[Show abstract][Hide abstract] ABSTRACT: Antibiotic resistance, a major public health problem, has been linked to antibiotic consumption. In Greece both consumption and resistance rates are among the highest in Europe. A multifaceted campaign targeting both physicians and parents of school children was implemented for the first time in order to educate the public and update doctors, aiming to promote judicious use of antibiotics and hopefully decrease its consumption.
BMC Public Health 08/2014; 14(1):866. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: To evaluate the impact of an antibiotic restriction policy on antibiotic consumption and Gram-negative resistance rates, in an environment of antibiotic overconsumption and increasing resistance rates for nosocomial pathogens. Methods: The study was a 'before and after' trial of 18-month duration; the antibiotic restriction policy program was implemented in 1998-2000 and was based on a government program addressed by the Ministry of Health to public hospitals on a national basis. This included prescribing of all newer antibiotics on an order form, auditing of the order forms and consultation with infectious diseases (ID) specialists, dispensing of treatment and prophylaxis guidelines, feedback, and face-to-face education. Antibiotic consumption and Gram-negative resistance rates were recorded before and after the intervention. Results: Despite the addition of a new 40-bed ID department in the hospital during the 'after' period, the consumption of restricted antibiotics was significantly reduced by 42% (and their cost by 31%). Gram-negative resistance rates for Pseudomonas, Klebsiella, and Enterobacter, serving as index microorganisms for Gram-negative nosocomial pathogens, were significantly reduced during the 'after' period, even against antibiotics for which there was an increase in consumption. Conclusions: Multidisciplinary restriction programs can reduce antibiotic consumption and Gram-negative resistance rates in the hospital setting.
Scandinavian Journal of Infectious Diseases 01/2013; · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 16S ribosomal RNA methylase-mediated high-level resistance to 4-,6-aminoglycosides has been reported in clinical isolates of gram-negative bacilli from several countries. Three of 1534 (0.2%) isolates of Klebsiella pneumoniae and three of 734 (0.4%) Proteus mirabilis isolates from a university hospital in Athens, Greece, were positive for rmtB and highly resistant to all aminoglycosides tested (MICs ≥256 mg/L). Two of the K. pneumoniae rmtB-bearing isolates, were KPC-2 and OXA-10 producers and the third was a DHA-1 producer. One of the P. mirabilis isolates was a VIM-1 and OXA-10 producer and one was an OXA-10 producer. All rmtB-harbouring isolates were clonally unrelated. None of the E. coli (n = 1398) and Enterobacter spp. (n = 414) isolates were positive for armA, rmtA, rmtB, rmtC or rmtD.
Clinical Microbiology and Infection 03/2012; 18(3):E52-4. · 4.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Using time-kill methodology, we investigated the interactions of fosfomycin with meropenem or colistin or gentamicin against 17 genetically distinct Klebsiella pneumoniae clinical isolates carrying blaKPC-2. Synergy was observed with meropenem or colistin against 64.7 and 11.8% of tested isolates, while the combination with gentamicin resulted in indifference. All studied combinations showed improved bactericidal activity, compared to fosfomycin alone and prevented the development of fosfomycin resistance in 69.2, 53.8, and 81.8% of susceptible isolates, respectively.
Antimicrobial Agents and Chemotherapy 02/2011; 55(5):2395-7. · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND. The Toll-like receptor 4 (TLR4) is an essential component of the innate immune response to various microorganisms. We investigated the association between TLR4 polymorphism and the risk of acquiring severe infections, in patients with human immunodeficiency virus (HIV)-1 infection. METHODS. The presence of TLR4 Asp299Gly and Thr399Ile single nucleotide polymorphisms (SNPs) was determined in a cohort of 199 HIV-1 infected patients and evaluated in relation to the occurrence of various infections. RESULTS. One hundred seventy-two patients were homozygous for the wild-type genotype; 22 patients (11%) were heterozygous for both SNPs; 4 were heterozygous for 1 polymorphism; 1 patient was heterozygous for the Asp299Gly SNP and homozygous for the Thr399Ile SNP. Of individuals with a nadir CD4 cell count of <100 cells/mm(3), those who carried both SNPs, compared with those who carried the wild-type genotype, demonstrated a >3-fold increase in the odds ratio (OR) of any serious infection (OR, 6.33 vs OR, 1.83, P = .043). CONCLUSIONS. This study suggests an association between the presence of TLR4 Asp299Gly and Thr399Ile polymorphisms and the occurrence of serious infections in HIV-1 infected patients with a history of nadir CD4 cell count of <100 cells/mm(3).
