Journal of Acute Disease

14-19

Authors: Mehmet Süleyman Sabaz1 , Nagihan Sabaz2 , Gökhan Sertçakacılar3 , Sinan Aşar 1

Objective: To investigate the code blue application at a training and research hospital in Turkey. Methods: The code blue declaration forms and the hospital database with 238 complete records between January 2016 and July 2017 were collected. The form involved individual characteristics, the reason for issuing the code blue call, the unit and block where the code was given, time and location related properties such as working time and arrival duration, properties regarding the intervention process such as its type, duration or result. The 24-hour and 30-day long survival data of the patients to whom cardiopulmonary resuscitation was implemented were obtained from the hospital database, or from their relatives. The influencing factors of arrival duration were analyzed. Results: The median duration of arrival was 2.14 (2.00-3.02) min. Code blue applications were performed more frequently in Departments of General Surgery, Internal Medicine, Orthopaedics, and Cardiology Clinics. Half of the code blue calls were due to cardiac arrest; the other half was due to shortness of breath or respiratory distress, syncope, and respiratory arrest. Three-outof four code blue calls were treated with orotracheal intubation and cardiopulmonary resuscitation, or only orotracheal intubation or only medical treatment; one-fourth of the calls were not intervened. Altogether, 72.36% of the code blue calls patients were intervened; 69.35% of them were made both orotracheal intubation and cardiopulmonary resuscitation, and 20.5% of them were made only orotracheal intubation and 10.55% of them made only medical treatment. It was found that giving the code blue day or night had no effect on the time to reach the area where the code was given. Similarly, it was found that giving the code blue within daytime or night shift had no effect on the time to reach the area where the code was given. (P>0.05). The survival rates were 39.1% within the first 24 h and 18.1% within the first 30 d. Conclusions: Applications of code blue should be analyzed at regular intervals as clinical quality indicators. Reasons for wrong calls should be determined. The duration of reaching locations where calls are made should also be decreased.

27-32

Authors: Fatemeh Shahi1,2,3, Hajar Hamidi2 , Saeed Khoshnood4 , Golshan Mehdipour2 , Aram Asarezadegan Dezfouli2 , Ahmad Farajzadeh Sheikh2,3

Objective: To evaluate the relationship between biofilm formation and incidence of virulence determinants in clinical isolates of Enterococcus. Methods: In this cross-sectional study, the clinical isolates of Enterococcus strains were collected from the university teaching hospitals in Ahvaz, Iran from June 2017 to June 2018. Then, the prevalence of Enterococcus species, antibiotic resistance, virulence factors, and biofilm-producing ability were determined. Results: Of the 119 tested isolates, 17 (14.3%) were Enterococcus faecalis, 72 (60.5%) were Enterococcus faecium and 30 (25.2%) were other Enterococcus spp. Gelatinase was detected in 97 (81.5%) isolates, enterococcal surface protein in 41 (34.5%) isolates, serine protease in 39 (32.8%) cases, accessory colonization factor in 111 (93.3%) cases and pathogenicity islands in 17 (14.3%) cases. The biofilm formation ability was observed in 75 (63.0%) of all isolates and the association between the presence of enterococcal surface protein gene and biofilm formation was statistically significant. Higher resistance to vancomycin, gentamycin, and teicoplanin was indicated in Enterococcus faecium with 81.8%, 58.4%, and 85.7% resistance rate, respectively. All Enterococcus faecalis isolates were sensitive to teicoplanin and vancomycin. Conclusions: The presence of antibiotic-resistance with several virulence factors in Enterococcus spp has become a concern. High prevalence of enterococcal surface protein gene among biofilmproducing isolates suggests a potential relation between biofilm formation and the enterococcal surface protein gene, and further studies are needed to identify the mechanism of biofilm inhibition.

40-42

Authors: Saurabh Karmakar1 , Somnath Bhattacharya1 , Shilpi Karmakar2 , Deependra Kumar Rai1

Rationale: Extensively drug resistant Klebsiella pneumoniae is defined as resistant to least one antimicrobial agent in all but two or lesser antimicrobial categories. Patient concerns: A 58-year-old diabetic male was admitted with bilateral pneumonia. Sputum culture grew Klebsiella pneumoniae which was sensitive to only colistin on culture. Diagnosis: Acute hypoxemic respiratory failure causes bilateral pneumonia (community acquired). Intervention: The combination therapy of oral faropenem and intravenous colistin for treatment. Outcome: The patient recovered fully and is doing well on followup. Lesson: Emerging antibiotic-resistant and hypervirulent strains of Klebsiella pneumoniae should drive further studies on novel antibiotic combinations for extensively drug-resistant Klebsiella pneumonia.