Facilitated Subcutaneous Immunoglobulin Treatment Increases the Quality of Life and Decreases the Number of Infections and Hospitalizations in Children with Primary Immunodeficiencies.

INTRODUCTION: Immunoglobulin replacement therapy is an effective lifelong treatment modality used in patients with primary immunodeficiency to prevent and/or reduce the incidence of serious infections. Facilitated subcutaneous immunoglobulin (fSCIG) was developed to combine the advantages of intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) and is the latest method of immunoglobulin G (IgG) administration. In this study, switching to fSCIG administration in primary immunodeficiency patients receiving regular IVIG or SCIG therapy was evaluated, and serum IgG trough levels, frequency of infections, frequency and duration of hospitalizations, duration of absence from school/work, and quality of life were determined. METHODS: In this study, fifteen patients with primary immunodeficiency who were previously receiving IVIG or SCIG treatment, followed by fSCIG, were evaluated retrospectively. Age, diagnosis, current complications, mean IgG value, frequency of infection, frequency of hospitalization, and duration of absenteeism from school and work were recorded during and before fSCIG treatment. At the beginning of fSCIG treatment, at 6th and 12th months, "The Quality of Life Scale" was also evaluated in patients and parents. RESULTS: The most common indications for initiation of fSCIG treatment were the difficulty of access to the hospital and the long transfusion periods. No systemic adverse reactions were reported except for redness, swelling, and mild pain on the injection site. The median IgG values for the last 1 year were 529.6 mg/dL for IVIG (n = 9), 876.2 mg/dL for SCIG (n = 6) and 856.7 mg/dL for fSCIG (n = 15, all patients) treatment. The frequency of infections and the number of hospitalizations decreased significantly in the fSCIG group compared to both previous treatment modalities. There was a significant increase in the quality of life score of the patients and their families when compared with previous treatment modalities. CONCLUSION: fSCIG is an effective treatment method and is well tolerated in patients with immunodeficiency. It provides stable immunoglobulin levels and excellent protection against infections and offers the patients the possibility of home-based therapy.

COVID-19 in patients with familial Mediterranean fever treated with colchicine: case based review.

Coronavirus disease 2019 (COVID-19) refers to the clinical picture of an important and severe infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Considering the current knowledge on the pathophysiology and clinical manifestations of COVID-19, it is safe to state that both COVID-19 and inflammatory rheumatic disorders cause a cytokine storm and merit treatment with anti-rheumatic drugs. Three patients, who were on regular follow-up due to the diagnosis of familial Mediterranean fever (FMF), contracted COVID-19 infection; and their pre-clinical and post-clinical data as well as laboratory, prognosis and treatment data were investigated. Effects of colchicine in FMF patients who contracted COVID-19 infection were presented in this study. All the cases recovered from COVID-19 without complications. The present study suggests that colchicine can positively affect the prognosis of COVID-19 in FMF patients; therefore, experience of rheumatologists in the use of anti-inflammatory drugs can be highly instrumental in management of COVID-19 patients.

Current genetic defects in common variable immunodeficiency patients on the geography between Europe and Asia: a single-center experience.

Identification of the causes of monogenetic common variable immunodeficiency (CVID) patients has rapidly increased in the last years by means of worldwide availability of appropriate genetic diagnostic methods. However, up to date, very limited numbers of reports demonstrating the role of geography, ethnicity, and consanguinity have been published. Here, we reported the first study of Turkish CVID patients and compared them with the results of three countries from America, Europe, and Asia. A total of 100 children diagnosed as CVID according to the criteria of European Society for Immunodeficiencies were enrolled, and they were genetically analyzed by using targeted next-generation sequencing and whole-exome sequencing. The median age of our patients was 5.8 years (range, 3.0-16.0 years) at clinical diagnosis and 9.0 years (range, 4.8-21.0 years) at the time of genetic diagnosis. The consanguinity rate was 24%. Disease-causing pathogenic variants were defined in 40% of patients in a total of 17 different genes. Sixteen of 40 identified pathogenic variants were novel (40%). We determined 18 surface molecular defects, 10 cytosolic defects, 9 nuclear defects, and 3 others. In our cohort, the most common gene was TACI (15/40 in pathogenic variant identified cases and 15/100 in all cases) followed by the others such as PLCÒ¯2, LRBA, TCF3, and STAT1. In contrast to our expectations, our results were more similar to American and European population rather than Asians, although we also have high consanguinity rates and live on the geography between Europe and Asia. Genetic investigation is a great challenge, because of the complexity and heterogeneity of the disease, and each country has to know their own current genetic landscape in CVID for a better and successful management of the patients.

