Is short course of antimicrobial therapy for asymptomatic bacteriuria before urologic surgical procedures sufficient?

INTRODUCTION: Duration of treatment of asymptomatic bacteriuria for patients undergoing urologic surgical procedures is undetermined. We compared the efficacy of long- versus short-course antimicrobial treatment in patients with asymptomatic bacteriuria undergoing urologic surgical procedures. METHODOLOGY: Patients were divided into two groups according to duration of antimicrobial treatment. Group A patients received a single dose of an appropriate antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the surgical procedure. If a urinary catheter was placed postoperatively, a second dose was given following the recommended dose interval. Group B patients received antimicrobial treatment prior to surgery at least until patient urine became sterile. All patients were monitored for signs and symptoms of septicemia following surgical procedures. RESULTS: None of the patients enrolled in the study developed infectious complications such as sepsis or upper urinary tract infection. In group A, 31 patients were treated with antimicrobials before 39 urological procedures. In group B, the mean treatment time for 28 patients before 30 urological procedures was 8.03 ± 3.86 days. There were also significant differences in length of stay and the cost of antimicrobial therapy between the groups (P < 0.0001). Isolation of an increased number of resistant microorganisms was associated with long course therapy in group B. CONCLUSIONS: Short course therapy protocol may be a practical, simple approach for antibiotic use; it decreases hospital stays, eliminates delayed procedure times, lowers the economic cost of antimicrobials and lessens the chance of superinfection with and spread of antimicrobial resistant microorganisms.

Nutrition assessment in critically ill patients.

BACKGROUND: The aim of this study was to assess whether subjective global assessment (SGA) is useful in identifying malnutrition and outcomes in the intensive care unit (ICU). METHODS: After obtaining institutional approval, 124 consenting patients were enrolled in this study. Patients were evaluated at admission using clinical data, SGA, height, weight, triceps skinfold thickness (TSF), mid-arm circumference (MAC), Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiologic Score (SAPS). Patients were classified as well nourished, moderately malnourished, or severely malnourished with SGA. RESULTS: According to SGA, 62% (n = 77) of the patients were classified as well nourished, 26% (n = 33) as moderately malnourished, and 11% (n = 14) as severely malnourished. Body weight, body mass index (BMI), MAC, TSF, and mid-arm muscle circumference (MAMC) were lower, whereas APACHE II and SAPS II scores and mortality were higher in the malnourished groups compared with the well-nourished group. The SGA rating correlated significantly with age, body weight, percentage of weight loss, serum albumin level, APACHE II and SAPS II scores, and mortality. Anthropometrics data were correlated with SGA. Mortality rate was correlated with high APACHE II score, SAPS II score, days in the ICU and low BMI, MAMC, and serum albumin level. CONCLUSIONS: The results support that SGA is simple and may predict the patient's outcomes in the ICU.

[Successful treatment of a patient with multidrug resistant Acinetobacter baumannii meningitis with high dose ampicillin-sulbactam]. / Coklu ilaç dirençli Acinetobacter baumannii menenjiti olgusunun yüksek doz ampisilin-sülbaktam ile basarili tedavisi.

Acinetobacter baumannii is an important pathogen which causes severe nosocomial infections such as meningitis. Multidrug resistance is a growing problem throughout the world. In this report a case of multidrug resistant A.baumannii meningitis, treated with high dose of ampicillin-sulbactam (SAM) was presented. Rhinorrhea and confusion developed on the postoperative seventh day in a 67 years old male patient operated for macroadenoma of the hyphophysis gland. Since the cerebrospinal fluid (CSF) findings indicated a central nervous system infection, nosocomial meningitis was diagnosed and intravenous ceftazidime and vancomycin have started. Blood and CSF cultures of the patient revealed no growth and his general condition has improved. However, fever and confusion emerged again on the 21st day of therapy and the repeat CSF sample revealed increased pressure, purulent appearance, 510/mm3 leukocytes (90% PMNL), 58 mg/dl glucose (simultaneous blood glucose was 144 mg/dl) and 49 mg/dl protein. Direct microscopic examination of CSF revealed gram-negative coccobacilli and A.baumannii was identified in the culture. The isolate was resistant to piperacillin-tazobactam, third generation cephalosporins, aztreonam, ciprofloxacin, carbapenems and aminoglycosides, susceptible to sulbactam ampicillin and colistin. Ampicillin (12 gr) and sulbactam (6 gr) treatment was initiated and at the 72nd hour of the therapy the temperature and conciousness level of the patient returned to normal. Control CSF sample obtained on the 14th day of treatment revealed no leukocytes and no bacterial growth. The treatment was continued for 21 days and the patient recovered without any sequela. Since colistin which is one of the alternative antimicrobial treatment choices for resistant Acinetobacter infections, is not found in Turkey, sulbactam-ampicillin might be an effective and safe choice for the treatment of multi-resistant A. baumannii meningitis if the isolate was proven to be susceptible by antibiotic susceptibility tests.