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PubMed1994

Therapeutic lamellar keratectomy in the management of experimental keratomycosis.

Keratomycosis, a vision-threatening corneal infection, is a challenge to the ophthalmologist because it is often refractory to medical treatment. Surgical keratectomy may not only debulk the major infectious source but potentiate the intracorneal penetration of the antifungal agents. To evaluate the efficacy of keratectomy in managing the fungal corneal ulcer, three common keratomycosis models, Candida, Fusarium, and Aspergillus keratitis, were established in 46 eyes of 23 rabbits (each group had 14, 16 and 16 eyes respectively). Within each keratitis group, the infected eyes were randomly divided into equally numbered experimental and control subgroups. The eyes of the experimental subgroups underwent therapeutic lamellar keratectomy once the typical fungal corneal infection had developed after inoculation. Following keratectomy, eyes of both the treated and control groups received natamycin eyedrops and were regularly examined biomicroscopically. Our results showed that therapeutic lamellar keratectomy is beneficial in chronic, indolent keratitis, such as Candida and Fusarium keratitis, where it promoted corneal healing and shortened the duration of treatment required. The procedure is a valuable adjunctive measure for antifungal agents in these two types of keratitis. However, acute keratitis of the Aspergillus group did not benefit from keratectomy; in these cases, surgery may actually increase the risk of corneal perforation.

Animals↗

PubMed1996

Submucosal collagen in experimental gastroschisis.

Gastroschisis is a congenital anomaly in which the intestines are exposed to amniotic fluid throughout fetal life. Previous studies in animal models have demonstrated smooth muscle thickening and decreased contractility, epithelial dysfunction, and submucosal thickening. The present studies were done to further define the mechanism of submucosal changes by investigating collagen deposition and gene expression in a rabbit model. Gastroschisis was surgically created in fetal rabbits at 24 days gestation (term is 31 days). Sham-operated and unoperated fetuses served as controls. Fetuses were sacrificed and bowels were harvested at 26, 28, and 31 days gestation. Animal weight and gross and histologic appearance were assessed. Submucosal collagen content was measured using the van Geison stain. In situ hybridization of the expression of alpha (1) procollagen RNA was done to determine the distribution and source of submucosal collagen. At term, submucosal thickening was present in animals with gastroschisis, associated with a significantly increased collagen content. Collagen distribution was also more diffuse in the gastroschisis animals than in controls. In situ hybridization revealed procollagen expression in round cells located in the submucosa and not in smooth muscle. These cells did not resemble fibroblasts, and their identity is uncertain. Experimental gastroschisis is characterized by submucosal thickening which is associated with changes in collagen, including increased deposition and more diffuse distribution in the submucosa. The cells responsible for production of procollagen are round, nonfibroblast cells which are located in the submucosa and not in the smooth muscle layer. These findings may have some importance in understanding the mechanisms responsible for intestinal malfunction in infants with gastroschisis.

Abdominal Muscles↗

PubMed2005

Minimally invasive abdominal surgery: lux et veritas past, present, and future.

BACKGROUND: Laparoscopic surgery has developed out of multiple technology innovations and the desire to see beyond the confines of the human body. As the instrumentation became more advanced, the application of this technique followed. By revisiting the historical developments that now define laparoscopic surgery, we can possibly foresee its future. DATA SOURCES: A Medline search was performed of all the English-language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: Minimally invasive surgery is becoming important in almost every facet of abdominal surgery. Optical improvements, miniaturization, and robotic technology continue to define the frontier of minimally invasive surgery. Endoluminal resection surgery, image-guided surgical navigation, and remotely controlled robotics are not far from becoming reality. These and advances yet to be described will change laparoscopic surgery just as the electric light bulb did over 100 years ago.

Abdomen↗

PubMed1999

Inflammatory alterations in mesenteric adipose tissue in Crohn's disease.

