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Zeina A Kanafani

Publications and source records attributed to Zeina A Kanafani.

18 recordsLinked to original sources
PubMed2006

Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia.

BACKGROUND: Because of its ease of dosing, vancomycin is commonly used to treat methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia in patients undergoing long-term hemodialysis. Clinical outcomes resulting from such a therapeutic strategy have not been well defined. METHODS: We prospectively identified patients undergoing long-term hemodialysis who received a diagnosis of MSSA bacteremia. Clinical outcomes were grouped according to the predominant antibiotic received during their therapy (vancomycin or a first-generation cephalosporin [cefazolin]). Treatment failure (defined as death or recurrent infection) was determined at 12 weeks after the initial positive blood culture results. A multivariable analysis was used to adjust for confounders. RESULTS: During an 84-month period, 123 hemodialysis-dependent patients with MSSA bacteremia were identified. Patients receiving vancomycin (n=77) tended to be younger (51 vs. 57 years; P=.06) and had a lower rates of metastatic complications at presentation (11.7% vs. 36.7%; P=.001) than did those receiving cefazolin (n=46). The 2 groups were similar with regard to Acute Physiology and Chronic Health Evaluation II scores, comorbidities, source of infection, type of hemodialysis access, and access removal rates. Treatment failure was more common among patients receiving vancomycin (31.2% vs. 13%; P=.02). In the multivariable analysis, factors independently associated with treatment failure included vancomycin use (odds ratio, 3.53; 95% confidence interval, 1.15-13.45) and retention of the hemodialysis access (odds ratio, 4.99; 95% confidence interval, 1.89-13.76). CONCLUSIONS: Hemodialysis-dependent patients with MSSA bacteremia treated with vancomycin are at a higher risk of experiencing treatment failure than are those receiving cefazolin. In the absence of patient specific circumstances (e.g., allergy to beta-lactams), vancomycin should not be continued beyond empirical therapy for hemodialysis-dependent patients with MSSA bacteremia.

Adult↗
PubMed2006

Surgical site infections following spinal surgery at a tertiary care center in Lebanon: incidence, microbiology, and risk factors.

Surgical site infections (SSIs) following spinal surgery are associated with significant morbidity and long-term complications. The epidemiology of these infections has not been previously studied in Lebanon. This nested case-control study was conducted between 2001 and 2003 at the American University of Beirut Medical Center. Cases were defined as patients who developed surgical site infection within 30 d of surgery. Controls were patients with no evidence of infection. There were 27 cases of surgical site infections among 997 surgeries with an incidence of 2.7%. Compared to controls, cases were older (mean age 59 vs 47 y, p=0.001), and were more likely to have diabetes (OR = 4.0; 95% CI 1.2-12.8) and foreign body implantation (OR = 3.4; 95% CI 1.3-9.3). Antibiotic prophylaxis was given for a range of 0-6 d in cases and 0-7 d in controls. Coagulase-negative staphylococci were the most commonly isolated organisms. Hospital stay was significantly longer in cases than controls. The rates of surgical site infections following spinal surgery at our center are comparable to worldwide rates. There is unjustified overuse of prophylactic antibiotics in our patients that has the potential of inducing emergence of antimicrobial resistance.

Adult↗
PubMed2006

Differential effects of levofloxacin and ciprofloxacin on the risk for isolation of quinolone-resistant Pseudomonas aeruginosa.

