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B2.1 Emerging infection at the UST hospital: Burkholderia cepacia bacteremia
Free Papers/International Journal of Antimierobial Agents 26S (2005) $65 Sl12
Setting: Tertiary university hospital Study Population: All patients, adults and children, with B. cepacia baeteremia Methodology: Review of charts of all patients at the University of Santo Tomas Hospital with B. cepacia bacteremia from January 2002-Decenlber 2003 Results: Out of 53 patients reported with B. cepacia bacteremia, only 41 records were available for review. Twenty three (56%) were males and 18 (44%) females. Thirteen (32%:) were children (<18 years old) and twenty nine (68%) adults. Mean age was 36.48 years. Fifty s£x percent (56%:) had nosocomial bacteremia, wtfile 44% acquired tile BurkJwkieria infection in tile community. Twenty seven of tile 41patients (66%1) had medical problems only, wtfile 14 (134%) were admitted due to sul~gical problems. Ninety percent (37/41) had signs and symptoms of sepsis 83% had fever, 73% had tachycardia; 71% hadtachypnea and only 54% manifested with leukocytosis. Associated co morbid conditions included: diabetes mellitus (24%), use of aerosols (24%1), malignancy (20%1), renal failure (15%1), previous cerebrovasculas accidents (112%1), prior steroid use (> 10 mg/day) (6%1); chronic obstructive puhnonary disease (2%1), congestive heart failme (:2%), multiple congenital anomalies (2%:), systemic lupus erythematosus (:2%) and trauma due to electrical burns (:2%:). There were six patients who had intravenous central line but only one patient grew B. eepaeia from tile vaaculax tip. Fourteen patients had indwelling urine catheter, but only one patient had simultaneous growth of B. cepacia from tile urine and tile blood. Seventy-one percent (171%1) received antimicrobial therapy prior to tile development of bacteremia; majority of cases were secondary bacteremia with the following common sources of infection lungs (41%:); urinary tract (:17%:); and abdominopelvic area (17%). Seventy percent (:70%:) improved, 12% transferred and 15% died two deaths (5%:) were directly related to B. cepacia bactelemia. Medications used in treatment included: B-lactams (193%1), quinolones (132%1), TMP-SMX (134%1) and chloramphenicol (4%). B. cepacia was noted to be higtdy sensitive to the following drugs: imipenem cflastatin (97.5%:) piperacillin tazobactam (:90%:), and ceftazidime (:87.5%:), while the organism was noted to be highly resistant to gentamicin (95%:) and amikacin (75%). Conclusion: BurkhoMeria eepaeia has been widely considered as a noancomial pathogen but there is also an increasing trend of B. cepacia infection acquired from tile community. Majority had sepsis with tile lungs, urinary tract and abdominopelvic area as tile most common foci of infection. Mortality was low. Imipenem, piperacillin tazobaetam and ceftazidime were noted to have good activity against B. eepacia while resistance to aminoglycosides was high.
B2.3 A Comparative Study of the Efficacy of Oral Ribavirin for Crimean-Congo Hemorrhagic Fever in Patients Treated during the Initial 5 Days vs after 5 Days of the Disease, Southeast I r a n Malihe METANAT, Batool SHARIFI MOOD, Masoud SALEHI. Boo-All
Hospital, Zahedan, Iran
Objectives: To evaluate the efficacy of oral ribavirin administered at different time periods in the course of confirmed Crimean~ongo Hemmrhagic Fever (CCHF) Significance: CCHF is a fatal vn'al disease that occurs in some parts of Asia, Africa, Eastern Europe and tile Middle-East. Recently outbreaks have been reported from Pakistan, Afghanistan and Iran. Now Southeast of Iran is an endemic area for this disease. In the last 3 decades, there has been no appropriate therapy available for patients with CCHF. Now ribavirin has been successfully used in tile treatment of patients with CCHF. Study Design: Retrospective study Setting: Boo-Aft Hospital, Zalledan, ftan Population: Confirmed CCHF cases who were treated in the Boo Ali Hospital in the last 5 years Methodology: We evaluated the efficacy of oral ribavirin in the treat ment of 179 confilrned CCHF cases by comparing tile outcome (recovery
$85
or death) in two groups of patients. Tile first group were patients treated during the initial 5 days of illness and in the second group, patients who were treated after 5 days of illness. Results: Of 179 established CCHF eases, 145 cases recovered and 34 cases (19%1) died. Of 179 cases, 109 cases (161%1) were treated with ribavirin during tile initial 5 days of disease. In this group 85% (193 patients) survived mid 15% (116 cases) expired. Of 70 patients who were treated after 5 days of disease, 74% (52 cases) survived and 26% (18 cases) died. The recovery rate was higher in the patients who were treated during the initial 5 days (Relative risk 1.75; 95% CI 0.96 3.2; P=0.06; absolute risk increase 0.09) Cmlclusion: Oral ribavirin can be an effective medical therapy for management of Crimean-Congo hemmrhagic fevea ff patients are treated with ribavirin during the initial 5 days of disease.