BACKGROUND & AIMS: Abnormalities of fat in the mesentery including adipose tissue hypertrophy and fat wrapping have been long recognized on surgical specimens as characteristic features of Crohn's disease. However, the importance, origin, and significance of the mesenteric fat hypertrophy in this chronic inflammatory disease are unknown. Peroxisome proliferator-activated receptor gamma (PPARgamma) is a crucial factor involved in the homeostasis of adipose tissue, a major source of biologically active mediators. METHODS: Intra-abdominal fat accumulation was quantified using a magnetic resonance imaging method in patients with Crohn's disease and controls. PPARgamma and inflammatory cytokines synthesized by mesenteric adipose tissues were assessed by quantitative polymerase chain reaction, in situ hybridization, and immunohistochemistry. RESULTS: In vivo, patients with Crohn's disease have an important accumulation of intra-abdominal fat. This mesenteric obesity, present from the onset of the disease, is associated with overexpression of PPARgamma and tumor necrosis factor (TNF)-alpha, synthesized, at least in part, by adipocytes. CONCLUSIONS: These results suggest that confined increased PPARgamma mesenteric concentrations could lead to the mesenteric fat hypertrophy, which could actively participate through the synthesis of TNF-alpha in the inflammatory response.

Abdomen↗

PubMed2006

Implantation of mesenchymal stem cells overexpressing endothelial nitric oxide synthase improves right ventricular impairments caused by pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH) is a life-threatening disease. Bone marrow cell transplantation is reported to reduce the development of PH by increasing vascular beds in pulmonary circulation. However, adenoviral overexpression of endothelial nitric oxide synthase (eNOS) in the lung is also known to reduce PH. Because mesenchymal stem cells (MSCs) are potential cell sources for neovascularization, the implantation of MSCs overexpressing eNOS (MSCs/eNOS) may further improve the surgical results. We evaluated the efficacy of MSCs/eNOS implantation in monocrotaline (MCT)-induced PH rats. METHODS AND RESULTS: MSCs were isolated from rat bone marrow. PH was induced in rats by subcutaneous injection of MCT. One week after MCT administration, the rats received 3 different treatments: MSCs (MSC group), MSCs/eNOS (MSC/eNOS group), or nontreatment (PH group). As the negative control, rats received saline instead of MCT (control group). Right ventricular (RV) hypertrophy and the elevation of RV systolic pressure (RVSP) were evaluated 3 weeks after MCT administration. Moreover, the effects of MSCs/eNOS on survival were investigated in PH induced by MCT 3 weeks earlier. RVSP in both the MSC and MSC/eNOS groups was significantly lower than the PH group. RVSP in the MSC/eNOS group was significantly lower than the MSC group. The RV weight to body weight ratio was significantly lower in the MSC and MSC/eNOS groups than the PH group. The survival time of rats receiving MSCs/eNOS was significantly longer than the nontreatment rats. CONCLUSIONS: Intravenous implantation of MSCs/eNOS may offer ameliorating effects on PH-related RV impairment and survival time.

Adenoviridae↗

PubMed1981

Effect of removal of follicles, corpora lutea or ovaries on maintenance of pregnancy in swine.

The effects of the removal of follicles, corpora lutea (CL) or ovaries at day 108 of gestation on maintenance of pregnancy and on concentrations of progesterone, prostaglandin 2 alpha-metabolite (PGF2 alpha-M) and relaxin in maternal plasma were studied in 20 gilts. Controls were subjected to sham surgical procedures. Removal of CL or ovaries decreased progesterone and relaxin and increased PGF2 alpha-M in the maternal circulation and prematurely terminated pregnancy without causing onset of lactation. Progesterone and relaxin decreased to a lower concentration after ovariectomy than after removal of CL, probably because of incomplete extirpation of luteal tissue. Ovariectomy increased the frequency of stillbirths. These results show that the CL are the main source of progesterone and relaxin in pregnant swine and that relaxin may play a role in parturition and the onset of lactation.

Animals↗

PubMed1986

A comparison of isobutyl 2-cyanoacrylate glue, fibrin adhesive, and oxidized regenerated cellulose for control of needle hole bleeding from polytetrafluoroethylene vascular prostheses.