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to report the prevalence of episodes of DSM-IV major depression, as well as their identification rates, in elderly inpatients in a general hospital in Greece.
200 selected patients, 65 years old and over, hospitalized in Surgery and Internal Medicine Departments, were assessed for major depression over a period of 12 months (October 2006-November 2007) by means of SCID-I/P, HADS, BDI and GDS-15. During the same period, liaison calls from the same departments were evaluated and findings were compared.
When psychiatric screening was performed, 28 patients (14%) were diagnosed as suffering from a major depressive episode. During the same period, there were only 20 liaison calls from the same departments for patients over 65 years old, from which 4 patients were found to be suffering from major depression. Comparison between the two periods showed significant underestimation of depression. All psychometric scales detected depression sufficiently.
In general hospital elderly inpatients, depression still remains underestimated. Depression symptom scales could be used as routine tests for screening major depression.
Aging clinical and experimental research 04/2010; 22(2):148-51. · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the effects of antimicrobial prophylaxis and possible predictors of failure in multiple sclerosis patients with bacteriuria and bladder dysfunction. patients were categorized into 3 groups, according to post-voided residual urine volume (PVR): patients with indications for self-intermittent catheterization (SIC) who elected (Group A, n=39) or not (Group B, n=53) to use SIC and patients with no indication for SIC (Group C, n=75). In group A, 90% of patients developed bacteriuria after SIC. Rates of bacteriuria in groups B and C were significantly lower (34% and 24%, respectively, all p<0.001). Prophylaxis failed in 31% and 22% of patients in groups A and b, respectively whereas all group C patients responded to prophylaxis. Symptomatic urinary tract infection was observed only in 14% of group A patients. Significant predictors of prophylaxis failure were an expanded disability status scale (EDSS) score >6 (p<0.05), a high pVR (p<0.075) and resistance to prophylaxis regimen (p<0.007). SIC did not have a significant association with prophylaxis failure. In multivariate analysis only a higher eDSS score (>6) predicted prophylaxis failure (p=0.019).
[Show abstract][Hide abstract] ABSTRACT: We describe the emergence and spread of Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing K. pneumoniae at a Greek University hospital.
Isolates with a carbapenem minimum inhibitory concentration >1 microg/mL and a negative EDTA-imipenem disk synergy test result were submitted to boronic acid disk test and to polymerase chain reaction (PCR) for KPC gene and sequencing. Records from patients who had KPC-2-producing K. pneumoniae isolated were retrospectively reviewed. Clinical isolates were submitted to molecular typing using pulsed-field gel electrophoresis, and the beta-lactamase content was studied using isoelectric focusing and PCR.
From January 2007 through December 2008, 50 patients (34 in the intensive care unit [ICU]) were colonized (n = 32) or infected (n = 18) by KPC-2-producing K. pneumoniae. Increasing prevalence of KPC-2-producing K. pneumoniae coincided with decreasing prevalence of metallo-beta lactamase-producing isolates in our ICU. Multidrug resistance characterized the studied isolates, with colistin, gentamicin, and fosfomycin being the most active agents. Besides KPC-2, clinical isolates encoded TEM-1-like, SHV-11, SHV-12, CTX-M-15, and LEN-19 enzymes. Four different clonal types were detected; the predominant one comprised 41 single patient isolates (82%). Sporadic multiclonal cases of KPC-2-producing K. pneumoniae infection were identified from September 2007 through May 2008. The outbreak strain was introduced in February 2008 and disseminated rapidly by cross-transmission; 38 patients (76%) were identified after August 2008. Fourteen cases of bacteremia, 2 surgical site infections, 2 lower respiratory tract infections (1 bacteremic), and 1 urinary tract infection were identified. Most patients received a colistin-containing combination treatment. Crude mortality was 58.8% among ICU patients and 37.5% among non-ICU patients, but attributable mortality was 22.2% and 33.3%, respectively.
The emergence of KPC-2-producing K. pneumoniae in Greek hospitals creates an important challenge for clinicians and hospital epidemiologists, because it is added to the already high burden of antimicrobial resistance.
