risk factors is important and necessary for decreasing the rate of BSIs and the mortality rates.

TNF-alpha, TGF-beta, IL-10, IL-6 and IFN-gamma gene polymorphisms as risk factors for brucellosis.

Polymorphisms in the regulatory regions of cytokine genes can affect the level of cytokine production, and may be associated with predisposition to infectious diseases as well as different clinical outcomes. The aim of this study was to investigate the association of the polymorphisms of IL-6 (-174), IL-10 (-1082, -819), IFN gamma (+874), TGF beta (codon 10, codon 25) and TNF alpha (-308) genes with brucellosis in terms of susceptibility and resistance to the disease or occurrence of focal complications. A case control study was carried out in 85 patients with brucellosis and 85 healthy controls. We studied the polymorphisms of IL-6, IL-10, IFN-gamma, TGF-beta 1 and TNF alpha genes, using the polymerase chain reaction with sequence-specific primers. The IL-10 CT, TGF-beta 1 codon 10 CC and TGF-beta 1 codon 25 GG genotypes were significantly more frequent in the patients compared to the controls. The IL-10 CC genotype was higher in the controls than in the patients. In addition, the IL-6 (-174) GG genotype was more frequent in the patients without focal forms, while the GC genotype was more frequent in the patients with focal forms. Our results showed that polymorphisms of IL-10 (-819) and TGF beta 1 codons 10 and 25 were associated with susceptibility or resistance to brucellosis. The IL-6 (-174) GC genotype may be a risk factor for the development of focal complications of brucellosis, whereas the GG genotype may be a protective factor against brucellosis.

Predictive value of clinical and laboratory findings in the diagnosis of the enteric fever.

Although the definitive diagnosis of enteric fever requires the isolation of Salmonella enterica serotype typhi or paratyphi, the diagnosis is usually made according to clinical and laboratory findings. There is usually a diagnostic dilemma. The aim of this study was to determine the minimum required parameters that could be valuable in the diagnosis of enteric fever. A retrospective study was performed to compare the clinical and laboratory findings in 60 patients who proved to have enteric fever by cultures and 58 patients with non-enteric fever. Features independently predictive of enteric fever were assessed by multivariate logistic regression. Sensitivity, specificity and positive predictive and negative predictive values were estimated. Significant clinical features of enteric fever were hepatomegaly, splenomegaly, relative bradycardia, rose spots, leucopenia, trombocytopenia, eosinopenia and elevated AST level. Five of these features were found to be predictive for the diagnosis of enteric fever; splenomegaly, relative bradycardia, rose spots and trombocytopenia and elevated AST level. In conclusion, clinical and laboratory findings can help the clinician to diagnose enteric fever in the absence of microbiological confirmation.