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).

BACKGROUND: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. METHODS: We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. RESULTS: During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. CONCLUSIONS: The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

Evaluation of Patients with Acute Respiratory Distress Syndrome Followed on Mechanical Ventilator in a Tertiary Pediatric Intensive Care and the Factors That May Be Associated with Death in These Patients.

OBJECTIVE: We aimed to evaluate the clinical, demographic, and laboratory characteristics of the patients followed up with pediatric acute respiratory distress syndrome in our pediatric intensive care unit and to determine the factors that have an effect on the outcomes. MATERIALS AND METHODS: The medical records of 40 patients with acute respiratory distress syndrome who were followed up on mechanical ventilators in the pediatric intensive care unit of Adiyaman University were retrospectively scanned. From the medical records, the demographic data, clinical features, and laboratory characteristics were recorded. RESULTS: Eighteen of the patients were female and 22 were male. The mean age was 45.25 ± 56.63 months. A total of 27 (67.5%) of the patients were classified as pulmonary and 13 (32.5%) as extrapulmonary acute respiratory distress syndrome. Sixteen (40%) patients were followed in pressure-controlled mode only, 2 (5%) patients in volume-controlled mode only, and 22 (55%) patients in alternate modes. A total of 17 (42.5%) patients died. The median pediatric index of mortality, pediatric index of mortality-II, pediatric risk of mortality, and pediatric logistic organ dysfunction score values of the surviving patients were significantly lower than the dead patients. Median aspartate aminotransferase (P = .003) and lactate dehydrogenase (P = .008) values were found to be significantly higher in patients who died, while median pH values (P = .049) were found to be lower. The median length of stay in pediatric intensive care unit and duration of mechanical ventilators were significantly shorter in patients who died. Also, the median pediatric index of mortality, pediatric index of mortality-II, pediatric risk of mortality, and pediatric logistic organ dysfunction values of pulmonary acute respiratory distress syndrome patients were significantly lower than those of extrapulmonary acute respiratory distress syndrome patients. CONCLUSION: Despite advances in follow-up and management, mortality due to acute respiratory distress syndrome is still high. Mechanical ventilator duration, length of stay in pediatric intensive care unit, some mechanical ventilator parameters, mortality scores, and laboratory tests were associated with mortality. Alternatively, mechanical ventilator applications may reduce mortality rates.

Susceptibility Patterns of Multidrug-Resistant Acinetobacter baumannii.

OBJECTIVES: To investigate the antimicrobial resistance patterns of multidrug-resistant Acinetobacter baumannii (MDRAB) in patients in pediatric intensive care units (PICU) in order to determine a guide for the empirical antibiotic treatment of MDRAB. METHODS: The authors retrospectively evaluated the medical records of patients with MDRAB infections in the PICU during a follow-up period, between January 2015 and January 2017. The identification of A. baumannii was performed using a BD Phoenix 100 Automated Microbiology System. A BD Phoenix NMIC/ID-400 commercial kit was used to test antibiotic susceptibility. All data was entered into Microsoft Excel, and the data was analyzed using SPSS version 23.0. RESULTS: The mean age of the patients was 8.1 ± 6.2 y. In all, 46 isolates were obtained from 33 patients. The most effective antimicrobial agents were colistin, trimethoprim/sulfamethoxazole, and tigecycline. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate of >45% for the isolates. Low sensitivities in 2015 to tigecycline, aminoglycosides, levofloxacin, and carbapenems had been lost in 2016. CONCLUSIONS: Many drugs that were previously effective against MDRAB, have lost their effectiveness. Currently, there is no effective drug to fight MDRAB, apart from colistin. Thus, it is clear that new drugs and treatment protocols should be developed urgently.

Vitamin B12 and folic acid levels in pediatric migraine patients.

