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Pyogenic splenic abscess: Report of 12 cases
Abstracts
admissions (629 women, 421 men) there were 209 identified UTIs (152 women, 94 at admission and 59 nosocomial; and 57 men, 32 at admission and 26 nosocomial), with an incidence of 15% and 7% respectively. The average age of women was 81.8 years, and men 75.2 years. Main risk factors were: Diabetes mellitus 23%, Cancers 13.3%, Bedridden 11.7%, Chronic Renal Failure 11.7%, Institutionalization 9.7%, Recurring UTIs, 8.1%, Bedsores 4.4%, Benign Prostatic Hypertophy 4.0%, Chronic indwelling urinary catheters 3.6%, Pregnancy 0.6%, among others. There were 19 deaths, mostly in immunocompromised patients with underlying malignacies (47.4%). There were 246 urine (UC) and 156 blood cultures (BC) performed for UTIs diagnosis with a total cost of €5203.80 and €3135.50, respectively. The diagnostic yield of urine culture tests enabled the identification of a microbiological agent in 67.1% of cases. Also, 19.5% UC were contaminated, 13% sterile, and 0.4% of UC were performed ambulatory. As for etiologic agents identified by HC (19.9%), 87.1% were concordant with UC, with only 4 cases of microbiologic disparity. Main etiological agents involved in either Admission UTI and Nosocomial UTI were similar and had superimposed representation: Escherichia coli (35.0% VS 36%), Klebsiellae pneumoniae (15.7% VS 12.0%), Pseudomonas aeruginosa (7.9% VS 4.0%), Proteus mirabilis (4.3% VS 7.0%), Enterococcus faecalis (1.4% VS 5.0%), Morganella morganii (1.4% VS 0%), among others. Regarding sensitivity profiles (S): E. coli and P. mirabilis were both susceptible to Amoxicillin + Clavulanic Acid, Quinolones and Cotrimoxazole (64.4%/72.7%, 56.3%/ 72.7%, 50.6%/54.5%) showing resistance (R) mainly to Ampicillin (57.5%/63.6%). Likewise, K. pneumoniae showed overlapping S and R for most of the tested antibiotics, and P. aeruginosa had the most pronounced resistance profile with a sensitivity b50% for all tested regimens. Concerning treatment, 1712 days of antimicrobial therapy were required to overcome the UTIs, with a total cost of €12,591.10. The most prescribed regimens were: Ceftriaxone, Amoxicillin + Clavulanic Acid, Piperacillin + Tazobactam, Ciprofloxacin, Cefuroxime and others. Conclusions: With this retrospective study, the authors intend to: stress the importance of surveillance of nosocomial UTIs for the development of effective therapeutic strategies appropriate to the local flora; raise awareness and highlight the inherent economic impact, and the need for development of infection prevention strategies. doi:10.1016/j.ejim.2013.08.528
ID: 373 Nosocomial infection of Crimean-Congo hemorrhagic fever in Kosovo L. Ajazaj-Berisha, S. Ahmeti, Sh. Dreshaj, S. Namani, E. Qehaja-Buqaj, A. Vishaj, B. Halili Infectious Disease Clinic, University Clinical Center of Kosova, Prishtina, Albania Aims: To analyze the clinical manifestations and outcome in four cases with nosocomial infection of Crimean–Congo hemorrhagic fever (CCHF) disease; treated at the Infectious Diseases Clinic in Prishtina (Kosovo). Material and methods: In this retrospective study, the medical data and the history of four health care workers with CCHF were analyzed. The diagnosis was confirmed by real-time polymerase chain reaction (RT-PCR). The health workers were engaged in the management of patients with severe forms of CCHF. Results: In all four cases the infection was caused by not following the protective measures.Three otolaryngology doctors were infected during tamponades of the nasal cavities of the patients with CCHF. Two of them did not wear any of the protective measures (the nasal tamponade was done without gloves and mask). The third
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doctor was not wearing the face shield and goggles with side shields (infection occurred after coughing blood drops were deposited on the doctor's face. The fourth case was a laboratory hygienist who cleaned test tubes with blood samples from patients with CCHF without the use of protective gloves. The mean incubation period of the disease was 6.2 days. Two of the cases manifested moderately severe disease by fever and other nonspecific symptoms including chills, severe headache, dizziness, neck pain, nausea, vomiting, myalgia, and arthralgia without hemorrhagic syndrome. In two cases the disease had severe clinical manifestations with fever, other nonspecific symptoms and hemorrhagic syndrome which in one case ended with hemorrhagic shock and fatal outcome. Discussion and conclusion: Kosovo is an endemic region, with frequent epidemic outbreaks and sporadic cases occurring with hospitalized case fatality of approximately 30%. CCHF is a very contagious disease which is transmitted among the health workers by blood and other body fluids. Accidental infections are possible if strict universal precautions are not followed. Nosocomial infections can be serious and with possible fatal outcome. Keywords: CCHF, Nosocomial infections, Kosovo. doi:10.1016/j.ejim.2013.08.529
