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עמוד בית
Mon, 15.07.24

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March 2017
Efraim Aizen MD, Bela Shifrin MD, Inna Shugaev MD and Israel Potasman MD

Background: The optimal approach to the evaluation of asymptomatic bacteruria in stroke patients is uncertain. 

Objectives: To compare elderly patients after an acute stroke with and without asymptomatic bacteriuria for the development of symptomatic urinary tract infections (UTI).

Methods: We prospectively monitored patients over 65 years of age admitted to our rehabilitation hospital after an acute stroke, with and without asymptomatic bacteriuria, for the development of symptomatic UTIs. The prevalence of bacteriuria was determined by urine cultures obtained 2 and 4 weeks after admission. Patients with and without persistent bacteriuria were compared to identify variables associated with bacteriuria.

Results: Fifty-five patients were included in the study. The prevalence of asymptomatic bacteriuria at baseline was 20%. Of all 55 stroke patients, 13 (23.6%) developed a symptomatic UTI during the 30 day follow-up. Patients with stroke and asymptomatic bacteriuria at baseline had an increased risk of developing a symptomatic UTI (54.5% with asymptomatic bacteriuria vs. 15.9% without, P = 0.011). To exclude the effects of several confounders, we performed multivariate Cox regression analysis, which showed that bacteruria remained a significant covariate for symptomatic UTI (hazard ratio 2.86, 95% confidence interval 0.71–10.46, P = 0.051). When subjects who experienced symptomatic urinary infection were included, the prevalence of bacteriuria in the study cohort declined to about 45.5% by 30 days. 

Conclusion: Elderly patients with stroke and asymptomatic bacteriuria have an increased risk of developing a symptomatic UTI compared to those without asymptomatic bacteriuria during a 30 day post-stroke follow-up.

 

April 2015
Vered Schichter-Konfino MD, Katalin Halasz, Galia Grushko, Ayelet Snir PhD, Tharwat Haj PhD, Zahava Vadasz MD PhD, Aharon Kessel MD, Israel Potasman MD and Elias Toubi MD

Abstract

Background: The mass influx of immigrants from tuberculosis-endemic countries into Israel was followed by a considerable increase in the incidence of tuberculosis (TB). All contacts of active TB patients are obliged to be screened by tuberculin skin tests (TST) and, if found positive, prophylactic treatment is considered.

Objectives: To assess the utility of interferon-gamma (IFNγ)-release assay with a prolonged follow-up in preventing unnecessary anti-TB therapy in individuals with suspected false positive results.

Methods: Between 2008 and 2012 the QuantiFERON TB gold-in-tube test (QFT-G) was performed in 278 sequential individuals who were mostly TST-positive and/or were in contact with an active TB patient. In all, whole blood was examined by the IFNγ-release assay. We correlated the TST diameter with the QFT-G assay and followed those patients with a negative assay.

Results: The QFT-G test was positive in only 72 (42%) of all 171 TST-positive individuals. There was no correlation between the diameter of TST and QFT-G positivity. Follow-up over 5 years was available in 128 (62%) of all QFT-G-negative individuals. All remained well and none developed active TB.

Conclusions: A negative QFT-G test may obviate the need for anti-TB therapy in more than half of those with a positive TST.

July 2012
I. Potasman, G. Naftali and M. Grupper
Background: Overuse and abuse of antibiotics is a major cause of microbial resistance. Within the hospital setting such overuse necessitates real-time supervision by infectious diseases (ID) specialists.

Objectives: To evaluate the impact of a recently introduced computerized antibiotic authorization system on the pharmacy budget.

Methods: The study was performed in a 400 bed university hospital. With the new system, antibiotic requests are entered electronically by the ward physician and reviewed within minutes to hours by ID specialists. The feedbacks are seen in the wards and pharmacy. Successive years, one before and the other after introduction of the system, were compared.

Results: During the first year with the new system 7167 antibiotic requests were entered 20% of them were rejected, mainly for improper indication (43% of the rejections). During that year the antibiotic expenditure was reduced by 17%, compared to the previous year (~equal to 200,000 US$), and was against the trend of the last 5 years. Of the 35 antibiotics under the control of the ID team, the use of 7 was probably curtailed by the supervision. Pareto analysis revealed that four drugs constituted > 50% of the pharmacy’s expenses. The mortality rate (per 1000 hospitalization days) during those 2 years fell from 4.0 to 3.8.

Conclusions: Computerized antibiotic control by ID specialists is a feasible cost-saving new modality that may help reduce unnecessary antibiotic prescriptions.
January 2011
E. Davidi, A. Paz, H. Duchman, M. Luntz and I. Potasman
 Background: Perichondritis of the auricle is a serious disease that may lead to residual deformity. 

Objectives: To assess our experience with perichondritis in a large group of patients hospitalized with this entity.

Methods: We retrospectively studied 114 patients who were admitted with perichondritis during 1987–2004, including their demographic details, medical history, current illness, etiology, pathogens and treatments. 

Results: The patients’ mean age was 41.8 ± 20.7 years. In more than half of the patients the etiology could not be determined. Forty-seven patients (41%) were treated prior to hospitalization for an average of 2.5 ± 1.9 days. Eight patients (7%) required surgical intervention. Pseudomonas aeruginosa was found to be the predominant organism (69% of available isolates) and was associated with a more advanced clinical presentation and longer hospitalization (P = 0.008). 

Conclusions:  Perichondritis develops in many cases after apparent minor trauma. Since P. aeruginosa is probably the predominant pathogen, initial treatment should include anti-pseudomonal antibiotics.

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