Migraine is a recurrent, primary cause of headache. Although prophylactic vitamin B12 therapy is used on migraine patients, there is a limited number of studies examining the levels of B12 vitamin and folic acid in pediatric patients diagnosed with migraine. The study group (Group 1) included 65 pediatric patients diagnosed with migraine in the Pediatric neurology outpatient clinic, and 87 healthy cases admitted to the general pediatric clinic were included in the control group (Group 2). Complete blood count parameters, vitamin B12, folic acid, ferritin, and 25 OH D vitamin levels of the study and control groups were compared. The mean vitamin B12 level was 196.42 ± 95.54 pg/mL (59-499) in Group 1 and 240 ± 105.24 pg/mL (74-619) in Group 2. The mean folic acid level was 8.85 ± 3.49 pg/mL (3.68-23.70) in Group 1 and 7.24 ± 7.17 pg/mL (1.11-35.50) in Group 2. There was a statistically significant difference between Group 1 and 2 in terms of vitamin B12 and folic acid levels (p = 0.008, p = 0.00). The results of this study indicate the requirement for routine evaluation of vitamin B12 and folic acid levels in pediatric patients diagnosed with migraine.

Are sinus-track cultures reliable for identifying the causative agent in chronic osteomyelitis?

PURPOSE: The infection of bone that contains bone marrow called osteomyelitis, and is caused by different microorganisms. In this study, we aimed to determine the diagnostic value and accuracy of cultures of material from a sinus track compared with those of cultures of bone specimens that have been controversial. MATERIALS AND METHOD: Prospective study was conducted at Hospital University of Dicle, a 1,090-bed university-based hospital located in Diyarbakir, Turkey. Between May 2005 and September 2006, sinus-track cultures were compared with those of bone cultures from 43 patients with chronic osteomyelitis. RESULTS: The patients' mean age was 30.6 +/- 3.6 years, and 29 (67%) male and 14 (33%) female. Organisms isolated from bone cultures were Staphylococcus 69% (29/42), Escherichia coli 9.5% (4/42), Pseudomonas aeruginosa 9.5% (4/42), Proteus mirabilis 7% (3/42), respectively. Cultures of sinus track and bone specimens gave identical results in 38% of patients. CONCLUSION: The value of bone culture in the therapy of osteomyelitis must be emphasized; it is the only reliable means of determining the responsible agent, up on which the antibiotic therapy is based. The correlation between sinus track and bone cultures was 38%, i.e., failure in the treatment for 6 patients out of 10.

Efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.

AIM: To evaluate the efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C. METHODS: Thirty-six hemodialysis patients with chronic hepatitis C were enrolled in a controlled and prospective study. All patients were treatment naive, positive tested for anti-HCV antibodies, and positive tested for serum HCV-RNA. Twenty-two patients received 135 microg peglyated-interferon alpha-2a weekly for 48 wk (group A). The remaining patients were left untreated, eleven refused therapy, and three were not candidates for kidney transplantation and were allocated to the control group (group B). At the end of the treatment biochemical and virological response was evaluated, and 24 wk after completion of therapy sustained virological response (SVR) was assessed. Side effects were monitored. RESULTS: Of 22 hemodialysis patients, 12 were male and 10 female, with a mean age of 35.2 +/- 12.1 years. Virological end-of-treatment response was observed in 14 patients (82.4%) in group A and in one patient (7.1%) in group B (P = 0.001). Sustained virological response was observed in 11 patients (64.7%) in group A and in one patient in group B (7.1%). Biochemical response parameters normalized in 10/14 patients (71.4%) at the end of the treatment. ALT levels in group B were initially high in six patients and normalized in one of them (25%) at the end of the 48 wk. In five patients (22.7%) therapy had to be stopped at mo 4 due to complications of weakness, anemia, and bleeding. CONCLUSION: SVR could be achieved in 64.7% of patients on hemodialysis with chronic hepatitis C by a treatment with peglyated-interferon alpha-2a. Group A had a significantly better efficacy compared to the control group B, but the side effects need to be concerned.

The efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis.