Prolonged anastomotic and needle hole bleeding from synthetic vascular prostheses is a common surgical problem in heparinized patients and in the patient with a coagulopathy. The relative effectiveness of various hemostatic agents has not previously been determined by controlled comparisons. In this study 6 mm polytetrafluoroethylene (PTFE) vascular prostheses were used to perform carotid-carotid and femorofemoral bypasses in eight heparinized dogs. The relative effectiveness of isobutyl 2-cyanoacrylate, fibrin adhesive, and oxidized regenerated cellulose was determined by application of these hemostatic agents to three sources of bleeding: arterial-PTFE anastomoses, PTFE-PTFE anastomoses, and 18-gauge needle holes in PTFE vascular prostheses. The mean time to hemostasis (MTH) was determined for each hemostatic agent. Although application of isobutyl 2-cyanoacrylate resulted in the shortest MTH in each experimental group, the reported inflammatory response that it induces and its possible carcinogenicity limits its availability for clinical use. Application of fibrin adhesive prepared from single-donor hepatitis-screened plasma resulted in a significantly shorter MTH in each experimental group when compared with oxidized regenerated cellulose. We recommend clinical use of fibrin adhesive to control needle hole and anastomotic bleeding from PTFE vascular prostheses.

Animals↗

PubMed1993

[Importance of surgical masks for peroperative asepsis].

For more than 70 years, the surgical mask has been used under operations as part of the maintenance of aseptic conditions in the operational field. Experiments with models and investigations of sources of infection carried out over the past 20 years have shown, however, that the bacterial flora of the upper respiratory tract do not contribute to airborne contamination of the surgical wound, but that persons who are situated directly beside the field may contaminate the wound directly by droplets released by speech, sneezing or coughing. Over the last ten years the usefulness of the surgical mask has been disputed several times, and a few controlled clinical trials have been able to confirm any benefits associated with use of surgical masks. There is therefore no reason from the point of view of preventing infection to maintain a general requirement for the use of surgical masks by others than those persons who may be situated within an arm's length of the operational field or instrument table.

Asepsis↗

PubMed1998

Management of non-traumatic subarachnoid hemorrhage in Filipinos.

A retrospective study of a consecutive series of 110 Filipino patients with non-traumatic subarachnoid hemorrhage (SAH) treated by the author in an urban setting is presented as to etiology, sex and age, diagnostic procedures employed, and short- and long-term results of non-surgical and surgical management. Aneurysms were the source of hemorrhage in 48%, arteriovenous malformation in 9%, and "other SAH" (hypertension/undetermined causes) in 43%. Fifty-seven (52%) patients were initially seen by a general practitioner, 44 (40%) by a neurologist, and only nine (8%) were seen directly by the neurosurgeon. A male sex preponderance for aneurysm was seen below the age of 50 years and a female preponderance for other SAH and aneurysm above age 50 years. The great majority of patients were admitted on the same day they had SAH--usually within 8 hours of onset. Delay in hospitalization did not adversely affect the clinical grade. SAH was demonstrated by lumbar puncture (71%) and computed tomography (29%). Of 74 patients who underwent angiography, vasospasm was associated mainly with aneurysms and present in 50% of these cases. Medications most commonly utilized were for control of edema, sedation, and anti-vasospasm. Forty-three of 53 patients with aneurysms underwent surgical procedures of various types. In general, patients admitted with good clinical grade had good outcomes of treatment. For high grade patients the attitude was to wait for an improvement in clinical grade before performing surgery.

Adolescent↗

PubMed1999

Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy.

OBJECTIVE: To examine potential changes in quality of care associated with a recent financing system implementation in Italy: in 1995, hospital financing reform implemented in Italy included the introduction of a DRG-based hospital financing system with the goals of controlling the growth of hospital costs and making hospitals more accountable for their productivity. DATA SOURCES: Hospital discharge abstract data from 1993 through 1996 for all hospitals (N=32) in the Friuli-Venezia-Giulia region of Italy. Regional population data were used to calculate rates. STUDY DESIGN: Changes between 1993 and 1996 in hospital admissions, length of stay, mortality rates, severity of illness, and readmission rates were studied for nine common medical and surgical conditions: appendicitis, diabetes mellitus, colorectal cancer, cholecystitis, bronchitis/chronic obstructive pulmonary disease (COPD), bacterial pneumonia, coronary artery disease, cerebrovascular disease, and hip fracture. PRINCIPAL FINDINGS: The total number of ordinary hospital admissions decreased from 244,581 to 204,054 between 1993 and 1996, a population-based decrease of 17.3 percent (p<.001). The mean length of stay decreased from 9.1 days to 8.8 days, resulting in a 21.1 percent decrease in hospital bed days (p<.001). Day hospital use increased sevenfold from 16,871 encounters in 1993 to 108,517 encounters in 1996. The largest decrease in hospital admissions among study conditions was a 41 percent decrease for diabetes (from 2.25 per 1,000 in 1993 to 1.31 in 1996, p<.001). For eight of the nine conditions, severity of illness increased. Differences between severity-adjusted expected and observed in-hospital mortality rates were small. CONCLUSIONS: Observed trends showed a decrease in ordinary hospital admissions, an increase in day hospital admissions, and a greater severity of illness among hospitalized patients. There was little or no change in mortality and readmission rates. Administrative data can be used to track changes in patterns of care and to identify potential quality problems deserving further review.

