Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey.

Candidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30 days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154-1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752-8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634-53.744, p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079-6.761, p = 0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057-6.439, p = 0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147-0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia.

Comparison of the effectiveness of caspofungin and liposomal amphotericin-B for the treatment of C. tropicalis-induced peritonitis in mice.

In order to compare the effectiveness of liposomal amphotericin B (LAB) and caspofungin monotherapy in Candida tropicalis-induced peritonitis in an experimental mice model 56 healthy male BALB/c mice (10-12 weeks; 20-25 g) were divided into groups and C. tropicalis strains were intraperitoneally (IP) inoculated into mice groups except the control group. After the injection, three doses of LAB (0.5, 1.0, 2.0 mg/kg/day) and caspofungin (1.0, 2.0, 5.0 mg/kg/day) were administered to groups for five consecutive days, starting 48-h post-infection. The mice were then followed up for 14 days and killed by cervical dislocation. When their peritoneal fluid was examined, the difference in fungal growth between the treatment group and control group was significant (p <0.05). Evaluation of the treatment groups revealed that fungal growth decreased with increasing dose of the antifungal agent (p >0.05). There was no dose-related difference from mice which received LAB or those which received caspofungin in our experimental model. During our study, no death was detected despite the similar injection doses compared with other studies using Candida species. The results of this study suggest that C. tropicalis could have lower virulence, perhaps limited by natural immunity, and causes mortality at much higher doses.

Imported Malaria in Turkey: The Importance of Diagnosis and Treatment of Plasmodium falciparum/Plasmodium vivax Mixed Infection.

The most common types of malaria in the world are Plasmodium vivax and P. falciparum. In countries where both species are endemic, P. vivax and P. falciparum coinfection also occurs. Thus, the possibility of mixed malaria in Turkey should always be considered in cases with a traveling history to these countries. Here, we report a case of P. vivax/P. falciparum mixed infection that was diagnosed as P. falciparum malaria in Ethiopia. However, the administered treatment was inadequate, and infection recurred because of the miss in the diagnosis of P. vivax malaria, for which an effective drug for hypnozoites was not administered. This case report emphasizes the importance of diagnosis, correct and adequate treatment of infections, and a close follow-up of diseases.

Colistin efficacy in the treatment of multidrug-resistant and extremelydrug-resistant gram-negative bacterial infections.

BACKGROUND/AIM: Colistin is used as a salvage therapy for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections. Our aim was to evaluate colistin efficiency and toxicity in the treatment of these resistant gram-negative bacterial infections. MATERIALS AND METHODS: This is a retrospective study carried out in a tertiary care hospital during 2011-2013. Study data were collected from the medical records and consultations of the infectious diseases clinic. RESULTS: The study group included 158 patients with nosocomial infections and 136 (86.1%) of them were hospitalized in the ICU. Respiratory tract infections were the most commonly observed ones (n = 103, 65.2%). The most frequently isolated microorganism was Acinetobacter baumannii (72.2%). A total of 98 (62.0%) patients had clinical cure. There was no statistically significant difference between monotherapy (n = 3/6, 50.0%) and combination therapies (n = 95/152, 62.5%) according to clinical response. Underlying ultimately fatal disease, previous renal disease, and total parenteral nutrition were independent risk factors for poor clinical response. Nephrotoxicity developed in 80 (50.6%) patients and clinical cure was statistically unrelated with nephrotoxicity. CONCLUSION: Colistin may be used as an effective agent for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections with close monitoring of renal functions, especially for older and critically ill patients.

Evaluation of patients with zygomycosis.

AIM: Zygomycosis is a severe angioinvasive infection caused by Zygomycetes. We retrospectively investigated 16 cases of zygomycosis. MATERIALS AND METHODS: The data of patients, who had been followed between 2004 and 2010 in 8 tertiary-care teaching hospitals, were reviewed. Demographic characteristics, underlying diseases, and clinical signs and symptoms of the patients, as well as diagnostic methods, data obtained by radiological imaging methods, and the therapies, were recorded. Therapeutic approaches, antifungal agents and duration of use, and the characteristics of the cases were identified. RESULTS: The study included 11 female and 5 male subjects. The most common symptoms and clinical signs were fever (n = 9) and retro- orbital pain (n = 7). Rhinocerebral zygomycosis was the most common form. The mean time elapsed for diagnosis was 14.26 + 13.96 (range: 2-52) days. Antifungal therapy was given to 15 patients (94%). In addition to antifungal therapy, 12 patients underwent surgical intervention 1 to 4 times. The mean duration of receiving antifungal therapy was 61.4 + 58.02 (range: 1-180) days. The median duration of treatment was 62.5 (range: 42-180) days in survivors. CONCLUSION: Zygomycosis is an infectious disease with high mortality despite antifungal therapy and surgical interventions.

Brucellosis: a rare cause of febrile neutropenia in acute myeloblastic leukemia.

Brucellosis is a zoonotic disease and endemically seen in the Middle East, Eastern Europe and continental America. Febrile neutropenia related to Brucellosis has been reported only in a few cases. Brucella was cultured from the bone marrow of a 42-year-old woman who was admitted to hospital with symptoms of fever and fatigue and later diagnosed as acute myeloblastic leukemia (AML). The patient was treated for both AML and Brucellosis without any problems and discharged from the hospital after scheduling her follow-up visits. Brucellosis might be considered in the etiology of febrile neutropenia in endemic regions and must be treated effectively to prevent possible morbidity and mortality during or after chemotherapy.

