[Current status of nosocomial infections in the Lebanese Hospital Center, Beirut]. / Aspects actuels des infections nosocomiales au Centre Hospitalier Libanais de Beyrouth.

Nosocomial infections are a significant problem and hospitals need to be aware of their nosocomial infection status. This retrospective study aimed to identify nosocomial bacterial infections in patients admitted to the Lebanese Hospital Center from January 2006 to January 2008 and determine the causative micro-organisms, the antibiotic sensitivity of the micro-organisms and evaluate the hospital treatment. In total 96 patients with nosocomial infection were included. Urinary infections were the commonest nosocomial infections (42%) followed by pulmonary infections (28%). Gram-negative bacteria were responsible for 89% of nosocomial infections and staphylococci for 7%, with Escherichia coli and Pseudomonas aeruginosa being the most common (46% and 26% respectively). The organisms were resistant to multiples antibiotics and 18% of the patients were treated with imipenem, 7% with vancomycin, 42% with third-generation cephalosporins and 24% with amikacin. Hospital hygiene measures and antibiotic prescription policies are required to fight nosocomial infections and reduce antibiotic resistance among organisms.

Current status of nosocomial infections in the Lebanese Hospital Center, Beirut

Nosocomial infections are a significant problem and hospitals need to be aware of their nosocomial infection status. This retrospective study aimed to identify nosocomial bacterial infections in patients admitted to the Lebanese Hospital Center from January 2006 to January 2008 and determine the causative micro-organisms, the antibiotic sensitivity of the micro-organisms and evaluate the hospital treatment. In total 96 patients with nosocomial infection were included. Urinary infections were the commonest nosocomial infections [42%] followed by pulmonary infections [28%]. Gram-negative bacteria were responsible for 89% of nosocomial infections and staphylococci for 7%, with Esherichia coli and Pseudomonos alrogenosa being the most common [46% and 26% respectively] The organisms were resistant to multiples antibiotics and 18% of the patients were treated with imipenem, 7% with vancomycin, 42% with third-generation cephalosporins and 24% with amikacin. Hospital hygiene measures and antibiotic prescription policies are required to fight nosocomial infections and reduce antibiotic resistance among organisms

[Acute interstitial pneumopathy with fever caused by hydroxyurea]. / Pneumopathie interstitielle aiguë fébrile à l'hydroxyurée.

BACKGROUND: Hydroxyurea has few side effects excepting the known bone marrow toxicity. Fever with or without pneumonia has occasionally been reported. CASE REPORT: A patient given hydroxyurea for polycythemia suddenly developed severe interstitial pneumonia with fever and hypoxemia. All bacteriological tests were negative and an empirical antibiotic regimen was ineffective. Fever recurred after reintroducing hydroxyurea and definitive cure was achieved after its withdrawal. The clinical course was rapidly favorable without the need for corticosteroids. DISCUSSION: Fever, and in some cases interstitial pneumonia, in patients given hydroxyurea generally suggests an infection. However, 15 cases of pneumonia have been reported as caused by hydroxyurea in patients treated for a myeloproliferative syndrome. Delay to onset is 3 to 8 weeks after initiating treatment. The course is favorable after withdrawal, with or without corticosteroids. Fever may be the only sign of a drug reaction, resolving with withdrawal and recurring at re-challenge. The underlying mechanism remains unknown. Definitive cure can be achieved by discontinuing hydroxyurea, avoiding the need for further investigations.

Glomerular disease during HCV infection in renal transplantation.

In general nephrology, HCV infection has been associated with type I membranoproliferative glomerulonephritis (MPGN type I) associated with cryoglobulinaemia. In a cohort of 399 renal transplantation (RT) recipients, 117 of whom (29%) were HCV-positive, we selected all patients diagnosed as having membranous GN or type I MPGN by graft biopsy. The prevalence of MGN was 16/399 (4%) with three recurrences, and 13 de novo cases. Only 5/16 (31%) were HCV+, not different from the general RT population. Five patients had an outcome of graft failure after 43 months. Conversely, there were 15 cases of type I MPGN (two recurrences, 13 de novo) but with eight HCV+ recipients (53%, P = 0.02). Considering only the French patients, prevalence was 44% vs 12% in the French RT population (P = 0.006). Eight patients had graft rejection after 59 months (five HCV+). In this type I MPGN subgroup, there were two positive cryoglobulins, two rheumatoid factors and four hypocomplementaemias. In conclusion, there is a clear association between HCV infection and the occurrence of type I MPGN in the allograft in renal transplantation, with terminal renal failure as an outcome.

Subcutaneous versus intravenous administration of erythropoietin improves its efficiency for the treatment of anaemia in haemodialysis patients.

Recombinant human erythropoietin (rHuEpo) seems to be more efficient when given subcutaneously (SC) instead of intravenously (IV) for therapy of anaemia in haemodialysis patients. This was a cross-over study designed to assess the efficiency of rHuEpo when given SC rather than IV in a 1 year follow-up. Sixteen patients received IV rHuEpo for 6 months, then SC rHuEpo for 6 months. They were four males and 12 females with a mean age of 56 years (range 15-82). Haemoglobin concentration ([Hb]) was kept at 10 g/dl and transferrin saturation (TS) at more than 25%. Mean [Hb] was 9.7 +/- 1.0 g/dl with IV rHuEpo and 9.9 +/- 0.9 g/dl with SC rHuEpo (NS). Transferrin saturation was 27% before rHuEpo, 31% with IV rHuEpo and 34% with SC rHuEpo (NS vs IV rHuEpo). Serum ferritin was 691 +/- 113 ng/ml before rHuEpo, 652 +/- 94 ng/ml with IV rHuEpo and 997 +/- 132 ng/ml with SC rHuEpo (P < 0.05 vs IV rHuEpo). Intact parathyroid hormone was 354 +/- 83 pg/ml before rHuEpo, 201 +/- 63 pg/ml with IV rHuEpo and 122 +/- 33 pg/ml with SC rHuEpo (NS vs IV rHuEpo). Doses of IV rHuEpo were 156 +/- 24 U/kg/week and SC rHuEpo 74 +/- 13 U/kg/week (i.e. a saving of 53%; P < 0.001). We conclude that subcutaneous administration of rHuEpo is twice as efficient as IV rHuEpo in patients with good functional iron reserve.