WCIM 2014 SEOUL KOREA 163
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0451 Infectious Disease
Antibiotic Stewardship Program and Strict Infection Control Implementation to Decrease the Prevalence of Antimicrobial Resistance Organism in Surabaya
Usman HADI1, Bramantono SOEKARMAN1, Musofa RUSLI2
Dr.Soetomo Hospital, Airlangga University School of Medicine, Indonesia1, Institute of Tropical Diseases Airlangga University, Indonesia2
Background: Antimicrobial resistant microorganism is a global problem that threat human live. Prevalence of ESBL’s producing bacteria in Indonesia is quite high. To overcome this problem antibiotic stewardship and better infection control must be implemented in all health facilities.
Methods: Evaluation of pre and post intervention in the department of Internal Med- icine and department of Surgery Dr. Soetomo Hospital in the year 2012 and 2013. The multifaceted intervention consisted of small group discussion, updating antibiotics guideline, training of the residents and paramedical staffs regarding prudent use of antibiotic and instruction of strict infection control procedure. The prevalence of ES- BL’s producing bacteria’s was collected from the Department of Microbiology Hospital.
Results: A decline in the prevalence of E.coli ESBL (+) by 11% and K.pneumoniae ESBL (+) by 24% after implementation of this program. These results are in accordance with the target of our program to reduce ESBL by 10%.
Conclusions: Implementation of antibiotic stewardship program and implementation of strict infection control is very important to manage patients and able to decrease the prevalence of ESBL producing bacteria
PS 0452 Infectious Disease
A Patient with Acute Disseminated Encephalomyelitis Caused by West Nile Virus Infection
Eko Oktiawan WICAKSONO1, Bramantono SOEKARMAN1, Usman HADI2
Dr. Soetomo Hospital/School of Medicine Airlangga University, Indonesia1, Institute of Tropical Diseases, Airlangga University, Indonesia2
Background: West Nile virus (WNV) is an arbovirus (arthropode borne viruses), wild and pet birds are the source of infection of this virus, although most patients with WNV infection reveal no symptoms (70-80 %) or mild fl u-like symptoms, but in some patients develop into severe disease involving the central nervous system (CNS), in- cluding meningitis, encephalitis, acute disseminated encephalomyelitis (ADEM) and acute paralysis, so that the disease has a greater potential to cause health problems.
Methods: This case report is intended to inform and to increase awareness that WNV is already exist and spread in Indonesia and has potentials to make serious health problem, so interventions to manage environment is needed to minimize vector popu- lation
Results: We reported a case of a man 17 years old, came to the hospital with fever and followed by upper and lower limb weakness caused by WNV infection, the con- fi rmation diagnosis was made by PCR examination. The results magnetic resonance imaging (MRI) appear of multi-focal lesions similar to the image of bilateral ischemic infarcts with gliosis in the cervical spinal cord asymmetrical, mesencephalon, cerebral peduncle, insulae gyrus and uncus, putamen, periventricular, pericolosal, corona radia- ta, centrum semiovale. Finally, the patient was diagnosed as ADEM, and cured with completely recovery without sequel with corticosteroid and intravenous immunoglob- ulin treatment.
Conclusions: Severe CNS symptoms can occur in people infected with West Nile virus, and complete recovery with supportive therapy; this is the fi rst case WNV infection reported in Indonesia.
PS 0453 Infectious Disease
Infective Endocarditis Case Presented with Endogenous Endophtalmitis
Kevser KUTLU TATAR1, Sibel SERIN1, Ece YIGIT TASKIN1, Betul AYAZ1, Sema UCAK BASAT1
Umraniye Educational and Research Hospital, Turkey1
Endogenous endophtalmitis (EE), a sight-threating emergency,has been reported as the 2–8% of all endophthalmitis cases. EE is most often associated with a diagnosed underlying medical condition, including DM, liver disease, cardiac disease, malignancy, in-dwelling catheters and intravenous drug abuse (IVDU). A woman, 69 year-old, diag- nosed with EE was followed up in the ophthalmology clinic for vitrectomy, consulted due to abdominal pain, pyuria and high levels of cholestasis enzymes. The patient had DM, hypertension, and ischemic heart disease for the last decade and severe heart failure for the last month. She had femoral catheter for ultrafi ltration two weeks ago.
She was transferred to the internal medicine clinic with the differential diagnosis of heart failure, acute cholecystitis and urinary tract infection. In the MRCP imaging fol- lowing an abdominal US, a signal differentiation due to possible metastasis or abscess was identifi ed in the liver. Multiple calculus in the neck of the bile cyst and cystic duct, sludge in gallbladder, expansion in choledoch diameter and multiple calculus at the distal part of choledoch were detected. A bilobular and fl at contoured, 85x140mm lesion was found at the left adnexa. A third echocardiography in a month was per- formed for her recently diagnosed cardiac failure and 2/6 systolic murmur, which was detectable best from the mitral point. The last echocardiography showed %50 EF, intermediate-advanced mitral insufficiency and a mass-vegetation on mitral valve.
TEE, performed afterwards, showed vegetation on mitral valve and the possibility of valve perforation. Due to the continuation of decompensation and total obstruction in circumfl ex artery seen on the coronary angiography, coronary bypass and vegetation removal operations were performed. In this case, we present a case which has almost all the etiological reasons together except IVDU and which was diagnosed as IE based upon the EE diagnosis.
PS 0454 Infectious Disease
Risk Factors for Neonatal Conjunctivitis in Babies of HIV-1 Infected Mothers
Njeri Rahab MBUGUA1, Asunta Wagura WAGURA2, Elizabeth Ann BUKUSI4 Kenya Medical Research Institute, Kenya1, Kenya Network of Women Living with HIV/AIDS, Kenya2, Kenyatta National Hospital, Kenya3, Nairobi University, Kenya4
Background: To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodefi ciency virus type 1 (HIV-1) infected mothers.
Methods: This was a nested case-control study within a perinatal HIV-1 cohort.
HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and short- course zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries.
Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratifi ed for infant HIV-1 status.
Results: Four hundred and fi fty-two infants were assessed and 101 (22.3%) had neo- natal conjunctivitis during the fi rst month postpartum. In multivariate analyses using odds ratios (OR) and confi dence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis.
Conclusions: Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.