ID: 391 Pyogenic splenic abscess: Report of 12 cases A. Albiñana, M. Lobo, A. Lopez, C. Perez de Oteiza, L. Alvarez-Sala, R. Salomon, C. Recarte, E. Bello, A. del Castillo, E. Donis Medicina Intera, Hospital General Universitario Gregorio Maraón, Madrid, Spain
Introduction: Pyogenic splenic abscess is a rare disease with non-specific symptoms such as fever and abdominal pain and mortality approaching 100% without treatment. For this reason, the clinical suspicion is very important in order to get a correct diagnosis and treatment. Objectives: Review the characteristics of pyogenic splenic abscess in patients diagnosed in our hospital in the last ten years, and identify associated pathology and analytical patterns, the imaging test used in each case and treatments applied. Material and methods: We present a descriptive study of all cases of pyogenic splenic abscess diagnosed in our hospital from April 2003 to April 2013, analyzing data collected from their medical records. Results: We found 12 cases of patients with pyogenic splenic abscess, 8 males and 4 females, with ages 29 to 90 years old. The predisposing conditions associated were alteration of immunity and recent infectious process. Clinical characteristics were fever above 38 °C, left upper quadrant pain, leukocytosis with neutrophilia. The diagnosis was given by CTScan. All patients were treated with antibiotic. Percutaneous drainage was necessary in 6 patients and splenectomy was needed in other 2 patients. doi:10.1016/j.ejim.2013.08.530
ID: 399 Candida spondylodiscitis and urinary colonization M. Ferrer Civeira, M. Clavero Olmos, A. Lopez Aparicio, A. Garcia-Espona Pancorbo, M. Villalba, C. Lopez Gonzalez-Cobos, S. Gamez Casado, B. Pinilla Llorente Internal Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain
admissions (629 women, 421 men) there were 209 identified UTIs (152 women, 94 at admission and 59 nosocomial; and 57 men, 32 at admission and 26 nosocomial), with an incidence of 15% and 7% respectively. The average age of women was 81.8 years, and men 75.2 years. Main risk factors were: Diabetes mellitus 23%, Cancers 13.3%, Bedridden 11.7%, Chronic Renal Failure 11.7%, Institutionalization 9.7%, Recurring UTIs, 8.1%, Bedsores 4.4%, Benign Prostatic Hypertophy 4.0%, Chronic indwelling urinary catheters 3.6%, Pregnancy 0.6%, among others. There were 19 deaths, mostly in immunocompromised patients with underlying malignacies (47.4%). There were 246 urine (UC) and 156 blood cultures (BC) performed for UTIs diagnosis with a total cost of €5203.80 and €3135.50, respectively. The diagnostic yield of urine culture tests enabled the identification of a microbiological agent in 67.1% of cases. Also, 19.5% UC were contaminated, 13% sterile, and 0.4% of UC were performed ambulatory. As for etiologic agents identified by HC (19.9%), 87.1% were concordant with UC, with only 4 cases of microbiologic disparity. Main etiological agents involved in either Admission UTI and Nosocomial UTI were similar and had superimposed representation: Escherichia coli (35.0% VS 36%), Klebsiellae pneumoniae (15.7% VS 12.0%), Pseudomonas aeruginosa (7.9% VS 4.0%), Proteus mirabilis (4.3% VS 7.0%), Enterococcus faecalis (1.4% VS 5.0%), Morganella morganii (1.4% VS 0%), among others. Regarding sensitivity profiles (S): E. coli and P. mirabilis were both susceptible to Amoxicillin + Clavulanic Acid, Quinolones and Cotrimoxazole (64.4%/72.7%, 56.3%/ 72.7%, 50.6%/54.5%) showing resistance (R) mainly to Ampicillin (57.5%/63.6%). Likewise, K. pneumoniae showed overlapping S and R for most of the tested antibiotics, and P. aeruginosa had the most pronounced resistance profile with a sensitivity b50% for all tested regimens. Concerning treatment, 1712 days of antimicrobial therapy were required to overcome the UTIs, with a total cost of €12,591.10. The most prescribed regimens were: Ceftriaxone, Amoxicillin + Clavulanic Acid, Piperacillin + Tazobactam, Ciprofloxacin, Cefuroxime and others. Conclusions: With this retrospective study, the authors intend to: stress the importance of surveillance of nosocomial UTIs for the development of effective therapeutic strategies appropriate to the local flora; raise awareness and highlight the inherent economic impact, and the need for development of infection prevention strategies. doi:10.1016/j.ejim.2013.08.528
