Dalia Adukauskiene

Kaunas University of Technology, Caunas, Kauno Apskritis, Lithuania

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Publications (23)21.06 Total impact

  • Dalia Adukauskiene · Viktorija Miliauskiene
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    ABSTRACT: Combined oral contraceptives have been known as a well-established contraceptive method already more than 50 years. Unfortunately, this method is not absolutely safe. Combined oral contraceptives include estrogens and progestagens, which may stimulate the blood coagulation and promote the occurrence of deep-vein thrombosis; adverse effects of oral contraceptives are also notably associated with increased risk of stroke and myocardial infarction. The risk of hypercoagulation and venous thrombosis is most likely to be influenced by the dose of estrogens, but recent investigations have showed that the type of progestagens is very important as well.
    Medicina (Kaunas, Lithuania) 01/2010; 46(4):293-7. · 0.49 Impact Factor
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    ABSTRACT: Besides crystalloids, colloids are used for the treatment of hypovolemia and shock. They are high-molecular-weight proteins of bovine origin with properties of more rapid replacement of circulating blood volume. Iso-oncotic character provides the volume effect (approximately equal to 100%) close to the volume intravenously infused with the duration of action for 2-4 hours. Gelatin solutions are excreted with urine and feces in unchanged form without prolonged fixation in organism. Even in case of acute renal failure, gelatin peptides do not accumulate due to increased activity of proteolytic enzymes; therefore, they are the first-choice colloids. Gelatin solutions do not change coagulation as other colloids; just they may cause hemodilution as crystalloids do, so they are safe in case of hemorrhage and thrombocytopenia. There is a decreased risk of bleeding when gelatin solutions are used in surgery as compared with other colloids; in addition, they protect from hypotension due to vasodilatation in epidural or spinal analgesia. Gelatin solutions may cause compensatory hyperemia and increase of cardiac output, cardiac index, myocardial contractility, mean arterial blood pressure, and diuresis; in addition, oxygen delivery to the tissues improves. The dosage depends on clinical condition of a patient, and it is suggested to be 100-2000 mL and even more, for isovolemic hemodilution--20 mL/kg of body weight. Adverse reactions such as anaphylactoid or anaphylactic to gelatin derivates are rare and similar to other colloids.
    Medicina (Kaunas, Lithuania) 02/2009; 45(1):77-84. · 0.49 Impact Factor
  • Dalia Adukauskiene · Sandra Mazeikiene · Arvydas Rumba · Venta Vizgirdaite
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    ABSTRACT: Caustic ingestions (alkalis, acids) may cause severe chemical burns and lifelong complications, which worsen life quality. Approximately 80% of caustic ingestions occur in children. They mostly intoxicate because of chemical substances kept insecurely or in inappropriate containers. Until now, there is no general opinion about diagnostics and management of caustic ingestions. Therefore, the main aim of this article is accurately represent diagnostic and treatment options believing that this information would help physicians to diagnose caustic ingestions easier and faster, to provide emergency management correctly, and to avoid acute and chronic complications.
    Medicina (Kaunas, Lithuania) 01/2009; 45(10):830-7. · 0.49 Impact Factor
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    ABSTRACT: To determine the associations between the source of infection and antibiotic resistance in patients with Pseudomonas aeruginosa bacteremia. A retrospective analysis of 50 patients with Pseudomonas aeruginosa bacteremia was carried out. If sepsis was suspected, blood culture was incubated in an automatic system BACTEC 9240. Then bacteria were identified, and their antibiotic resistance was estimated by disc diffusion method. If Pseudomonas aeruginosa strains were resistant to three or more antibiotics, they were considered as multidrug-resistant. The origin of bacteremia was confirmed in 33 (66%) patients. Lower respiratory tract was the predominant source of Pseudomonas aeruginosa bacteremia (81.8%, n=27) as compared with infection of wound (39.4%, n=13), urinary tract (15.2%, n=5), and drain or cerebrospinal fluid (9.1%, n=3) (P<0.05). Eighteen percent (n=9) of strains, which caused bacteremia, were resistant to ceftazidime; 38% (n=19), to piperacillin; 22% (n=11), to imipenem; 26% (n=13), to meropenem; 24% (n=12), to ciprofloxacin; 40% (n=20), to gentamicin; and only 8% (n=4), to amikacin. Multidrug-resistant Pseudomonas aeruginosa strains were more frequently isolated if a source of infection was wound comparing to a source of other localization (61.5%, n=8 and 20.0%, n=4, respectively; P<0.05). Resistance of Pseudomonas aeruginosa strains to imipenem was associated with resistance to ciprofloxacin (13.2%, n=5 and 50.0%, n=6, retrospectively; P<0.05), but resistance to meropenem--both to ciprofloxacin and amikacin. The predominant source of Pseudomonas aeruginosa bacteremia was lower respiratory tract, and multidrug-resistant strains caused bacteremia more frequently if a source infection was wound. Pseudomonas aeruginosa resistance to carbapenems was associated with resistance to ciprofloxacin and resistance to meropenem--also to amikacin. Resistance of strains to ceftazidime and piperacillin was associated with resistance to gentamicin.