B2.5 Current Clinical and Microbiological Profile of Infective Endocarditis in UERMMMC Leall Divina G. MABILANGAN, Adrian C. PEI~A, Masio M. PANALIGAN. University of the East-Ramon Magsaysay Memorial
Medical Center (UERMMMC), Quezon City, Philippines
Objective: To investigate tile current clinical and microbiological profile of Infective Endocaxditis in UERMMMC; and to compare tile results of the study with previous studies to determine any change in the profile of the disease Significance: Infective endocarditis (IE) is a potentially life threatening disease that requires institution of effective therapy under tile colTect diagnosis. Tile advent of Duke's criteria enhanced tile sensitivity of diagnosing IE. Likewise, tile improvement in microbial diagnosis and mltimicrobial selection has led to the improvement in its outcome. Study Design: Retrospective Setting: University hospital Population: Hospitalized patients with IE MetftodMogy: From 1999 to 2004, 23 cases of Infective Endocaxditis were reviewed retrospectively. The demographics, clinical characteristics, echocasdiographic findings, culture results, treatment and outcomes were gathered and analyzed. Results of the present study were compared to previous local data. Results: Of the 23 eases reviewed, 12 were males and 11 females, with a mean age of 39 years (range 6 to 851) Rheumatic beast disease was tile major predisposing cardiac abnomlality (74%). Tile anulve of bactelemia could not be identified in most patients. The mean duration of symptoms before presentation was 22.6 days. Fever (:95.6%) was the most common symptom and an audible heart murmur (95.6%:)was the most frequent sign. Leukocytosis (82.6%:) was the most frequent laboratory abnormality noted. Tbere was an almost equal involvement of tile aortic (30%1) and rm~ral (26%) valves. Blood culture isolation rate was high in this series (83%), with Gram-positive cocci (70%1) as tile most predominant m~ganisms. Tile in hospital mortality rate in this series was 26%. Compared to the previous study done in UF~MMMC (:1960 1975:), the age and sex distribution, predisposing cardiac abnormality and clinical manifestations were similar, though there was a higher isolation rate of m~ganisms mid a slightly lower mortality rate in tile present study. Cmlclusion: Tbere has been no sigllificmrt change in tile clinical profile of Infective Endocarditis in UF~MMMC. A slight decrease in mortality rate can be attributed to improvement in microbial diagnosis and antimicrobial selection.
Setting: Tertiary university hospital Study Population: All patients, adults and children, with B. cepacia baeteremia Methodology: Review of charts of all patients at the University of Santo Tomas Hospital with B. cepacia bacteremia from January 2002-Decenlber 2003 Results: Out of 53 patients reported with B. cepacia bacteremia, only 41 records were available for review. Twenty three (56%) were males and 18 (44%) females. Thirteen (32%:) were children (<18 years old) and twenty nine (68%) adults. Mean age was 36.48 years. Fifty s£x percent (56%:) had nosocomial bacteremia, wtfile 44% acquired tile BurkJwkieria infection in tile community. Twenty seven of tile 41patients (66%1) had medical problems only, wtfile 14 (134%) were admitted due to sul~gical problems. Ninety percent (37/41) had signs and symptoms of sepsis 83% had fever, 73% had tachycardia; 71% hadtachypnea and only 54% manifested with leukocytosis. Associated co morbid conditions included: diabetes mellitus (24%), use of aerosols (24%1), malignancy (20%1), renal failure (15%1), previous cerebrovasculas accidents (112%1), prior steroid use (> 10 mg/day) (6%1); chronic obstructive puhnonary disease (2%1), congestive heart failme (:2%), multiple congenital anomalies (2%:), systemic lupus erythematosus (:2%) and trauma due to electrical burns (:2%:). There were six patients who had intravenous central line but only one patient grew B. eepaeia from tile vaaculax tip. Fourteen patients had indwelling urine catheter, but only one patient had simultaneous growth of B. cepacia from tile urine and tile blood. Seventy-one percent (171%1) received antimicrobial therapy prior to tile development of bacteremia; majority of cases were secondary bacteremia with the following common sources of infection lungs (41%:); urinary tract (:17%:); and abdominopelvic area (17%). Seventy percent (:70%:) improved, 12% transferred and 15% died two deaths (5%:) were directly related to B. cepacia bactelemia. Medications used in treatment included: B-lactams (193%1), quinolones (132%1), TMP-SMX (134%1) and chloramphenicol (4%). B. cepacia was noted to be higtdy sensitive to the following drugs: imipenem cflastatin (97.5%:) piperacillin tazobactam (:90%:), and ceftazidime (:87.5%:), while the organism was noted to be highly resistant to gentamicin (95%:) and amikacin (75%). Conclusion: BurkhoMeria eepaeia has been widely considered as a noancomial pathogen but there is also an increasing trend of B. cepacia infection acquired from tile community. Majority had sepsis with tile lungs, urinary tract and abdominopelvic area as tile most common foci of infection. Mortality was low. Imipenem, piperacillin tazobaetam and ceftazidime were noted to have good activity against B. eepacia while resistance to aminoglycosides was high.