Due to the greater in vitro activity of ciprofloxacin than that of levofloxacin against Pseudomonas aeruginosa, the likelihood of isolating a clinical strain of quinolone-resistant (QR) P. aeruginosa might be greater after exposure to levofloxacin than ciprofloxacin. We examined the risk of isolating QR P. aeruginosa in association with prior levofloxacin or ciprofloxacin exposure. A case-case-control study was conducted. Two groups of cases, one with nosocomial QR P. aeruginosa infections and one with nosocomial quinolone-susceptible (QS) P. aeruginosa infections, were compared to a control group of hospitalized patients without P. aeruginosa infections. Bivariable and multivariable analyses were used to determine risk factors for isolation of QR P. aeruginosa and QS P. aeruginosa. One hundred seventeen QR P. aeruginosa and 255 QS P. aeruginosa cases were identified, and 739 controls were selected. Exposures to ciprofloxacin were similar among all three groups (8% for controls, 9.4% for QR P. aeruginosa cases, and 7.5% for QS P. aeruginosa cases; P >/= 0.6). Levofloxacin use was more frequent in the QR P. aeruginosa cases than in the controls (35.9% and 22.1%, respectively; odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.3 to 3.0) and less frequent in QS P. aeruginosa cases (14.1% of QS P. aeruginosa cases; OR = 0.6; 95% CI = 0.4 to 0.9). In multivariable analysis, levofloxacin, but not ciprofloxacin, was a significant risk factor for isolation of QR P. aeruginosa (OR for levofloxacin = 1.7 [95% CI = 1.0 to 2.9]; OR for ciprofloxacin = 1.2 [95% CI = 0.6 to 2.5]). Levofloxacin was associated with a reduced risk of isolation of QS P. aeruginosa (OR = 0.6; 95% CI = 0.4 to 0.9), whereas ciprofloxacin had no significant effect (OR = 1.0; 95% CI = 0.6 to 1.8). In conclusion, the use of levofloxacin, but not ciprofloxacin, was associated with isolation of QR P. aeruginosa.

Aged↗
PubMed2006

[Staphylococcus aureus infections: new challenges from an old pathogen].

Staphylococcus aureus is a versatile organism with several virulent characteristics and resistance mechanisms at its disposal. It is also a significant cause of a wide range of infectious diseases in humans. S. aureus often causes life-threatening deep seated infections like bacteremia, endocarditis and pneumonia. While traditionally confined mostly to the hospital setting, methicillin-resistant S. aureus (MRSA) is now rapidly becoming rampant in the community. Community-acquired MRSA is particularly significant because of its potential for unchecked spread within households and its propensity for causing serious skin and pulmonary infections. Because of the unfavorable outcome of many MRSA infections with the standard glycopeptide therapy, new antimicrobial agents belonging to various classes have been introduced and have been evaluated in clinical trials for their efficacy in treating resistant staphylococcal infections. A number of preventive strategies have also been suggested to contain the spread of such infections. In this review, we address the recent changes in the epidemiology of S. aureus and their impact on the clinical manifestations and management of serious infections. We also discuss new treatment modalities for MRSA infections and emphasize the importance of preventive approaches.

Humans↗
PubMed2006

Telavancin: a new lipoglycopeptide with multiple mechanisms of action.

Antimicrobial resistance among Gram-positive organisms continues to increase and has reached epidemic proportions in numerous countries. Telavancin is a semisynthetic lipoglycopeptide with a dual mechanism of action that involves the inhibition of cell-wall synthesis and disruption of bacterial cell-membrane barrier functions. Telavancin exhibits a rapid bactericidal activity against Staphylococcus aureus. It is also active against coagulase-negative staphylococci, enterococci, streptococci and various anaerobic Gram-positive organisms. Telavancin has a prolonged postantibiotic effect and distributes well into cutaneous and pulmonary tissues. Furthermore, it has a low potential for development of resistance and is well tolerated. The overall incidence of adverse events in patients receiving telavancin was similar to that observed with standard therapy and recent data from preliminary clinical trials have demonstrated similar efficacy to standard therapy in the treatment of complicated skin and skin-structure infections. Therefore, telavancin is a promising new antimicrobial agent for the treatment of infections caused by resistant Gram-positive pathogens.

Aminoglycosides↗
PubMed2005

Antibiotic use in acute cholecystitis: practice patterns in the absence of evidence-based guidelines.

OBJECTIVES: Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear. METHODS: We conducted a retrospective review of all cases of acute cholecystitis between 1996 and 2001 at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis. A MEDLINE search for guidelines for antibiotic use in acute cholecystitis was conducted. RESULTS: The number of cases of acute cholecystitis was 79. The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively. Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days. Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis. CONCLUSIONS: The use of antibiotics in patients with acute cholecystitis is erratic and costly. Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.

Adult↗
PubMed2005

Epidemiology and risk factors for extended-spectrum beta-lactamase-producing organisms: a case control study at a tertiary care center in Lebanon.