    Medicina (Kaunas, Lithuania) 01/2009; 45(1):1-7. · 0.49 Impact Factor
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    ABSTRACT: Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. OBJECTIVE. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. MATERIAL AND METHODS. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. RESULTS. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). CONCLUSIONS. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.
    Medicina (Kaunas, Lithuania) 01/2009; 45(5):351-6. · 0.49 Impact Factor
  • Dalia Adukauskiene · Edmundas Sirvinskas · Egidijus Kevelaitis
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    ABSTRACT: Vasopressin is a 9-amino acid peptide synthesized by magnocellular neurons of the hypothalamus and released from posterior pituitary gland. The primary physiological role of vasopressin is the maintenance of fluid homeostasis. In this review, the classification of vasopressin receptors, namely V1 vascular, V2 renal, V3 pituitary, oxytocin receptors, and purinergic receptors, and the effects of vasopressin on vascular smooth muscles, the heart, and the kidneys are discussed. Mortality rates of vasodilatory (or distributive), for example septic shock, are high. The use of vasopressin is an alternative therapy for vasodilatory shock with better outcome. Vasopressin is effective in resuscitation of adults after ventricular fibrillation or pulseless tachycardia, when epinephrine is not effective.
    Medicina (Kaunas, Lithuania) 02/2008; 44(2):167-73. · 0.49 Impact Factor
  • Dalia Adukauskiene · Brigita Budryte · Diana Karpec
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    ABSTRACT: Coma is the disorder of consciousness because of the damage to diffused bilateral cerebral hemisphere cortex or reticular activating system. Coma can be caused by neurogenic (head brain injury), metabolic (endogenic), and toxic (exogenic) factors. To determine the cause of metabolic and toxic coma, laboratory tests are performed; in case of neurogenic coma, the neurologic examination is essential, when five systems are evaluated: the level of consciousness (according to Glasgow Coma Scale or Full Outline of Unresponsiveness Scale), photoreaction of pupils and ophthalmoscopic examination, oculomotoric, motoric, and cardiopulmonary systems. For the treatment of coma, adequate oxygenation and correction of blood circulation disorders are important. The treatment of metabolic coma is guided by special schemes; antidotes often are needed in the treatment of toxic coma, and surgery helps if traumatic brain injury is present. The prognosis and outcomes of the comatose patient depend on the age and comorbid diseases of the patient, the underlying cause of coma, timely medical help and its quality, and intensive treatment and care of the patient in coma.
    Medicina (Kaunas, Lithuania) 02/2008; 44(10):812-9. · 0.49 Impact Factor
  • Dalia Adukauskiene · Aida Kinderyte · Audrone Veikutiene
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    ABSTRACT: Relevance of platelet transfusion is related to an increasing number of indications due to conditions with an increased risk for hemorrhage and a lack of standard protocols both for treatment and prophylaxis of thrombocytopenia, in the presence of high costs of this procedure. The appropriate use of platelet transfusion is associated with reduction of thrombocytopenia, which actually in a critically ill patient is associated with increased length of stay both in intensive care unit and hospital. In 2003, the Professional Consensus was established to define the main recommendations for platelet transfusion. Not only the number of platelets but also the presence of critical conditions (disorders of thermoregulation, trauma, head brain damage, etc.) increasing the risk for bleeding is relevant. It is recommended that the platelet count in one dose of platelets transfused would be not lower than 55 x 10(9)/L in order to increase the platelet count by 5-10 x 10(9)/L. The effectiveness of platelet transfusion is evaluated 10-60 min, 18 hours, and 24 hours after transfusion. Advantages of platelet transfusion of small and large doses are presented.
