[A report of rarely observed resistance pattern to carbapenems in a clinical isolate of Enterobacter cloacae]. / Prikaz rijetko videnog oblika otpornosti na karbapeneme u vrste Enterobacter cloacae.

The paper reports on the emergence of strain in which Enterobacter cloacae has demonstrated an unusual form of resistance to carbapenems mediated by enzyme IMI-1, class A beta-lactamase. The strain was isolated from a wound swab in the patient who had a surgical wound infection previously treated with meropenem. Limited choice of antibiotics that can treat infections caused by these pathogens indicates the necessity of accurate identification of multiple resistant gram-negative microorganisms and mechanisms of their resistance. Recognition of multiresistant gram-negative microorganisms emphasizes the importance of continuous microbiological monitoring of patients, especially in intensive care units. In the investigated institution there was no secondary spread of this strain. Identifying new mechanisms of resistance will be helpful to clinicians in selection of targeted therapy, while important for efficient prevention of spreading infections caused by multiple resistant microorganisms.

Combined surgical approach to carotid and coronary artery disease.

The aim of this study was to compare two different surgical approaches to patients with coexistent significant carotid and coronary artery obstruction. Patients were treated with combined operation of carotid endarterectomy and coronary artery bypass grafting (CEA/CABG). The first group of patients underwent the CABG procedure with the cardiopulmonary bypass (CPB) on arrested heart and the second group without the CPB on a beating heart--off pump. Between May 15 1998, and October 9 2003, thirty-five consecutive patients underwent the combined procedure. In both groups there were no cases of transient or permanent perioperative neurological events. Overall, early mortality was 5.6%. The incidence of a perioperative myocardial infarction was 5.5%. In the follow-up period there were no cases of late stroke. According to the presented results in this study, it was found that the combined CEA and CABG is an equally safe and effective procedure performed with or without cardiopulmonary bypass for patients with a severe coexistent carotid and coronary artery disease.