RESUMO
OBJECTIVES: Crimean-Congo haemorrhagic fever (CCHF) is a zoonotic viral infection which is an important public health problem in Turkey. CCHF causes fever and bleeding and can lead to severe health outcomes. The study aims to report a case of a male patient with severe CCHF, hemophagocytic lymphohistiocytosis (HLH) treated with steroids and portal vein thrombosis. CASE REPORT: A 37-year-old man was admitted to the emergency department with complaints of high fever, headache, myalgia and diarrhoea. The patient travelled to the endemic region of Turkey. In laboratory findings, thrombocytopenia, abnormal liver function tests and elevated coagulation parameters were observed. Real-time polymerase chain reaction assay was used for diagnosis of CCHF. Hypofibrinogenemia, hypertriglyceridemia, elevated ferritin and d-dimer levels were observed in the clinical follow-up. Prednisolone treatment was performed due to considered the diagnosis of HLH. Portal vein thrombosis was detected on abdominal computed tomography scan. He was successfully treated with ribavirin, corticosteroids, anticoagulant and supportive therapy. CONCLUSION: The clinical presentation of CCHF can range from self-limiting flu-like to severe symptoms possibly fatal. Acute portal vein embolism is a rare complication that has not been reported before to our knowledge. Corticosteroids may be a life-saving treatment for CCHF patients presenting with HLH.
Assuntos
Febre Hemorrágica da Crimeia , Linfo-Histiocitose Hemofagocítica , Veia Porta , Trombose Venosa , Humanos , Masculino , Febre Hemorrágica da Crimeia/complicações , Adulto , Trombose Venosa/etiologia , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/complicações , Turquia , Ribavirina/uso terapêutico , Prednisolona/uso terapêuticoRESUMO
BACKGROUND: To have country-wide information about multidrug resistance (MDR) in isolates from community-acquired urinary tract infections (CAUTI) of Turkey, in terms of resistance rates and useful options. METHODS: We used a geocode standard, nomenclature of territorial units for statistics (NUTS), and a total of 1588 community-acquired isolates of 20 centres from 12 different NUTS regions between March 2019 and March 2020 were analysed. RESULTS: Of the 1588 culture growths, 1269 (79. 9%) were Escherichia coli and 152 (9.6%) were Klebsiella spp. Male sex, advancedage, and having two or more risk factors showed a statistically significant relation with MDR existence (p < 0.001, p: 0.014, p < 0.001, respectively) that increasing number of risk factors or degree of advancing in age directly affects the number of antibiotic groups detected to have resistance by pathogens. In total, MDR isolates corresponded to 36.1% of our CAUTI samples; MDR existence was 35.7% in E. coli isolates and 57.2% in Klebsiella spp. isolates. Our results did not show an association between resistance or MDR occurrence rates and NUTS regions. DISCUSSION: The necessity of urine culture in outpatient clinics should be taken into consideration, at least after evaluating risk factorsfor antibacterial resistance individually. Community-acquired UTIs should be followed up time- and region-dependently. Antibiotic stewardship programmes should be more widely and effectively administrated.
Assuntos
Infecções Comunitárias Adquiridas , Infecções por Escherichia coli , Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Infecções Urinárias , Humanos , Masculino , Escherichia coli , Infecções por Escherichia coli/microbiologia , Esclerose Múltipla Recidivante-Remitente/complicações , Universidades , Farmacorresistência Bacteriana Múltipla , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Klebsiella , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality. METHODS: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]). RESULTS: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP. CONCLUSIONS: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.
