Implementation of the EUCAST rapid antimicrobial susceptibility test (RAST) for carbapenemase/ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates, and its effect on mortality.

OBJECTIVES: With the rise in antimicrobial resistance, there is a growing demand for rapid antimicrobial susceptibility testing (RAST). In this study, we applied the EUCAST RAST method to ESBL/carbapenemase-producing Escherichia coli and Klebsiella pneumoniae isolates without using advanced identification systems and analysed the effect of this method on mortality rates Also the clinical impact of this method on patients infected with these bacteria and its effect on mortality rates were investigated. METHODS: RAST was used for clinical blood cultures containing carbapenemase/ESBL-producing E. coli and K. pneumoniae without advanced identification systems (e.g. MALDI TOF), with preliminary identification by simple diagnostic tests (predicted RAST, or p-RAST), and its categorical agreement was investigated. The impact of the method on mortality was analysed by comparing the clinical data of patients whose blood cultures were subject to p-RAST (p-RAST group, n = 49) and those who were not subject to p-RAST (non-RAST group, n = 145). RESULTS: p-RAST results were analysed based on 539 antibiotic-bacteria combinations. Total error rates at 4, 6 and 8 h of incubation were 2.9%, 3.9% and 3.8%, respectively. In the p-RAST group, patients who did not receive appropriate antibiotics (29/45, 59.1%) were switched to appropriate treatment within 8 h at the latest. In contrast, in the non-RAST group, treatment of patients who received inappropriate antibiotics (79/145, 54.5%) could be changed after at least 24 h. Mortality rates were lower in the p-RAST group than in the non-RAST group (28.6% versus 51.7%, P = 0.005). CONCLUSIONS: p-RAST can be used safely in hospital laboratories with high rates of antimicrobial resistance and can reduce mortality rates by shortening the transition time to appropriate treatment.

Serum thrombin-activatable fibrinolysis inhibitor levels and its relation with pathogenesis and bleeding and prognosis in patients with Crimean Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a viral hemorrhagic fever, which is common in Turkey and globally. The pathogenesis of coagulation disorders, which is seen in viral hemorrhagic fevers remains to be elucidated. Thrombin-activatable fibrinolysis inhibitor (TAFI) has a key role in this process In this study, we aimed to evaluate whether TAFI levels contributed to bleeding and whether it is related to prognosis in CCHF patients. Eighty-four patients older than 15 years of age, who were admitted to our hospital who had positive immunoglobulin M (enzyme-linked immunosorbent assay [ELISA]) and/or polymerase chain reaction test results for CCHF between 2009 and 2010, were included in the study. The control group included 30 healthy adults. The plasma TAFI levels were compared between patients and controls, and also between patients with bleeding and no bleeding, and between patients with mild-moderate and severe disease. The mean TAFI levels were lower in patients (mean: 87.82 ng/ml, median: 61.69 ng/ml (interquartile range [IQR] 30.49-537.95) than controls (mean: 313.5 ng/ml with a median: 338.5 ng/ml (IQR 182-418). However, median TAFI levels were significantly higher in patients with bleeding compared to those without bleeding (78.99 and 50.28 ng/ml, respectively; p = 0.032). Median IQR TAFI levels were similar between patients with mild-moderate and severe disease (64.72 (41.37-113.85), and, 58.66 (42.44-118.93) ng/ml, respectively; p = 0.09) and survivors and nonsurvivors (86.14 ± 77.98 and 103.48 ± 69.92, respectively; p = 0.3). Although TAFI levels were lower in the patients with CCHF compared to healthy controls, it does not seem to be a major player in the prognosis.

Multidrug resistance in pathogens of community-acquired urinary tract infections in Turkey: a multicentre prospective observational study

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.

[Acute muscle loss and early effects of COVID-19 on skeletal muscle in adult patients: a retrospective cohort study]. / Pérdida muscular aguda y primeros efectos de la COVID-19 en el músculo esquelético de pacientes adultos: estudio de cohortes retrospectivo.