    Medicina (Kaunas, Lithuania) 02/2008; 44(11):905-9. · 0.49 Impact Factor
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    ABSTRACT: Acute liver failure (ALF) is a life-threatening condition that can rapidly progress into coma and death due to the cerebral edema and multi-organ dysfunction. The ALF etiology and risk factors have been investigated in West Europe, North America, and Asia; however, there are still no published data about the causes and prognosis of ALF in Central and East European countries. The aim of our study was to analyze the causes, outcomes, and prognostic factors of ALF in patients referred to tertiary care center in Lithuania. A total of 28 consecutive patients admitted to the tertiary care center (one of two university-level medical centers in Lithuania) over the period of January 1996 and December 2004 and who fulfilled the entry criteria of ALF (presence of hepatic encephalopathy (HE) and prothrombin international normalized ratio (INR) >1.5) were included into a prospective study. In our study the most frequent causes of ALF were acute viral hepatitis B (21.4 %), drug-induced hepatitis (21.4%), and indeterminate hepatitis (17.9%); other etiologies included Budd-Chiari syndrome (10.7%), ischemic hepatitis (10.7%), Wilson's disease (7.1%), Amanita phalloides-induced liver damage (3.6%), acute fatty liver of pregnancy (3.6%), and malignant infiltration of the liver (3.6%). Among patients with drug-induced liver injury, only one case of acetaminophen poisoning was diagnosed. Clinical status of 9 persons in all patients with ALF corresponded to criteria for liver transplantation (LT) (one liver transplantation was performed), 6 of them had contraindications, and 13 patients did not fulfill requirements for urgent LT. The patients' survival rate in these groups was 11.1%, 16.7% and 69.2%, respectively. In 27 non-transplanted patients univariate analysis revealed the grade of HE on the day of enrolment, total serum bilirubin, pH, and prothrombin INR as risk factors for death from ALF. Multivariate logistic regressive analysis determined only prothrombin INR >3.24 and serum pH <or=7.29 as independent predictors of lethal outcome in ALF. Acute viral hepatitis B, drug-induced liver injury, and indeterminate hepatitis are the main ALF causes in Lithuania. In non-transplanted patients, the main predictors of lethal outcome were severe coagulopathy and metabolic acidosis. Improvement of liver donation system for urgent liver transplantation is essential requirement for amelioration of ALF patient's survival.
    Medicina (Kaunas, Lithuania) 01/2008; 44(7):536-40. · 0.49 Impact Factor
  • Audrone Veikutiene · Edmundas Sirvinskas · Dalia Adukauskiene
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    ABSTRACT: Recently the use of allogeneic (donor) blood transfusion is widely accepted in the clinical practice. Despite of good quality and safety of preparation of allogeneic blood, there are some risks related with transfusion: hemolytic, febrile, and allergic reactions, transfusion related acute lung injury, negative immunomodulatory effect, transmission of infections diseases, dissemination and recurrence of cancer. This is why the indications for donor blood transfusion are restricted, so new safer methods are discovered to avoid or to decrease the heed for allogeneic blood transfusion. Nowadays, there is an increased interest in autologous blood transfusion as the most acceptable alternative to allogeneic blood transfusion. Autologous transfusion is the collection and reinfusion of the patient's own blood (donor and recipient is the same person). Several types of autologous transfusion can be used: preoperative autologous blood donation, acute normovolemic hemodilution, intraoperative blood salvage, postoperative blood salvage. Neverless, autologous transfusion does not protect from all risks, it still remains the safest type of blood transfusion and is important in the strategy of blood conservation.
    Medicina (Kaunas, Lithuania) 01/2008; 44(6):482-8. · 0.49 Impact Factor
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    ABSTRACT: The aim of the study was to evaluate the effect of hypertonic NaCl hydroxyethyl starch solution on haemodynamics and cardiovascular parameters in the early postoperative period in patients for correction of hypovolaemia after heart surgery. Eighty patients undergoing myocardial revascularisation at the Clinic of Cardiac Surgery of the Heart Centre (Kaunas University of Medicine) were randomly divided into two groups. The HyperHaes group (n = 40) received 250ml 7.2% NaCl/6% HES solution and the control Ringer's acetate group (n = 40) received placebo (500 ml Ringer's acetate solution) for volume correction after the surgery. After infusion of HyperHaes solution, cardiac index increased from 2.69 (0.7) to 3.52 (0.8) l/min/m2, systemic vascular resistance index, pulmonary vascular resistance index and the gradient between central and peripheral temperature decreased, and oxygen transport parameters improved. Ringer's group patients needed more intensive infusion therapy (4050.0 (1102.2) ml in the Ringer's group, 3513.7(762.5) ml in the HyperHaes group). During the first 24 hours postoperatively, diuresis was significantly higher in the HyperHaes group (3640.0 (1122.9) ml and 2736.0 (900.7) ml), total fluid balance was lower in HyperHaes group (1405.6 (1519.0) ml and 2718.3 (1508.0)ml, respectively). After the infusion of HyperHaes solution, no adverse events were noted. HyperHaes solution had a positive effect on haemodynamic parameters and microcirculation. Oxygen transport was more effective after HyperHaes solution infusion. Higher diuresis, lower need for the infusion therapy for the first 24 hours and lower total fluid balance were determined in the HyperHaes group. No adverse effects were observed after HyperHaes solution infusion.