Diagnosis-Related Groups↗

PubMed1983

Cerebral emboli of paradoxical origin.

A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

Adult↗

PubMed1994

Creutzfeld-Jakob disease: recommendations for infection control.

Creutzfeld-Jakob disease, an infectious, progressive, degenerative neurologic disorder, has a presumably long incubation period but a rapid, fatal course. Brain tissue at autopsy resembles that seen in spongioform encephalopathies of other species. Creutzfeld-Jakob disease is transmitted by a proteinaceous infectious agent, or "prion." Epidemiologic patterns remain uncertain; various studies have reported conflicting risk factors in different populations, and genetic susceptibility may be involved. Although natural transmission routes are still unclear, both iatrogenic and nosocomial transmissions have been identified. Transmission has occurred through contaminated electrodes, contaminated biologic products from cadaveric brains, and infected donor tissues, including dura mater and corneas. Because the prion is difficult to eradicate, stringent sterilization precautions must be taken with all surgical instruments. Some tissues and body fluids (e.g., brain, ocular, central nervous system) from the patient with Creutzfeld-Jakob disease are highly infectious and must be contained or incinerated. Some body fluids, however, are not considered infectious. Persons with known or suspected Creutzfeld-Jakob disease, or with exposure to potential sources of iatrogenic infection, should not be considered as donors for any tissues or biologic products. Occupational transmission to health care and pathology workers is also possible. Therefore, specific preventive measures are necessary. Many questions remain regarding transmission and risk factors for Creutzfeld-Jakob syndrome, and the precautions presented here must be considered only preliminary.

Creutzfeldt-Jakob Syndrome↗

PubMed2003

Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis.

BACKGROUND: Acute pancreatitis is a common acute abdominal emergency which lacks specific therapy. In severe attacks, areas of the pancreas may become necrotic. The mortality risk rises to >40% if sterile necrosis becomes superinfected, usually with gut derived aerobic organisms. Experimental and clinical studies indicate a window of opportunity of 1-2 weeks, when superinfection, and thus high-risk surgical debridement, may be prevented by administering systemic antibiotics to 'sterilise' tissues adjacent to necrotic areas. There are theoretical risks of encouraging antibacterial resistance and opportunistic fungal infections. OBJECTIVES: To determine the effectiveness and safety of prophylactic antibiotic therapy in patients with severe acute pancreatitis who have developed pancreatic necrosis. SEARCH STRATEGY: MEDLINE, EMBASE, and the Cochrane Library were searched. We also examined other sources including Conference Abstracts (published and unpublished data). SELECTION CRITERIA: Randomised controlled trials (RCT) were sought using the search strategy detailed below. No linguistic limitations were applied. RCTs were selected in which antibacterial therapy was evaluated in patients with severe acute pancreatitis associated with pancreatic necrosis proven by intravenous contrast-enhanced computed tomography (CT). No linguistic limitations were applied. Searching was undertaken initially in November 2001 and updated in March 2003. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data from trial publications independently, concerning rates for the primary end-points: with respect to: all cause mortality and rates of infection of pancreatic necrosis (proven by microbiological examination of fine needle aspirate or operative specimens). In addition, secondary end-points included peri-pancreatic sepsis, remote sepsis (respiratory, urinary, central venous line sources), operative rates, length of hospital stay, adverse events including the incidence of drug resistant microorganisms and opportunistic fungal infection. MAIN RESULTS: It was possible to evaluate mortality in all four included studies, and it demonstrated a survival advantage for antibiotic therapy (Odds ratio 0.32, p=0.02). Pancreatic sepsis (infected necrosis) was also measurable in all four studies and showed an advantage for therapy (Odds ratio 0.51, p=0.04). Extra-pancreatic infection could be evaluated in three studies, but showed no significant advantage for therapy (Odds ratio 0.47, p=0.05).Operative treatment data was available in three studies, but surgery rates were not significantly reduced (Odds ratio 0.55, p=0.08). Fungal infections showed no strongly increased preponderance with therapy (Odds ratio 0.83, p=0.7), but there were no data on infection with resistant organisms. Length of hospital stay could only be evaluated in two studies and was not significantly different. Sub-group analyses planned for the influence on outcome measures of the antibiotic regimen, the time of commencement of therapy in relation to symptom onset and/or hospitalisation, duration of therapy, and aetiology could not be performed as no data were available. REVIEWER'S CONCLUSIONS: Despite variations in drug agent, case mix, duration of treatment and methodological quality (especially the lack of double blinded studies), there was strong evidence that intravenous antibiotic prophylactic therapy for 10 to 14 days decreased the risk of superinfection of necrotic tissue and mortality in patients with severe acute pancreatitis with proven pancreatic necrosis at CT. Further studies are required to confirm all of the benefits suggested (in particular the need for operative debridement), to provide more adequate data on adverse effects, to address the choice of antibacterial agents and effects of varying duration of therapy, and whether outcome is related to aetiology.