OBJECTIVE: To evaluate the efficacy of dexamethasone added to the treatment of adult patients with bacterial meningitis in our region. METHODS: One hundred and forty-four patients were randomized prospectively and evaluated to determine the efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis at Dicle University Hospital, Diyarbakir, Turkey between January 2000 and December 2004. While the first group received ceftriaxone 4 gr/day plus dexamethasone, the second group received ceftriaxone 4 gr/day only. Dexamethasone was given 10-15 minutes before the first 8 mg dose of antibiotic treatment. It was continued at 16 mg/day for 3 days. RESULTS: The study included 144 patients with the diagnosis of acute bacterial meningitis. Cerebrospinal fluid (CSF) was analyzed at the time of admission, after 24-48 hours (Table 1), and at the end of treatment. Accordingly, CSF leukocyte level was found to be 1710+/-2140/mm3 in group 1 receiving dexamethasone treatment compared to 1950+/-2244/mm3 in group 2 (p=0.001). The consciousness in the group receiving dexamethasone improved significantly more rapidly than the control group (p=0.001). While mortality was 9.7% in the patient group receiving dexamethasone it was 16.7% in the control group, however, it was not significant (p=0.093). CONCLUSION: The use of dexamethasone in adult patients is still under debate, and the administration of dexamethasone 10-15 minutes before antibiotherapy to unconscious patients in a poor state of health, is effective in the clinical improvement of the patient.

A 6-year prospective surveillance study for healthcare associated infections in a neurology unit.

OBJECTIVE: To assess the epidemiology of healthcare-associated infections (HAIs) in a neurology unit in a university hospital. METHODS: The study was carried out prospectively at Dicle University Hospital, Diyarbakir, Turkey (1050-bed) between 1st January 1999 and 31st December 2004. Active surveillance for HAIs was performed by the infection control team, using the criteria proposed by the Centers for Diseases Control and Prevention (CDC) and National Nosocomial Infections Surveillance System (NNIS) methodology. RESULTS: During the 6-year follow up period, 219 HAIs episodes were detected in 203 patients out of 3323 in patients. The mean length of stay of patients with HAI was 28+/-5 days, while that of patients without infections was 11+/-1 days. Eighty-two patients died with HAIs, while 1330 died in the patients without infections. The overall incidence rates (HAI/100) and incidence densities (HAI/1000 days of stay) of HAIs were 6.6% and 4.4/1,000 patients-days. The most common HAIs by primary site were urinary tract infection (44.2%) and decubitus infection (30.4%). The most prevalent microorganisms were Escherichia coli (27%), Klebsiella species (14%), Pseudomonas aeruginosa (13%), Enterobacter species (12%), coagulase-negative Staphylococci (10%) and Staphylococcus aureus (7%). CONCLUSION: The results may contribute to observe the magnitude and characteristics of HAIs and to plan and evaluate policies and guidelines of infection control in neurology units.

Cervical intramedullary granuloma of Brucella: a case report and review of the literature.

The aim of this study was to present a unique case of intramedullary brucellar granuloma (IBG) and to discuss the diagnosis and management. To our knowledge, only one case of thoracic IBG has been reported previously, and our case is the first in cervical spine. A 35-year-old female patient was admitted with headache, pain and weakness in her four extremities. She had no gastrointestinal symptoms and fever. She had been diagnosed with Brucella meningitis 3 months ago and a triple therapy of doxycyclin, rifampicin and trimetoprim/sulfametoxazol (TMP/SMZ) had been started. Medical history revealed that she had ingested raw cheese and taken her medication improperly. Loss of strength was detected in her four extremities, which led us to assume the formation of a mass lesion at cervical level. Therefore, we performed a magnetic resonance imaging scan and found enhancement of an intramedullary mass lesion at cervical 1-2 level. Diagnosis of neurobrucellosis was confirmed by titer of >1/160 Brucella antibodies both in blood and cerebrospinal fluid. Based on these findings, brucellar granuloma of cervical spine was diagnosed and a combination therapy of doxycyclin, TMP/SMZ and rifampicin was administered for additional 6 months. At the ninth month of treatment, the patient recovered both radiologically and clinically. Our case is unique, in terms of cervical IBG formation. The excellent response to antimicrobial therapy in our patient suggests that, a trial of medical treatment for 6 months may be effective in such cases.

A simple validated prediction rule to diagnose typhoid fever in Turkey.

The goal of this study was to develop a simple prediction rule for the diagnosis of typhoid fever. A model for the prediction of patients with typhoid fever at hospital admission was derived and validated by assigning weighted point values to independent predictive factors associated with a diagnosis of typhoid fever at hospital admission. Patient demographic, clinical and laboratory variables were used to compare patients with blood culture-confirmed typhoid fever with patients with fever of unknown origin. The model was derived and validated in two separate cohorts of patients from Dicle University Hospital in Diyarbakir, Turkey. A total of 371 patients were enrolled. A diagnostic index score was created using seven independent predictive factors associated with typhoid fever at hospital admission: age <30 years, abdominal distention, confusion, leukopenia, relative bradycardia, positive Widal test and a typhoid tongue. A clinical prediction rule helped to differentiate patients with typhoid fever.

Comparison of lamivudine and alpha-interferon combination with alpha-interferon alone in the treatment of HBeAg-positive chronic hepatitis B.

AIM: To compare the efficacy of a combination of a-interferon (IFN-a) and lamivudine with IFN-a alone in the treatment of patients with HBeAg-positive chronic hepatitis B (CHB). METHODS: Sixty-eight treatment-naove patients with HBeAg-positive CHB were randomized to receive either 9 MU of IFN-a2a three times a week and lamivudine 100 mg daily (Group 1), or IFN-a2a alone in the same dosage (Group 2), for 12 months. Serum ALT, HBeAg, anti-HBe and HBV DNA were tested at the end of treatment and 6 months later. Complete response was defined as normal ALT, negative HBeAg and negative HBV DNA, six months after stopping treatment. RESULTS: Of the 68 patients, 64 completed the study. In Group 1 (n=31), mean (SD) ALT levels decreased from 124 (59) IU/L to 39 (18) IU/L at 12 months; corresponding values in Group 2 (n=33) were 128 (57) and 56 (11) IU/L (p< 0.05). Absence of HBV DNA at the end of treatment was more common in Group 1 (28/31) than in Group 2 (22/33; p< 0.022). The number of patients with seroconversion to anti-HBe (4/31 [13%] vs. 4/33 [12%], respectively; p>0.05), as also those with complete response (4/31 [13%] and 4/33 [12%], respectively; p>0.05) six months after completion of treatment was similar in Group 1 and Group 2. CONCLUSION: Combination treatment with IFN-a and lamivudine was better than IFN-a monotherapy in normalization of ALT and clearance of HBV DNA; however, it did not have a better sustained response rate than IFN-a alone.

Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey.

This prospective study was carried out in two university hospitals between January 2000 and December 2002. The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination > or =1/160 titres, and/or the isolation of Brucella species. The patients were followed up without intervention. One hundred and thirty-eight patients with active brucellosis were evaluated. Of the participants, 79 (57.2%) cases were acute, 23 (16.7%) sub-acute and 36 (26.1%) chronic. Brucella melitensis was isolated in the specimens of 24 (26.9%) out of 89 patients. The most frequent symptoms were fever (78.3%), arthralgia (77.5%) and sweating (72.5%). The most common physical findings were fever (40.6%), splenomegaly (36.2%), and hepatomegaly (26.8%). The osteoarticular involvement was found in 64 patients (46.4%). Ten (7.5%) patients had orchiepididymitis. Meningitis, pulmonary involvement, endocarditis, and hepatitis were found in five (3.6%), three (2.1%), two (1.5%) and one (0.7%) patient, respectively. Relative lymphomonocytosis was found in 80 cases (58.8%), anaemia in 46 (33.3%) and leucopoenia in 30 cases (21.7%). Clinical relapse was observed in 14 patients (10.1%).

Anti-hepatitis delta virus seroprevalence and risk factors in patients with hepatitis B in Southeast Turkey.

