Faculty of Medicine

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    RECURRENT CLOSTRIDIOIDES DIFFICILE COLITIS – CASE REPORT
    (Peytchinski Publishing Ltd., 2024-10-06)
    Georgievska, Dajana
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    Vidinic, Ivan
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    Shopova, Zhaklina
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    Rangelov, Goran
    Recurrent Clostridium difficile infection (rCDI) is usually defined as the reappearance of enteral symptoms 2-8 weeks after resolution of the initial episode with an appropriate therapy. Recurrence occurs in approximately 25% of patients within the first 30 days of the treatment. A 62-year-old female was initially hospitalized at our hospital within the intensive care unit (ICU) due to acute encephalitis and bilateral bronchopneumonia. Her comorbidities were diabetes mellitus and hypertension. She was treated with a combination of parenteral beta-lactam antibiotics for 35 days, acyclovir, probiotics, gastric suppression, and other supportive therapies. On the 18th hospital day, she developed diarrhea with liquid mucous green stools, prompting stool cultures and a C.difficile toxins test, which were negative and her condition stabilized spontaneously. A week later, she experienced a recurrence of enteral symptoms when stool cultures showed C.difficile positivity, but negative toxin tests. A colonoscopy was performed, revealing pseudomembranous pancolitis. Treatment continued with intravenous metronidazole and oral vancomycin for two weeks, alongside probiotics. This led to gradual improvement and normalization of stool consistency. Control cultures were C.difficile negative, and she was discharged after 49 days. Three weeks later, she complained of persistent watery stools and malaise, thus she was readmitted. New stool cultures confirmed C.difficile positivity with negative toxin tests. A repeat colonoscopy showed significant regression of pseudomembranous colitis and biopsy results indicated chronic nonspecific colitis. She was treated with probiotics, intravenous metronidazole for a week, and oral vancomycin. On first follow-up visit after three weeks, she returned asymptomatic with normal stools, and was advised to continue oral vancomycin, rifaximin, and probiotics. A second follow-up visit two weeks later confirmed normal stool characteristics. Prolonged use of antibiotics, extended hospital stays, advanced age, severe preexisting illness are significant risk factors for recurrent CDI. Prolonged oral vancomycin therapy has shown high efficacy in treatment of this serious condition.
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    PHARMACOEPIDEMIOLOGY AND ANTIMICROBIAL RESISTANCE DATA FOR BACTERIAL INFECTIONS IN HOSPITALIZED CHILDREN
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2019)
    Pechiareva Sadikarijo, Iskra
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    Serafimovska, Tijana
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    Darkovska Serafimovska, Marija
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    Antimicrobial resistance is a global problem that needs an urgent action. The irrational use of antibiotics is widespread and leads to potential usefulness of medicines and negative therapeutic outcome.In April 2016, WHO stated that the problem of antibiotic resistance is a major clinical problem resulting in treatment failures even in a case ofeasy to treat diseases. Resistance to first line medicines results in huge spending on new generation of antibiotics. In some instances resistance to second- and third-line agents is seriously compromising treatment outcome.Seriousness of the situation requires extensive research and constantly monitoring of the spread of bacteria resistance.Another problem regarding bacteria resistance is the lack of new antibiotics reported by the US Center for Control and Prevention of Disease.A systematic literature search of databasesgave us enough information about the use of antibiotics, most often isolated bacteria and resistance to different classes of antibiotics. According to the official data, bacterial resistance is lowest in the countries where guidelines for prescribing and use of antibiotics are consistently implemented, such as Scandinavian countries, The Netherlands, Germany and Great Britain. It is necessary to create a complete database of bacterial resistance and information on whether patients receive medicines appropriate to their clinical conditionin our country.
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