BACKGROUND: Infections caused by extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli constitute a growing problem worldwide. At the American University of Beirut Medical Center (AUBMC), we have observed a significant rise in the rates of ESBL-producing organisms over the past 5 years. METHODS: Using a case control study design, we compared 99 patients with infections caused by ESBL-producing Escherichia coli and Klebsiella species and 99 frequency-matched controls from which ESBL-nonproducing isolates were recovered at AUBMC. RESULTS: The most notable risk factor for acquiring infections with ESBL-producing organisms was antibiotic consumption within 30 days of the infection (OR, 7.06; 95% CI: 3.27-15.24), with third-generation cephalosporins being associated with the highest risk (OR, 28.4; 95% CI: 3.7-215.8). Other risk factors included recent surgery, presence of a urinary catheter, and need for mechanical ventilation. Moreover, cases had a longer mean duration of hospitalization and were more likely to have relapse of their infection than controls. CONCLUSIONS: Recent antibiotic use is by far the most important predisposing factor to infection with ESBL-producing organisms. Such infections are associated with prolonged hospital stay and increased morbidity. Attention should be redirected toward the unjustified liberal use of broad-spectrum antibiotics both in the hospital and in the community.

Anti-Bacterial Agents↗
PubMed2003

A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation.

BACKGROUND: Colonoscopy preparation regimens are often poorly tolerated because they require use of large-volume bowel preparation solution and diet restrictions for adequate cleansing. This study evaluated the efficacy and tolerability of a split-dose polyethylene glycol-electrolyte solution plus bisacodyl and a regular diet. METHODS: A total of 187 patients (104 men, 83 women; age range 18-91 years) were randomly assigned to receive either 3 L of polyethylene glycol-electrolyte solution (n = 96; Group A) with a liquid diet on the day before colonoscopy, or 2 L of polyethylene glycol-electrolyte solution, one tablet of bisacodyl, and a minimally restricted diet on the day before colonoscopy, and then 1 L of the same solution on the day of colonoscopy (n = 91; Group B). Acceptability, adverse events, and willingness to retake the preparation were assessed by questionnaire. The quality of the preparation was graded by an endoscopist, blinded to the type of preparation, by using a previously described scale (excellent to poor). RESULTS: There were 96 patients in Group A and 91 in Group B. Colon cleansing was significantly better in Group B with regard to the overall quality of the preparation (p lt; 0.05). Compliance was significantly higher in Group B as evidenced by the lower number of patients who discontinued the preparation (4 vs. 15; p = 0.02) because of side effects such as nausea or vomiting. The degree of discomfort, adverse events, and willingness to retake the preparation were not significantly different between the groups. CONCLUSIONS: Colonic preparation with split-dose polyethylene glycol-electrolyte provided better quality colon cleansing and higher compliance, with less dietary restrictions, than preparation with whole-dose polyethylene glycol-electrolyte.

Adolescent↗
PubMed2003

Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms.

OBJECTIVE: Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country. DESIGN: Prospective observational cohort study. SETTING: The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries. PATIENTS: All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed. RESULTS: Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate. CONCLUSION: Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.

Acinetobacter↗
PubMed2003

Endemic gastrointestinal anthrax in 1960s Lebanon: clinical manifestations and surgical findings.

Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment.

Adolescent↗
PubMedDate not supplied

Anthrax: a review.

Explore the source record for details and available documents.

Anthrax↗
PubMedDate not supplied

Fungal infections of the genitourinary tract.

Fungal infections of the urinary tract are increasing in incidence, mostly because of the increasing use of antibacterial agents and indwelling urinary catheters. This review will focus mainly on the spectrum of genitourinary infections caused by Candida spp., including asymptomatic candiduria, cystitis, pyelonephritis, and renal candidiasis. Special emphasis will be placed on the therapeutic approach to the various clinical entities. Other fungal infections, such as urinary aspergillosis and cryptococcosis will be discussed briefly.

Antifungal Agents↗
PubMedDate not supplied

Epidemiology of HIV infection in Lebanon. Data from 1985-2005.

Lebanon is considered among the countries where the HIV epidemic is still in its early phase of spread. Little information is available on the magnitude of the problem due to the lack of an efficient surveillance system. In this review, we report on the epidemiology of HIV infection in Lebanon, based on limited data generated by the Lebanese National AIDS Control Program (NAP). By May 2005, a cumulative number of 813 cases had been diagnosed. The most prevalent mode of HIV transmission in Lebanon is heterosexual exposure accounting for around 50% of the cases. Two hundred ninety-six patients (36.4%) fulfilled the AIDS case definition. Despite the availability of highly active antiretroviral therapy (HAART) provided by the Ministry of Health, the disease burden of HIV infection remains unknown in this country.

Adolescent↗