    Perfusion 04/2007; 22(2):121-7. DOI:10.1177/0267659107078484 · 0.94 Impact Factor
  • Dalia Adukauskiene · Venta Vizgirdaite · Sandra Mazeikiene
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    ABSTRACT: Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can vary a lot and range from mild complaints not demanding serious medical help to life-threatening conditions. Lightning causes serious injuries in 1000-1500 individuals every year worldwide. The case fatality rate is about 20-30%, with as many as 74% of survivors experiencing permanent injury and sequela. The primary cause of death in victims of lightning strike or other electrical trauma is cardiac or respiratory arrest. That is why appropriate urgent help is essential. Subsequently electrical burns, deep-tissue and organ damage caused by electricity, secondary systemic disorders often demand intensive care and prompt, usually later multistage surgical treatment; therefore, prevention of electrical trauma, which would help to reduce electrical injuries in children and working-age population, is very actual. The most important is to understand the possible danger of electricity and to avoid it.
    Medicina (Kaunas, Lithuania) 02/2007; 43(3):259-66. · 0.49 Impact Factor
  • Dalia Adukauskiene · Asta Bivainyte · Edita Radaviciūte
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    ABSTRACT: Cerebral edema is a life-threatening condition that develops as a result of an inflammatory reaction. Most frequently, this is the consequence of cerebral trauma, massive cerebral infarction, hemorrhages, abscess, tumor, allergy, sepsis, hypoxia, and other toxic or metabolic factors. At present, the following types of cerebral edema are differentiated: the vasogenic cerebral edema resulting from an increased permeability of the endothelium of cerebral capillaries to albumin and other plasma proteins; the cytotoxic cerebral edema resulting from the exhaustion of the energy potential of cell membranes without damage to the barrier; the hydrostatic cerebral edema resulting from disturbance of the autoregulation of cerebral blood circulation; the osmotic cerebral edema resulting from dilution of blood; and the interstitial cerebral edema resulting from acute hydrocephaly. Some authors also differentiate ischemic cerebral edema. At present, when various traumas and traumatic cerebral injuries are frequent causes of death in young people, treatment strategy for cerebral edema is of utmost importance. Monitoring of the patient's condition in the intensive care unit is a necessity. It is important to ensure proper positioning of the patient--the head should be tilted at 30 degrees in order to optimize the cerebral perfusion pressure and control of the increase in intracranial pressure. Hyperventilation should be applied. Controlled hypothermia decreases the rate of metabolism in the brain. Slightly positive fluid balance should be maintained using crystalloid or colloid (hypertonic-hyperoncotic) solutions, at the same time maintaining cerebral perfusion pressure exceeding 70 mmHg. The treatment includes administration of antihypertensive medications, nonsteroidal antiinflammatory drugs, and barbiturates. Steroids decrease the permeability of capillaries and the hemato-encephalic barrier, promoting the movement of Na(+)/K(+) ions and water through the main endothelial membrane, and therefore they are used in the treatment of vasogenic cerebral edema as well as edema caused by a cerebral tumor. Glutamate and N-methyl-D-aspartate receptor antagonists improve cerebral microcirculation and metabolism. Trometamol corrects cerebral acidosis. Extended cerebral edema is treated surgically via a bilateral decompressive craniotomy, sometimes including craniotomy of lateral and posterior fossae. The treatment of cerebral edema is complex, and positive results may be expected only if the diagnosis and the provision of assistance are timely.