OBJECTIVE: To obtain regional epidemiological data on hepatitis delta virus (HDV, a defective virus) infections, the incidence of anti-HDV positivity and the associated risk factors in asymptomatic hepatitis B virus surface antigen (HBsAg) carriers and in patients with chronic active hepatitis B. METHODS: The study took place at Dicle University Hospital (Diyarbakir, Southeast of Turkey) between January 2002 and July 2004. Anti-HDV screening was performed in asymptomatic hepatitis B carriers (N=889) and in patients with chronic active hepatitis B infection (N=120). We explored the association between anti-HDV positivity and asymptomatic hepatitis B carrier status, presence of active hepatitis B, age, gender, the durations of HBsAg positivity and hepatitis B e antigen (HBeAg) positivity. RESULTS: In 6% of asymptomatic hepatitis B carriers (53/889) and in 27.5% of patients with chronic active hepatitis B (33/120) anti-HDV was positive. The incidence of anti-HDV positivity was significantly higher in patients with chronic active hepatitis B compared with asymptomatic carriers (p<0.001). A significant association between the duration of HBsAg carrier status (3.2 +/- 1.4 years) and anti-HDV positivity was also found (p<0.001). Age, gender, and HBeAg positivity were not significantly associated with anti-HDV positivity (p>0.05). CONCLUSION: Anti-HDV positivity was significantly more common in patients with chronic hepatitis B compared with asymptomatic hepatitis B virus (HBV) carriers in a region with a high prevalence of HBV infection. We found a significant relationship between the duration of HBsAg carrier status and anti-HDV positively, however, age, gender, and presence of HBeAg were not significantly associated with the development of anti-HDV positivity.

Multiresistant bacterial colonization due to increased nurse workload in a neurology intensive care unit.

OBJECTIVE: To determine the relationship between nurse workload and multiresistant bacteria colonization or infection (MRB+) in a neurology intensive care unit (ICU). METHODS: We studied the relationship between nurse workload and MRB+ development in patients who were hospitalized in Dicle University Neurology Department ICU, Turkey during a 6-month period from November 15, 2003 to April 15, 2004. The intensity of workload and procedures applied to the patients were scored with the Project de Recherche en Nursing (PRN) and the Omega scores. RESULTS: Of 138 patients followed, 71 (51.4%) were female and 67 (48.6%) were male. The mean age of females was 65.6+/-6.7 years, and of males was 62.2+/-15.8 years. The mean time of hospitalization in the ICU was 13+/-7.6 days. In 26 (18.8%) cultures taken from patients, multiresistant bacteria (MRB) were demonstrated. The development of MRB+ infection was correlated with length of stay (LOS), Omega 2, Omega 3, Total Omega, daily PRN, and total PRN (p<0.05). There was no correlation between development of MRB+ infection with gender, age, APACHE-II and Omega 1 scores (p>0.05). In the PRN system, when the workload of nurses was compared, it was seen that in the MRB colonized patient group, the workload of nurses was meaningfully higher than the MRB patient (-) group (p<0.001). CONCLUSION: As a result, the risk of MRB+ development in the ICU is directly proportional to understaffing, increased nurse workload, LOS, and procedures applied to patients. In management of nosocomial infection, it is crucial to increase the number of nurses in the ICU, and thus, decrease the workload.

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach, over 8 years, in 11 cities of Turkey.

AIMS: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. DESIGN: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. RESULTS: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6-93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79-0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73-0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54-0.60, p 0.0001). CONCLUSIONS: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Epidemiology of burn unit infections in children.

OBJECTIVE: The aim of this study was to determine the epidemiology of burn unit infections, the effect of these infections on the mortality rate, and antibiotic resistance pattern of the predominant bacteria isolated from children. Patients and method Epidemiologic data for 610 children, aged 0 to 15 years, admitted to the burn unit at Dicle University Hospital during a 5-year period were collected and analyzed. RESULTS: In 207 patients (33.9%), 279 nosocomial infections were identified. The most common types of infections were burn wound infections (72.4%), urinary tract infections (10.8%), pneumonia (9.3%), and septicemia (7.5%). Pseudomonas aeruginosa (181 isolates) was the most common microorganism. Thirty-six patients (5.9%) died at the hospital. Sepsis was associated with mortality in 18 (50%) cases, pneumonia in 6 (17%), and varied noninfectious reasons in 12 patients (33%). P aeruginosa isolates showed high resistance to commonly used antimicrobials. Antibiotic susceptibility test results suggested that imipenem was the most effective agent for P aeruginosa and Escherichia coli strains. CONCLUSION: The major type of nosocomial infections in the burn unit was burn wound infections, and the majority of nosocomial infections resulted from multiple drug-resistant, gram-negative bacteria.