ID: 373 Nosocomial infection of Crimean-Congo hemorrhagic fever in Kosovo L. Ajazaj-Berisha, S. Ahmeti, Sh. Dreshaj, S. Namani, E. Qehaja-Buqaj, A. Vishaj, B. Halili Infectious Disease Clinic, University Clinical Center of Kosova, Prishtina, Albania Aims: To analyze the clinical manifestations and outcome in four cases with nosocomial infection of Crimean–Congo hemorrhagic fever (CCHF) disease; treated at the Infectious Diseases Clinic in Prishtina (Kosovo). Material and methods: In this retrospective study, the medical data and the history of four health care workers with CCHF were analyzed. The diagnosis was confirmed by real-time polymerase chain reaction (RT-PCR). The health workers were engaged in the management of patients with severe forms of CCHF. Results: In all four cases the infection was caused by not following the protective measures.Three otolaryngology doctors were infected during tamponades of the nasal cavities of the patients with CCHF. Two of them did not wear any of the protective measures (the nasal tamponade was done without gloves and mask). The third
e207
doctor was not wearing the face shield and goggles with side shields (infection occurred after coughing blood drops were deposited on the doctor's face. The fourth case was a laboratory hygienist who cleaned test tubes with blood samples from patients with CCHF without the use of protective gloves. The mean incubation period of the disease was 6.2 days. Two of the cases manifested moderately severe disease by fever and other nonspecific symptoms including chills, severe headache, dizziness, neck pain, nausea, vomiting, myalgia, and arthralgia without hemorrhagic syndrome. In two cases the disease had severe clinical manifestations with fever, other nonspecific symptoms and hemorrhagic syndrome which in one case ended with hemorrhagic shock and fatal outcome. Discussion and conclusion: Kosovo is an endemic region, with frequent epidemic outbreaks and sporadic cases occurring with hospitalized case fatality of approximately 30%. CCHF is a very contagious disease which is transmitted among the health workers by blood and other body fluids. Accidental infections are possible if strict universal precautions are not followed. Nosocomial infections can be serious and with possible fatal outcome. Keywords: CCHF, Nosocomial infections, Kosovo. doi:10.1016/j.ejim.2013.08.529
ID: 391 Pyogenic splenic abscess: Report of 12 cases A. Albiñana, M. Lobo, A. Lopez, C. Perez de Oteiza, L. Alvarez-Sala, R. Salomon, C. Recarte, E. Bello, A. del Castillo, E. Donis Medicina Intera, Hospital General Universitario Gregorio Maraón, Madrid, Spain
Introduction: Pyogenic splenic abscess is a rare disease with non-specific symptoms such as fever and abdominal pain and mortality approaching 100% without treatment. For this reason, the clinical suspicion is very important in order to get a correct diagnosis and treatment. Objectives: Review the characteristics of pyogenic splenic abscess in patients diagnosed in our hospital in the last ten years, and identify associated pathology and analytical patterns, the imaging test used in each case and treatments applied. Material and methods: We present a descriptive study of all cases of pyogenic splenic abscess diagnosed in our hospital from April 2003 to April 2013, analyzing data collected from their medical records. Results: We found 12 cases of patients with pyogenic splenic abscess, 8 males and 4 females, with ages 29 to 90 years old. The predisposing conditions associated were alteration of immunity and recent infectious process. Clinical characteristics were fever above 38 °C, left upper quadrant pain, leukocytosis with neutrophilia. The diagnosis was given by CTScan. All patients were treated with antibiotic. Percutaneous drainage was necessary in 6 patients and splenectomy was needed in other 2 patients. doi:10.1016/j.ejim.2013.08.530
ID: 399 Candida spondylodiscitis and urinary colonization M. Ferrer Civeira, M. Clavero Olmos, A. Lopez Aparicio, A. Garcia-Espona Pancorbo, M. Villalba, C. Lopez Gonzalez-Cobos, S. Gamez Casado, B. Pinilla Llorente Internal Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain