Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey.

BACKGROUND: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Secondary infections after cytotoxic chemotherapy in patient with hematological malignancies.

INTRODUCTION: This study was initiated to investigate the risk factors of secondary infections in febrile neutropenic patients following chemotherapy, and to evaluate the clinical, microbiological, and mortality outcomes of these infections. METHODOLOGY: An evaluation was done on all patients with hematological malignancy who developed a febrile neutropenic episode (FNE) after cytotoxic chemotherapy in the Department of Hematology, Akdeniz University Faculty of Medicine, between January 2007 and December 2008. RESULTS: A total of 294 primary FNEs that responded to the initial empirical or targeted treatment were included in the study, and secondary infections developed after 72 (24.5%) of 294 primary FNEs. Risk factors for secondary infections were determined as acute leukemia as the underlying disease, salvage chemotherapy for refractory/relapse diseases, prolonged neutropenia (10 days and over), Multinational Association of Supportive Care in Cancer (MASSC) score < 21, and fungal infection during the primary episode. The mortality rate of patients who developed secondary infections was significantly higher compared to patients without secondary infections (27.8% and 5.4%, respectively; p = 0.001). CONCLUSIONS: The development of secondary infections in patients with hematological malignancy was not very rare. Greater concern should be shown for these infections to increase patient survival rates.

[Renal cyst hydatid]. / Renal Kist Hidatik.

Hydatid cyst disease is an oral transmitted parasitosis caused by the larval form of the Echinococcus granulosus tapeworm that penetrates the intestinal mucosa and reaches the internal organs via the blood and lymphatic stream. Hydatid cyst disease is an important health problem, especially in developing countries, such as Turkey. Renal hydatid cyst is extremely rare, and kidney involvement is seen in only 2% of all cases. In this study, we present two patients with renal hydatid cyst. Hydatid cyst was not suspected before pathological diagnosis in both patients. At first, the patients were suspected of having malignancy, and the treatment modality was made accordingly. When the pathology results revealed hydatid cyst, the treatment of the patients was modified. Renal hydatid disease should be kept in mind in the differential diagnosis of patients presenting with renal cyst in Turkey.

An outbreak of Pseudomonas aeruginosa infective endocarditis subsequent to coronary angiography.

OBJECTIVES: To describe an endocarditis outbreak affecting three patients due to Pseudomonas aeruginosa infection post coronary angiography performed in the Cardiovascular Surgery and Cardiology Medical Center of a private hospital. METHODS: After recognition of an infection cluster within a onemonth period, the outbreak was reported to Antalya Department of Health and a broad investigation was initiated in order to determine the most probable cause and/or source of nosocomial pseudomonal endocarditis. Patient data were obtained by medical record review as well as interviews with patients or their next of kin. Thirty-six surveillance samples for P. aeruginosa were collected from various locations within the coronary angiography unit. The outbreak research team reviewed the private hospital's Cardiovascular Surgery and Cardiology Medical Center's infection control procedures. The epidemiology of P. aeruginosa was studied through analysis of phenotypic markers, including antimicrobial sensitivity profiles. RESULTS: The infection control audit revealed multiple breaches of infection control procedures. Only 1/36 environmental samples yielded, which was isolated from a radio-opaque solution within an angiography injector pump. P. aeruginosa from the radio-opaque solution had an identical antimicrobial susceptibility pattern to the strain isolated from patients. Both samples were susceptible to all antipseudomonal agents. This outbreak could have been successfully controlled by instituting combined infection control measures. CONCLUSIONS: This outbreak emphasizes the important of adherence to infection control standards and practices for cardiac catheterization, as well as the need for closer collaboration between the Infection Control Committee and coronary angiography personnel.

Un brote epidémico de endocarditis por Pseudomonas aeruginosa secundario a angiografía coronaria / An outbreak of Pseudomonas aeruginosa infective endocarditis subsequent to coronary angiography

Objectives: To describe an endocarditis outbreak affecting three patients due to Pseudomonas aeruginosa infection post coronary angiography performed in the Cardiovascular Surgery and Cardiology Medical Center of a private hospital. Methods: After recognition of an infection cluster within a onemonth period, the outbreak was reported to Antalya Department of Health and a broad investigation was initiated in order to determine the most probable cause and/or source of nosocomial pseudomonal endocarditis. Patient data were obtained by medical record review as well as interviews with patients or their next of kin. Thirty-six surveillance samples for P. aeruginosa were collected from various locations within the coronary angiography unit. The outbreak research team reviewed the private hospital's Cardiovascular Surgery and Cardiology Medical Center's infection control procedures. The epidemiology of P. aeruginosa was studied through analysis of phenotypic markers, including antimicrobial sensitivity profiles. Results: The infection control audit revealed multiple breaches of infection control procedures. Only 1/36 environmental samples yielded, which was isolated from a radio-opaque solution within an angiography injector pump. P. aeruginosa from the radio-opaque solution had an identical antimicrobial susceptibility pattern to the strain isolated from patients. Both samples were susceptible to all antipseudomonal agents. This outbreak could have been successfully controlled by instituting combined infection control measures. Conclusions: This outbreak emphasizes the important of adherence to infection control standards and practices for cardiac catheterization, as well as the need for closer collaboration between the Infection Control Committee and coronary angiography personnel.

Objetivos: Describir un brote de endocarditis por Pseudomonas aeruginosa que afectó a tres pacientes tras habérseles efectuado una coronariografía en el Centro Médico de Cardiología y de Cirugía Cardiovascular (CMC-CCV) de un hospital privado. Métodos: Después de reconocer la aparición de un brote en un periodo de un mes, este hecho fue comunicado al Departamento de Salud de Antalya, iniciándose una exhaustiva investigación para precisar la más probable causa y/o fuente de las endocarditis nosocomiales. Se extrajo de los registros médicos los datos clínicos de los pacientes y se efectuaron entrevistas a los pacientes o sus familiares. Se extrajo 36 muestras medioambientales de vigilancia en busca de P. aeruginosa de diversos sitios dentro de la unidad de coronariografía. Un team que investigó el brote revisó los procedimientos en uso para la prevención de infecciones en el CMC-CCV. Se estudió la epidemiología de la P. aeruginosa mediante análisis de su fenotipos, incluyendo el perfil de susceptibilidad in vitro a antimicrobianos. Resultados: La auditoria comprobó el quiebre de diversas normas de control de infecciones. Sólo 1/36 de las muestras ambientales arrojó el cultivo de P. aeruginosa, a partir de una solución de medio radio-opaco dentro de una bomba inyectora empleada en las angiografías. Los aislados de P. aeruginosa desde la solución del medio radio-opaco tenían idéntico patrón de susceptibilidad antimicrobiana que las cepas recuperadas de los pacientes. Ambos tipos de muestras eran susceptibles a todos los antimicrobianos con actividad anti-pseudomonas. El brote pudo evitarse si se hubieran instaurado una serie de medidas de control de infecciones. Conclusiones: Este brote enfatiza la importancia de adherir a los estándares y prácticas de control de infecciones para la cateterización cardiaca, así como la necesidad de una estrecha colaboración entre el Comité de Control de Infecciones y el personal involucrado en el procedimiento de coronariografía.

Evaluation of vancomycin resistance 3 multiplexed PCR assay for detection of vancomycin-resistant enterococci from rectal swabs.

BACKGROUND: Active screening for vancomycin-resistant enterococci (VRE) using rectal specimens is recommended to limit the spread of antimicrobial resistance within certain high-risk populations. We evaluated the diagnostic performance of Vancomycin Resistance 3 Multiplexed Tandem PCR assay (AusDiagnostics, Australia), a rapid multiplex real-time PCR assay that detects vanA and/or vanB. METHODS: Two-hundred-and-eleven rectal swabs from Hematology and Oncology unit were submitted for VRE surveillance via direct detection of vanA and/or vanB by culture and by using Vancomycin Resistance 3 Multiplexed Tandem PCR assay. Enterococci were identified to the species level by using standard biochemical tests and BD Phoenix Automated Microbiology System (BD Diagnostic Systems, USA). Vancomycin susceptibility of enterococci was determined using Etest (BioMerieux, France). RESULTS: Compared to the culture method, Vancomycin Resistance 3 Multiplexed Tandem PCR assay had a sensitivity of 84.0%, specificity of 98.8%, positive predictive value (PPV) of 91.3%, and negative predictive value (NPV) of 97.6%. The assay failed to detect 18 (8.5%) specimens because of the presence of PCR inhibitors; of the remaining 193 specimens, 25 (12.9%) were positive, 23 for vanA, and 2 for vanB. Although both sensitivity and specificity for vanA VRE was 100% compared to the culture method, all vanB-positive specimens tested negative by VRE culture. CONCLUSIONS: Vancomycin Resistance 3 Multiplexed Tandem PCR assay is a rapid and laborsaving option for VRE surveillance for direct use on rectal swabs. However, the high rate of PCR failure owing to the inhibitors in the specimens and the low specificity for vanB should be considered when interpreting the results.

[Clinical evaluation of forty-four patients with necrotizing fasciitis]. / Nekrotizan fasiit tanisiyla izlenen 44 olgunun klinik degerlendirmesi.

BACKGROUND: Necrotizing fasciitis is a rare but life-threatening soft-tissue infection primarily involving the superficial fascia and subcutaneous tissue. METHODS: We conducted a retrospective study of 44 patients with necrotizing fasciitis between 2004 and 2008 in Akdeniz University Hospital, Department of Infectious Diseases and Clinical Microbiology and other departments. The aim of this study was to determine the causative agents of the necrotizing fasciitis, and the localization, predisposing factors, and comorbid conditions. RESULTS: We found that diabetes mellitus, trauma and surgery were the most important predisposing factors. Moreover, the lower extremity and perianal region were the most frequently involved sites. Polymicrobial agents were the most frequent and the mortality was found as 25%. CONCLUSION: In conclusion, necrotizing fasciitis cases followed in our hospital were evaluated in this study.

The effect of granulocyte colony-stimulating factor in the treatment of Escherichia coli peritonitis with or without ceftriaxone in a nonneutropenic rat model.

PURPOSE: To investigate the effect of granulocyte colony-stimulating factor (G-CSF) in the treatment of Escherichia coli peritonitis with and without ceftriaxone in a nonneutropenic rat model. METHODS: The rats were divided into five groups: control group (C) receiving physiological saline; peritonitis group (P) infected intraperitoneally with a live bacterial suspension of E. coli; peritonitis and antibiotic group (PA) receiving ceftriaxone 3 h after being infected; peritonitis, antibiotic, and G-CSF group (PAG) receiving G-CSF and antibiotic 3 h after infection; and peritonitis and G-CSF group (PG). RESULTS: All rats in group C survived. Any animals which did not survive died within 24h after inoculation. A significantly higher rate of survival, 95%, was observed with antibiotic treatment alone (PA), in comparison to the G-CSF-treated groups, PAG and PG, 52% and 57%, respectively. CONCLUSION: No beneficial effect of G-CSF treatment was seen in the E. coli peritonitis and antibiotic therapy remains the basic treatment for this disease.