    Medicina (Kaunas, Lithuania) 02/2007; 43(2):170-6. · 0.49 Impact Factor
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    I Cicinskaite · D Adukauskiene · V Pilvinis · J Pundzius · L Kupcinskas
    Critical Care 03/2006; 10(Suppl 1). DOI:10.1186/cc4780 · 4.48 Impact Factor
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    ABSTRACT: To determine the incidence and variety of microorganisms of positive urine culture in patients of intensive care units of Kaunas University of Medicine Hospital and to estimate the risk factors for colonization, development of urinary tract infection, and outcome during the period of 2003-2004. We retrospectively reviewed patients with a positive urine culture with or without clinical symptoms of urinary tract infection admitted to an intensive care unit. The growth of microorganisms was determined in urine of 82 (3.9%) patients: urinary tract infection in 64 (78%) and colonization in 18 (22%) patients. Among pathogens of urinary tract infection rods predominated significantly (p<0.05). No significant difference was found among colonizing microorganisms (p>0.05). E. coli in urine culture was obtained exclusively in cases of urinary tract infection. All patients with a positive urine culture had catheterized urinary bladder (p<0.05). No influence of age, sex, or duration of catheterization alone on the occurrence of urinary tract infection, colonization, or outcome was found (p>0.05). In cases of the same sex, age, and underlying disease of the patients, the risk of urinary tract infection with every day of catheterization significantly increased by 21.7% (p<0.05). Among patients with lethal outcome there was a significant prevalence of rods in urine culture (p<0.05). In survivors, no significant pathogen was detected in urine culture (p>0.05). In cases of the same sex, age, underlying disease, and duration of catheterization, the development of urinary tract infection significantly increased the risk of lethal outcome by 5.5 times (p<0.05). Positive urine culture was found in 3.9% of patients, three-quarters of them were due to urinary tract infection. Rods were the predominant pathogens in urinary tract infection. E. coli in urinary tract always resulted in urinary tract infection. Catheterization of urinary bladder resulted in urinary tract infection or colonization. Each day of urinary bladder catheterization increased the risk of development of urinary tract infection by 21.7%. Rods in urine culture were associated with lethal outcome. Development of urinary tract infection increased the risk of lethal outcome 5.5 times.
    Medicina (Kaunas, Lithuania) 02/2006; 42(10):805-9. · 0.49 Impact Factor
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    ABSTRACT: HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is a severe, life-threatening pregnancy pathology, which occurs in 0.2-0.8% of all pregnancies, and approximately 10% (2-20%) of pregnancies are complicated with severe preeclampsia. This syndrome usually develops in the third trimester of pregnancy in preeclamptic patients, sometimes it occurs in the second trimester of pregnancy, and very rarely HELLP syndrome may develop within 48-72 hours after delivery. Diagnosis is complicated as there are no specific clinical signs, therefore, this syndrome may be confused with other pathologies like acute fatty liver of pregnancy, idiopathic thrombocytopenia, hemolytic uremic syndrome, appendicitis, and etc. The patients with HELLP syndrome should be treated in the tertiary care hospital, where appropriate diagnostics and multidisciplinary help for mother and fetus can be assured. When the syndrome was described for the first time, L. Weinstein recommended prompt delivery as the only possible treatment. Current studies show that conservative treatment of patients with HELLP syndrome is safe, without an increase in morbidity and mortality. That is why now many authors agree that treatment approach should be based on the estimated gestational age and the condition of the mother and fetus.
    Medicina (Kaunas, Lithuania) 02/2006; 42(9):695-702. · 0.49 Impact Factor
  • Dalia Adukauskiene · Jurgita Blauzdyte
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    ABSTRACT: Diagnosis and treatment of hypoglycemia is an actual problem because glucose is the principal source of energy for central nervous system except permanent starvation when the ketone bodies are used by the central nervous system for energy. Glucose homeostasis depends on primary glucoregulatory organs--pancreas, liver, adrenal glands, and hypophysis. Insulin, glucagon, cathecholamines, cortisol, and growth hormone take part in this interaction. Hypoglycemia can develop if there are disorders of glucoregulatory organs resulting in imbalance of normal glucose homeostasis. Hypoglycemia presents with autonomic symptoms--hunger, palpitations, tremor, sweating--and with neuroglycopenic symptoms--confusion, drowsiness, odd behavior, speech difficulties, incoordination. None of these symptoms is specific just to hypoglycemia. Frequently hypoglycemia has to be differentiated with neurologic, psychiatric, and cardiovascular disorders. In this article the causes, symptoms, diagnosis, and treatment of hypoglycemia are reviewed.