B2.3 A Comparative Study of the Efficacy of Oral Ribavirin for Crimean-Congo Hemorrhagic Fever in Patients Treated during the Initial 5 Days vs after 5 Days of the Disease, Southeast I r a n Malihe METANAT, Batool SHARIFI MOOD, Masoud SALEHI. Boo-All
Hospital, Zahedan, Iran
Objectives: To evaluate the efficacy of oral ribavirin administered at different time periods in the course of confirmed Crimean~ongo Hemmrhagic Fever (CCHF) Significance: CCHF is a fatal vn'al disease that occurs in some parts of Asia, Africa, Eastern Europe and tile Middle-East. Recently outbreaks have been reported from Pakistan, Afghanistan and Iran. Now Southeast of Iran is an endemic area for this disease. In the last 3 decades, there has been no appropriate therapy available for patients with CCHF. Now ribavirin has been successfully used in tile treatment of patients with CCHF. Study Design: Retrospective study Setting: Boo-Aft Hospital, Zalledan, ftan Population: Confirmed CCHF cases who were treated in the Boo Ali Hospital in the last 5 years Methodology: We evaluated the efficacy of oral ribavirin in the treat ment of 179 confilrned CCHF cases by comparing tile outcome (recovery
$85
or death) in two groups of patients. Tile first group were patients treated during the initial 5 days of illness and in the second group, patients who were treated after 5 days of illness. Results: Of 179 established CCHF eases, 145 cases recovered and 34 cases (19%1) died. Of 179 cases, 109 cases (161%1) were treated with ribavirin during tile initial 5 days of disease. In this group 85% (193 patients) survived mid 15% (116 cases) expired. Of 70 patients who were treated after 5 days of disease, 74% (52 cases) survived and 26% (18 cases) died. The recovery rate was higher in the patients who were treated during the initial 5 days (Relative risk 1.75; 95% CI 0.96 3.2; P=0.06; absolute risk increase 0.09) Cmlclusion: Oral ribavirin can be an effective medical therapy for management of Crimean-Congo hemmrhagic fevea ff patients are treated with ribavirin during the initial 5 days of disease.
B2.5 Current Clinical and Microbiological Profile of Infective Endocarditis in UERMMMC Leall Divina G. MABILANGAN, Adrian C. PEI~A, Masio M. PANALIGAN. University of the East-Ramon Magsaysay Memorial
Medical Center (UERMMMC), Quezon City, Philippines
Objective: To investigate tile current clinical and microbiological profile of Infective Endocaxditis in UERMMMC; and to compare tile results of the study with previous studies to determine any change in the profile of the disease Significance: Infective endocarditis (IE) is a potentially life threatening disease that requires institution of effective therapy under tile colTect diagnosis. Tile advent of Duke's criteria enhanced tile sensitivity of diagnosing IE. Likewise, tile improvement in microbial diagnosis and mltimicrobial selection has led to the improvement in its outcome. Study Design: Retrospective Setting: University hospital Population: Hospitalized patients with IE MetftodMogy: From 1999 to 2004, 23 cases of Infective Endocaxditis were reviewed retrospectively. The demographics, clinical characteristics, echocasdiographic findings, culture results, treatment and outcomes were gathered and analyzed. Results of the present study were compared to previous local data. Results: Of the 23 eases reviewed, 12 were males and 11 females, with a mean age of 39 years (range 6 to 851) Rheumatic beast disease was tile major predisposing cardiac abnomlality (74%). Tile anulve of bactelemia could not be identified in most patients. The mean duration of symptoms before presentation was 22.6 days. Fever (:95.6%) was the most common symptom and an audible heart murmur (95.6%:)was the most frequent sign. Leukocytosis (82.6%:) was the most frequent laboratory abnormality noted. Tbere was an almost equal involvement of tile aortic (30%1) and rm~ral (26%) valves. Blood culture isolation rate was high in this series (83%), with Gram-positive cocci (70%1) as tile most predominant m~ganisms. Tile in hospital mortality rate in this series was 26%. Compared to the previous study done in UF~MMMC (:1960 1975:), the age and sex distribution, predisposing cardiac abnormality and clinical manifestations were similar, though there was a higher isolation rate of m~ganisms mid a slightly lower mortality rate in tile present study. Cmlclusion: Tbere has been no sigllificmrt change in tile clinical profile of Infective Endocarditis in UF~MMMC. A slight decrease in mortality rate can be attributed to improvement in microbial diagnosis and antimicrobial selection.