[Investigation of nasal carriage of community-acquired methicillin resistant Staphylococcus aureus in primary and high school students]. / Ilkögretim ve lise ogrencilerinde toplum kökenli metisiline dirençli Staphylococcus aureus burun tasiyiciliginin arastirilmasi.

The aim of this study was to evaluate the carriage rate and risk factors of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) among the students in Manisa, Turkey. A total of 2015 students (1012 from the last phase of high schools and 1003 from the first phase of primary schools) were included in the study. None of the students had nasal MRSA carriage. Methicillin-sensitive S. aureus (MSSA) colonization rate was 14.7% (296/2015). Nasal carriage of MSSA was significantly higher in the primary school students (17.8%) than the high school students (11.6%) (p < 0.001). MSSA carriage was also higher in students of higher socioeconomical status than the students of lower status (p < 0.05). A statistically significant relationship was not determined between the nasal carriage and the risk factors (history of hospitalisation or surgical operation in the previous one year, use of antibiotics or history of skin/soft tissue infection in the last 6 months, presence of children < 15-years-old in the family, presence of healthcare workers in the same house, living in a crowded house). Penicillin and erythromycin resistance was found in 93.6% and 14.2% of MSSA strains, respectively. No resistance was detected against ciprofloxacin, co-trimoxazole, linezolid and vancomycin. There was a statistically significant difference between erythromycin resistance and antibiotic use within the last six months and the number of family members (p < 0.05). In conclusion, current treatment regimens still seem to be affective and safe for the empirical treatment of community-acquired S. aureus infections. Although CA-MRSA infections seem not to be a serious threat in our region yet, it is essential to carry out prevalence studies in the different populations of the community.

Experimental sinusitis in a rhinogenic model.

OBJECTIVES/HYPOTHESIS: The objectives were to determine the optimal sinusitis induction period and to examine microbiological and histopathological changes of sinusitis recovery stage in a rhinogenic sinusitis model. METHODS: A synthetic sponge was inserted into the right-side nasal cavities of rabbits. The sponge was impregnated with a Streptococcus pneumoniae strain in group 1 and with sterile saline solution in groups 2 and 3. After the fourth day of sponge insertion, sinuses were examined by coronal computed tomography scans at two-day intervals until any radiological evidence of sinusitis was observed. When sinusitis was detected radiologically, five rabbits each from groups 1 and 2 were killed for histological examination. To determine the recovery period of sinusitis, sponges were removed from the rest of the rabbits in groups 1 and 2. Rabbits were selected randomly and killed on the 15th and the 30th days of the recovery period, immediately after radiological examinations. Group 3 was considered a sham group. RESULTS: Sinusitis induction was performed in all rabbits in groups 1 and 2 until the 8th day. After the sponges were removed, inflammation persisted until the 30th day of the study. CONCLUSION: In a rhinogenic sinusitis model, although histological features of sinusitis were demonstrated, further studies are required to standardize this model and to examine whether or not the studied bacterial strain spreads from nasal cavity into sinus.

Emergence of phenotypic resistance to ciprofloxacin and levofloxacin in methicillin-resistant and methicillin-sensitive Staphylococcus aureus strains.

The emergence of phenotypic resistance to ciprofloxacin and levofloxacin in methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MRSA) strains was studied. Twenty MRSA and 77 methicillin-sensitive S.aureus (MSSA) strains susceptible to both quinolones were investigated for resistance after single step or serial passages. No growth of 20 MRSA strains was observed at 4xMIC of levofloxacin after 48 h incubation, but 4 of 77 (5%) MSSA strains grew at the same concentration. At 4xMIC concentration of ciprofloxacin, 10 MSSA (13%) and five MRSA (25%) strains were grown. In the serial passages of MRSA strains, resistance to ciprofloxacin was 75 and 5% for levofloxacin by the third passage. In the seventh passage this resistance was 100 and 15%, respectively. In MSSA strains, resistance to ciprofloxacin was 75 and 19% to levofloxacin at the third passage and at the seventh passage, 100 and 61%, respectively. Emergence of ciprofloxacin resistance was more common and developed more rapidly than resistance to levofloxacin in both MRSA and MSSA strains.

Experimental sinusitis in nasally catheterised rabbits.

AIM: The aim of the study was to create an experimental rabbit model for investigating the effects of nasal catheterization on rhinosinus mucosa, bacterial flora and observing the development of bacterial sinusitis. METHODS: Healthy adult white rabbits of either sex and with body weights of 2.5-3 kg were used. Rabbits were randomly separated into two groups; the first group was catheterized by 12 French and the second group was catheterized by 8 French catheters blindly and the non-catheterized left sides were accepted as control. Three randomly chosen rabbits from each group were examined by computerized tomography scans (CT) and sacrified in the first, second and the fourth week of the study. Microbiological and histopathological examinations were performed. RESULTS: In both study groups after the first week of nasal catheterization, opacity or air-fluid level was detected in maxillary sinuses by CT scans, which was significant in group 1. Inflammation spread by the prolongation of nasal catheterization and rapidly development of sinusitis was observed by thicker catheters' usage. CONCLUSION: In this study, the role of nasal catheterization as a predisposing factor in the development of sinusitis and the increase of sinusitis development risk in relation with the catheterization period and the catheters' thickness was shown.