    Medicina (Kaunas, Lithuania) 02/2006; 42(10):860-7. · 0.49 Impact Factor
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    ABSTRACT: Urinary tract infections are responsible for 40-60% of all hospital-acquired infections. Increased age of patients and comorbid diseases render hospitalized patients more susceptible to infection. Almost 80% of hospital-acquired urinary tract infections are associated with urinary catheters, and only 5-10% of urinary infections are caused by invasive manipulations in the urogenital tract. Pathogens of hospital-acquired urinary tract infections are frequently multi-resistant, and antibiotic therapy can only be successful when the complicating factors are eliminated or urodynamic function is restored. For treatment of complicated hospital-acquired urinary tract infections, the antibiotics must exhibit adequate pharmacodynamic and pharmacokinetic properties: high renal clearance of unmetabolized form with good antimicrobial activity in both acidic and alkaline urine. For selection of empirical treatment of hospital-acquired urinary tract infections, it is necessary to evaluate localization of infection, its severity, possible isolates, and the most frequent pathogens in the department where patient is treated. The best choice for the starting the antimicrobial therapy is the cheapest narrow-spectrum effective antibiotic in the treatment of urinary tract infection until microbiological evaluation of pathogens will be received. Adequate management of urinary tract infections lowers the rate of complications, requirements for antibacterial treatment, selection of multi-resistant isolates and is cost effective.
    Medicina (Kaunas, Lithuania) 02/2006; 42(12):957-64. DOI:10.1016/S0195-6701(00)90821-1 · 0.49 Impact Factor
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    ABSTRACT: To determine the relationship between the production of extended-spectrum beta-lactamases (ESBLs) in Klebsiella pneumoniae (K. pneumoniae) strains resistant to third-generation cephalosporins and resistance of these strains to antibiotics used. A total of 157 cultures of K. pneumoniae resistant to third-generation cephalosporins were obtained from bronchial secretions of patients treated in intensive care units (ICUs) at Kaunas University of Medicine Hospital (KUMH). The secretions were cultured, and antibacterial susceptibility was tested in the Laboratory of Microbiology at KUMH according to the recommendations of the National Committee for Clinical Laboratory Standards (NCCLS). Using a method of double-disc synergy test, K. pneumoniae strains possibly producing ESBL were considered for further testing by means of E-tests. The resistance to carbapenems, piperacillin, gentamycin, amikacin, and ciprofloxacin was compared between ESBL-producing and non-ESBL-producing K. pneumoniae strains resistant to third-generation antibiotics. Almost one-third of K. pneumoniae strains (n=28, 32.8%) were resistant to third-generation cephalosporins in 2001 and 50.0% (n=36)--in 2004 (p<0.05). Half of the strains (n=7, 50%) were producing ESBLs in 2001 and 50% (n=12)--in 2004. All strains of K. pneumoniae were susceptible to carbapenems. Resistance rates to piperacillin and gentamicin were higher in ESBL-producing strains compared with non-ESBL-producing strains (94.7% (n=18) vs. 15.8% (n=3) (p<0.05) for gentamicin and 100% (n=19) vs. 36.8% (n=7) (p<0.001) for piperacillin, respectively). No significant differences were found in the resistance rates to amikacin and ciprofloxacin. The resistance of K. pneumoniae strains, isolated from bronchial secretions of patients treated in ICUs at KUMH, to third-generation cephalosporins increased significantly during the period of 2001-2004. However, the proportion of ESBL-producing strains remained unchanged. Resistance to certain antibacterials could be suspected if ESBL production is present - higher rates of resistance to piperacillin and gentamicin were found in the group of ESBL-producing K. pneumoniae strains.
    Medicina (Kaunas, Lithuania) 02/2006; 42(4):288-93. · 0.49 Impact Factor
  • Dalia Adukauskiene · Astra Vitkauskiene
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    ABSTRACT: Nosocomial pneumonia, especially ventilator-acquired pneumonia, has the greatest impact on patients' management in intensive care unit. Inappropriate initial antimicrobial treatment increases attributable and crude mortality from ventilator-acquired pneumonia. De-escalation therapy improves short-term survival of patients with ventilator-acquired pneumonia without increasing the emergence of resistant organisms.
    Medicina (Kaunas, Lithuania) 02/2006; 42(9):703-8. · 0.49 Impact Factor