[Show abstract][Hide abstract] ABSTRACT: Although major changes of the immune system have been described in sepsis, it has never been studied whether these may differ in relation to the type of underlying infection or not. This was studied for the first time.
The statuses of the innate and adaptive immune systems were prospectively compared in 505 patients. Whole blood was sampled within less than 24 hours of advent of sepsis; white blood cells were stained with monoclonal antibodies and analyzed though a flow cytometer.
Expression of HLA-DR was significantly decreased among patients with severe sepsis/shock due to acute pyelonephritis and intraabdominal infections compared with sepsis. The rate of apoptosis of natural killer (NK) cells differed significantly among patients with severe sepsis/shock due to ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) compared with sepsis. The rate of apoptosis of NKT cells differed significantly among patients with severe sepsis/shock due to acute pyelonephritis, primary bacteremia and VAP/HAP compared with sepsis. Regarding adaptive immunity, absolute counts of CD4-lymphocytes were significantly decreased among patients with severe sepsis/shock due to community-acquired pneumonia (CAP) and intraabdominal infections compared with sepsis. Absolute counts of B-lymphocytes were significantly decreased among patients with severe sepsis/shock due to CAP compared with sepsis.
Major differences of the early statuses of the innate and adaptive immune systems exist between sepsis and severe sepsis/shock in relation to the underlying type of infection. These results may have a major impact on therapeutics.
Critical care (London, England) 01/2010; 14(3):R96. · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Antibiotic resistance has been associated with the use of antibiotics. The dispensing of antimicrobials without prescription is a potential source of inappropriate antibiotic use. In our study, antibiotics were requested without prescription from pharmacies in the metropolitan area of Athens in Greece in 2008. Twenty-one collaborators visited 174 pharmacies and asked for either amoxicillin/clavulanate acid or ciprofloxacin without providing a prescription or any other justification for the request. In Greece additional restrictions for fluoroquinolone prescriptions were implemented in 2003 after which a separate specific prescription form needs to be filled in by the prescriber, justifying the choice of any fluoroquinolone. Amoxicillin/clavulanate acid was dispensed in all cases. Furthermore, despite the regulation restricting the prescription of ciprofloxacin, this drug was dispensed by 53% of the pharmacies. It appears that the implementation of measures to restrict the use of certain antibiotics (e.g. ciprofloxacin that was studied in our case) was effective in reducing, although not eliminating, inappropriate dispensing. Overall, dispensing of antimicrobials without prescription is a widespread practice in the studied area and is contributing to the overuse of antibiotics.
Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2010; 15(7). · 5.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.
Women scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.
One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004-July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p=0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p=0.004), membrane rupture for more than 6 hours (p=0.08) and blood loss greater than 500 ml (p=0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p=0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p=0.004).
Ampicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.
Clinicaltrials.gov identifier: NCT01138852.
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to explore the epidemiological features and resistance rates in uropathogens isolated from cases of acute uncomplicated cystitis (AUC) in Greece, and subsequently to guide empirical treatment. Urine samples from outpatients aged >16 years were cultured and for each uropathogen isolated non-susceptibility to orally administered antimicrobial agents was defined. Demographic and clinical data were provided in questionnaire form. From January 2005 to March 2006 a total of 1936 non-duplicate positive urinary cultures were collected and 889 AUC cases were evaluated. Escherichia coli was the main aetiological agent (83%). In the AUC group, non-susceptibility rates for E. coli isolates were as follows: amoxicillin 25.8%; co-trimoxazole 19.2%; cefalothin 14.9%; nitrofurantoin 10.7%; amoxicillin/clavulanic acid 5.2%; nalidixic acid 6%; mecillinam 3.4%; ciprofloxacin 2.2%; cefuroxime 1.7%, and fosfomycin 1.6%. Amoxicillin and/or co-trimoxazole use in the previous 3 months was significantly associated with isolation of a co-trimoxazole-resistant E. coli isolate. The same applied for previous use of a fluoroquinolone agent and isolation of a ciprofloxacin-resistant E. coli isolate. In conclusion, increased co-trimoxazole non-susceptibility rates undermine its use as a first-line agent in empirical treatment, especially in cases of recent use of co-trimoxazole and/or amoxicillin. Fluoroquinolones display potent in vitro activity against community uropathogens, but prudent use is warranted for uncomplicated infections. Mecillinam and nitrofurantoin could serve as effective front-line agents in an effort to design fluoroquinolones-sparing regimens.