Acute Disease↗

PubMed2004

Vacuum-assisted biopsy device-diagnostic and therapeutic applications in breast surgery.

BACKGROUND: The last three decades have seen a gradual shift in the surgical treatment of breast diseases. An example of this is the popularization of minimal invasive procedures. The vacuum-assisted biopsy device (VABD) was originally introduced as a diagnostic tool; however, improvement in technology (by production of larger calibre tools) has now extended the role of VABD to therapeutic procedures. DATA SOURCES: An extensive pubmed and medline search was conducted from 1990 to 2004, all articles involving the use of VABD were retrieved, secondary referencing of suitable articles was also done. CONCLUSION: VABD has an expanding role in the surgical treatment of benign breast diseases, improvement in technology may further extend its therapeutic role to the excision of small malignant lesions. However, the perceived benefits of minimal invasive breast surgery need to be validated in randomized controlled studies.

Biopsy, Needle↗

PubMedDate not supplied

Perioperative hyperfractionated high-dose rate brachytherapy combined with external beam radiotherapy in the treatment of soft tissue sarcomas.

AIMS AND BACKGROUND: Low-dose rate brachytherapy alone or in combination with external beam radiotherapy represents a well-established adjuvant treatment in soft tissue sarcomas following surgical resection. The experience with high-dose radiotherapy in this indication is limited. The purpose of our study was an evaluation of the viability of perioperative hyperfractionated high-dose rate brachytherapy in combination with external beam radiotherapy for primary and recurrent soft tissue sarcomas. PATIENTS AND METHODS: From February 1998 through June 2002, 10 adult patients with soft tissue sarcomas were treated by interstitial perioperative high-dose rate brachytherapy and external beam radiotherapy. TNM classification was pT2bpN0pM0 in 9 patients and pT1bpN0pM0 in 1 patient. Grade of differentiation was G1 (2 patients), G2 (n = 1), G3 (n = 5), G4 (n = 2). Surgical margins were negative in 7 cases, close in 2 cases and positive in 1 case. The tumor was localized in an extremity in all cases. Hyperfractionation 3 Gy twice daily at 10 mm from the plane of sources was used for brachytherapy, with total doses 18-30 Gy. The patients received external beam radiotherapy with doses 40-50 Gy after brachytherapy. Follow-up periods were between 24-71 months (median, 46). RESULTS: Local control of the disease was achieved in all 10 patients. Distant metastases occurred in 2 cases. One patient was disease free after salvage surgery and chemotherapy, and one patient died of lung disease progression 14 months after brachytherapy. In one case, subcutaneous fistula occurred after radiotherapy and was cured by an excision. Six patients experienced grade 1 or 2 fibrosis and 1 case a mild peripheral neuropathy was recorded. CONCLUSIONS: Our study on a small number of patients suggests that perioperative hyperfractionated high-dose rate brachytherapy with doses 8 x 3 Gy in combination with external beam radiotherapy 40-50 Gy is a promising method to achieve high biological doses in the postoperative radiotherapy of soft tissue sarcomas without severe late morbidity and warrants further research.

Adult↗

PubMed1979

Adjuvant radiation therapy in colon cancer.