Assuntos
COVID-19 , Pé Diabético , Humanos , Pé Diabético/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Masculino , Feminino , Turquia/epidemiologia , Pessoa de Meia-Idade , Idoso , Pandemias , SARS-CoV-2 , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Negativas , HospitalizaçãoRESUMO
Enterococci are mostly isolated from urinary tract infections (UTIs). Increasing antibiotic resistance affects the success rate in empirical treatment, thus makes antibiotic susceptibility tests important. The aim of this study was to determine the species distribution and resistance patterns of Enterococcus strains isolated from urine samples to antibacterial agents including fosfomycin in a teaching hospital, Istanbul. The identification of 100 Enterococcus strains were determined by using conventional methods and API 20 Strep (bioMerieux France). The susceptibility testing was performed by disk diffusion and Etest. The majority of isolates were E. faecalis (67%), followed by E. faecium (33%). The ratio of E. faecalis to E. faecium was 2.03/1. E. faecalis and E. faecium strains were resistant to penicillin (38.8, 93.9%), ampicillin (4.8, 84.8%), vancomycin (1.5, 18.2%), teicoplanin (1.5, 18.2%), gentamicin (13.4, 58%), ciprofloxacin (34.3, 84.8%), levofloxacin (34.3, 87.9%), norfloxacin (38.8, 84.8%), tetracycline (89.6, 48.5%), nitrofurantoin (1.5, 39.4%), and fosfomycin (2.3, 0%) (p < 0.0001), respectively. Resistance to fosfomycin was observed in neither E. faecium strains, nor vancomycine-resistant enterococci strains. It was concluded that, enterococci are important pathogens for UTI; species identification and periodic evaluation of antibiotic susceptibility pattern would be guide for early empirical treatment and in uncomplicated UTI, fosfomycin could be an alternative option for therapy.
Assuntos
Antibacterianos/farmacologia , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Fosfomicina/farmacologia , Infecções Urinárias/microbiologia , Farmacorresistência Bacteriana , Enterococcus faecalis/isolamento & purificação , Enterococcus faecium/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Infecções Urinárias/urinaRESUMO
OBJECTIVES: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A). MATERIALS AND METHODS: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. PRIMARY END-POINT: 14-day mortality. SECONDARY END-POINTS: Microbial eradication and clinical improvement. RESULTS: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. CONCLUSION: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter/efeitos dos fármacos , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Colistina/uso terapêutico , Farmacorresistência Bacteriana Múltipla , APACHE , Acinetobacter/patogenicidade , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Distribuição de Qui-Quadrado , Colistina/efeitos adversos , Comorbidade , Quimioterapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Indução de Remissão , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Turquia , Adulto JovemRESUMO
The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum ß-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed.
Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Pneumonia Associada à Ventilação Mecânica/microbiologia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitais de Ensino , Humanos , Incidência , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Estudos Prospectivos , Turquia/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.
Assuntos
Brucella/isolamento & purificação , Brucelose/tratamento farmacológico , Ceftriaxona/farmacologia , Endocardite Bacteriana/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminoglicosídeos/administração & dosagem , Aminoglicosídeos/farmacologia , Valva Aórtica/microbiologia , Brucella/patogenicidade , Brucelose/diagnóstico , Brucelose/microbiologia , Brucelose/mortalidade , Ceftriaxona/administração & dosagem , Quimioterapia Combinada , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/microbiologia , Turquia/epidemiologia , Adulto JovemRESUMO
In this study, the epidemiological, clinical, laboratory and therapeutic features of forty adult malaria patients referred our clinic between February 1996-September 2009, were assessed retrospectively. Diagnosis was established by Giemsa-stained thick and/or thin blood smears in all cases. Thirty-four patients were male and 6 patients were female and mean age was 31.1 years. All patients had a history of travel to endemic areas (24 cases to Africa, Afghanistan, Azerbaijan, Arabian Peninsula, 16 cases to Southestern Anatolia Region), and none of them had chemoprophylaxis. Plasmodium vivax was detected in 20 patients, and P.falciparum in 18 and mixed (P. vivax and P. falciparum) in two. Parasitemia ranged from 0.5%- 25%. Fever (100%), periodic fever (62.5%), splenomegaly (72.5%), hepatomegaly (45.0%), anemia (67.5%), leukopenia (32.5%), thrombocytopenia (75.0%), a rise in erytrocyte sedimentation rate (65.0%), abnormalities in hepatic enzymes (62.5%), hyponatremia (32.5%), hypoglisemia (25%) and an elevated serum creatinine level (27.5%) were determined in the patients. Two patients with P. falciparum developed acute renal failure and cerebral involvement died soon after admission. Acute renal failure, acute respiratory distress syndrome, cerebral involvement and dissemine intravasculer coagulation were observed in one patient with falciparum malaria who recovered completely. In conclusion, every febril patients with a history of travel to the endemic regions should raise the suspicion of malaria. Effective pre-exposure chemoprophylaxis and personal protection measures should be provided to travellers visiting endemic regions.