International journal of antimicrobial agents 11/2009; 35(1):62-7. · 3.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A recent randomized clinical trial of our group disclosed considerable reduction of the infective sequelae after administration of a synbiotic formula, namely Synbiotic 2000FORTE, in patients with multiple injuries, the latter being a preparation of four probiotics. The mechanism of action of synbiotics was studied.
A total of 72 patients with severe multiple injuries were allocated to a 15-day administration of either placebo or the synbiotic formula. The association of bloodstream infections, ventilator-associated pneumonia (VAP), serum levels of C-reactive protein (CRP), and endotoxins (LPS) were studied.
Sepsis in the field of bacteremia occurred in 13 patients treated with placebo (36.1%) compared with 5 patients treated with Synbiotic 2000FORTE (13.9%, p = 0.028 between groups). The time to progression to primary bacteremia was longer among patients treated with Synbiotic 2000FORTE compared with placebo (p = 0.0237 between groups). Twelve (33.3%) and five (13.9%) placebo-treated and probiotic-treated patients, respectively, developed ventilator-associated pneumonia with Acinetobacter baumannii as a bacterial cause (p = 0.047 between groups). Treatment with synbiotics was accompanied by reduction of white blood cell counts and LPS and CRP levels in either patients who did or did not develop sepsis.
Synbiotics contained in the studied formula decrease significantly the risk for sepsis by bloodstream infections and the occurrence of VAP by A. baumannii. The mechanisms of action might involve direct immunomodulatory effect, prevention of bacterial translocation, or most likely a combination of both.
The Journal of trauma 10/2009; 67(4):815-21. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers.
A study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped.
Between February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%). Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped.
Recent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of S pneumoniae. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.
[Show abstract][Hide abstract] ABSTRACT: A cohort study of patients (pts) presenting with symptoms of chronic prostatitis over 2 years was performed. Appropriate antimicrobials were administered to confirmed cases of chronic bacterial prostatitis (CBP) after a Stamey-meares (S-M) test for a period of 6 weeks and the test was repeated 1 and 6 months post therapy completion. 145 male patients presented for evaluation. the most prevalent symptoms included dysuria (68%), frequency (38%), and pain which was present in 50%. S-M testing was performed in 69% and expressed prostatic specimen was collected in 53.8%. the diagnosis of CBP was established in 26.9% of the total cohort. Escherichia coli (28.2%) and Enterococcus spp (23.1%) were the most frequently implicated pathogens and ciprofloxacin the most commonly prescribed antimicrobial. A 12-month follow-up was completed in 87% of the pts and 35.3% relapsed a mean of 4.75 months after the initial treatment.
[Show abstract][Hide abstract] ABSTRACT: Clinical experience of prolonged use of linezolid in patients with bone infections is accumulating. However more efficacy and safety data are required. this is a case-control study of patients who received linezolid for difficult-to-treat, intolerant or resistant-to-other-antibiotics bone infections. Linezolid was administered i.v. or orally in 34 patients. Results concerning efficacy and safety were compared to a group of well-matched controls. The clinical arrest rate was 74% in the linezolid group and 68% in the control group (p=NS). treatment was discontinued in 14 (44%) patients of the linezolid group and in 2 (6%) patients of the control group due to adverse events. In the linezolid group 11 (33%) patients developed anemia and 3 (9%) developed thrombocytopenia that led to discontinuation of treatment. Linezolid is effective in a substantial proportion of patients, but the incidence of hematologic adverse events makes close follow-up and laboratory monitoring mandatory.
[Show abstract][Hide abstract] ABSTRACT: A synthetic crystallic semihydrate form of calcium sulfate, Stimulan, was evaluated as a biodegradable carrier for the daily in vitro elution of daptomycin. Daptomycin and Stimulan were admixed at a ratio of 95:5. Elution lasted for 28 days. Eluted concentrations peaked on days 1 and 11, when the mean values were 1,320.1 and 949.2 microg/ml, respectively. The lowest eluted concentration was detected on day 28. These results support the application of the system described in experimental models of osteomyelitis.
Antimicrobial Agents and Chemotherapy 05/2009; 53(7):3106-7. · 4.57 Impact Factor