The overall five year survival of patients with colorectal cancer is excellent compared with other major visceral malignancies. This is attributable to effect surgical treatment, yet the death rate per 100,000 population has improved little in recent decades, stimulating a search for adjuvant treatment modalities until a better understanding of etiology and pathogenesis results in prevention of earlier diagnosis. Combination of the known cancerocidal effect of ionizing radiation and surgical excision has been used sporadically for over six decades, but only recently has this combined modality therapy been studied in a scientific manner. Numerous variables such as source of radiation, total tumor dose, dose-time factors, location of portals of treatment, size and shape of radiation fields, and the radiation-surgery sequence are now being studied. Current information leaves little doubt of the effectiveness of this combined modality therapy in selected patients. Controlled clinical trials must continue in order to obtain more solid data, which hopefully will eventually result in substantially improved survival.

Adenocarcinoma↗

PubMed1995

Controversies in shock research: hypertonic resuscitation--pros and cons.

The proper fluid resuscitation of hemorrhagic shock is still controversial. Hypertonic saline has been suggested for prehospital resuscitation of hemorrhagic shock, because of its superior ability to expand blood volume and elevate systemic blood pressure and cardiac output in a small volume and during a short time period. We have defined two types of hemorrhagic shock: controlled hemorrhagic shock (CHS), where the bleeding source is immediately occluded following hemorrhage, and uncontrolled hemorrhagic shock (UCHS), where bleeding is induced by injury to blood vessels that are left unoccluded. It was observed that hypertonic saline (HTS) treatment of controlled hemorrhagic shock leads to an increase in blood pressure and cardiac output, while HTS treatment of UCHS leads to increased bleeding from injured blood vessels, hemodynamic deterioration, and increased mortality. Conversion of UCHS to CHS by tourniquet, military antishock trousers, or surgical hemostasis prevented excessive bleeding and mortality following HTS. Several clinical studies have used hypertonic saline dextran (HSD) or hypertonic saline (HS) for treatment of trauma casualties, but to date no significant improvement in mortality has been demonstrated by either HS or HSD. A more favorable effect but still not statistically significant effect has been demonstrated in patients with a Glasgow Coma Scale of 8 or less. The efficacy of HS has not clearly been established in clinical trials, in all of which HS was used in combination with conventional crystalloid therapy. Further human trials are required to better define the patient population that would benefit most from the prehospital administration of HS.

Animals↗

PubMed2005

[Nosocomial Stenotrophomonas maltophilia infections in a university hospital].

Stenotrophomonas maltophilia is a nosocomial pathogen of increasing importance. In our study, 190 S. maltophilia strains isolated from 153 hospitalized patients between January 2000-April 2004, at Farabi Hospital at Medical School of Karadeniz Technical University, were prospectively evaluated. Of these patients 67.9% were clinically compatible with nosocomial infection, and 32% were considered as colonization. It was observed that rate of infection had a tendency to increase one year of age and above 50 years of age. Nosocomial infection and/ or colonization with S. maltophilia was detected in 19.7 +/- 15.2 (1-89) days after hospitalization. The clinical manifestations were bacteremia (36.5%), pneumoniae (28.8%), urinary system infection (12.5%), surgical site infection (11.5%) and peritonitis (6.7%). The bacteremia episodes were associated with central venous catheter in 37.3% (19/51), ventilator associated pneumonia in 11.7% (6/51), urinary system infection in 7.8% (4/51), peritonitis in 3.9% (2/51), and surgical site infection in 1.9% (1/51) of cases. Nineteen patients (37.3%) had no apparent primary source of infection. Higher APACHE II score, longer duration of hospitalization and prior extended-spectrum antibiotic therapy were observed in most of the patients. Antibiotic susceptibility testing revealed that, the most effective antibiotics against the isolates were trimethoprim-sulfamethoxazole (94%), ticarcillin/clavulanate (79%) and ciprofloxacin (53.5%). Crude mortality rate in the patients with S. maltophilia infections was found to be 25%. In addition, it was observed that proper antibiotic treatment had protective role against mortality (14.6% vs 63.6%; OR = 0.1, Cl95 0.12-0.42, P = 0.000). It can be concluded that to prevent infections due to S. maltophilia , effective infection control programmes and rational antibiotic use policies should be established promptly.

Adolescent↗