OBJECTIVES: It is known that COVID-19 has multisystemic effects. However, its early effects on muscle tissue have not been clearly elucidated. The aim of this study is to investigate early changes in the pectoral muscle in patients with COVID-19 infection. MATERIALS AND METHODS: The pectoral muscle areas (PMA) and pectoral muscle index (PMI) of 139 patients diagnosed with COVID-19 were measured from chest CTs taken at the time of the first diagnosis and within 6 months after the diagnosis. The effect of the infection on the muscle area was investigated by evaluating whether there was a change between the two measurements. Lung involvement of the infection in the first CT was scored with the CT severity score (CT-SS). In addition, the effects of patients' clinics, CT-SS, length of hospital stay, and intubation history on changes in the muscle area were investigated. RESULTS: When the PMA and PMI values were compared, there was a statistically significant decrease in the values in the control CT group compared to the first diagnosis CT group. The difference was found higher in intubated patients. CT-SS was associated with a decrease in PMI.COVID-19 is one of the causes of acute sarcopenia. Pectoralis muscle is part of the skeletal muscle, and there may be a decrease in the muscle area in the early period of the disease.

Implementation of the EUCAST rapid antimicrobial susceptibility test (RAST) directly from positive blood culture bottles without the advanced identification systems.

OBJECTIVES: EUCAST published its recommendations for rapid antimicrobial susceptibility tests (RASTs) directly from positive signal blood culture (BC) bottles. The objective of the present study was to investigate the accuracy and applicability of the predicted RAST (p-RAST) method without using automated identification systems, and the effects of the results obtained with this method on the treatment decision of the clinician. METHODS: The RAST procedure was applied to positive BC samples between November 2020 and June 2021. The categorical results of the method were obtained by comparing the p-RAST results obtained at 4, 6 and 8 h of incubation according to predicted bacterial species with conventional methods and standard disc diffusion results. The effects of these results on the treatment decision of the clinician were evaluated retrospectively. The actual categorical results of the EUCAST RAST [standard RAST (s-RAST)] method were identified. RESULTS: The p-RAST and s-RAST results were analysed according to 145 and 111 isolates, respectively. The p-RAST total error rates were 3.0%, 3.1% and 2.8% at 4, 6 and 8 h of incubation, respectively, and the s-RAST total error rates were determined as 2.7%, 3.3% and 3.2%, respectively. With p-RAST's results, it was observed that effective escalation was performed in the antimicrobial treatment for 45 patients, and effective de-escalation could be performed in 32 patients, but it was recommended not to perform de-escalation. CONCLUSIONS: Even in a microbiology laboratory with limited facilities, reliable antimicrobial susceptibility test results can be obtained in a short time with the p-RAST method without using automated systems and antimicrobial choice can be guided in a shorter time.

Prognostic nutritional index: Is it associated with the prognosis of Crimean Congo hemorrhagic fever.

INTRODUCTION: The prognostic nutritional index (PNI) is calculated using total serum lymphocyte counts and albumin levels. We aimed to analyze the role of PNI in predicting intensive care unit (ICU) referral and mortality in patients with Crimean Congo hemorrhagic fever (CCHF). MATERIALS AND METHODS: Our target population was adult (age >18) patients who presented between March 2015 and October 2021 within 5 days of symptom emergence and were diagnosed with CCHF. The predictive value of PNI was analyzed by the receiver operating curve analysis. The patients were categorized based on the severity grading scores (SGS) as mild, moderate, and severe. The relationship between PNI and ICU referral and mortality was analyzed by logistic regression analysis. RESULTS: Overall, 115 patients with the diagnosis of CCHF were included. 13.9% (n = 16) of the patients were referred to ICU while 11.3% (n = 13) died. A comparison of the patients with different SGS grades revealed that they were significantly different regarding PNI (p < 0.001). There was a significant negative correlation between PNI and SGS (r = -0.662; p < 0.001). PNI had a PV regarding ICU referral and mortality ([area under the curve [AUC] = 0.723, 95% confidence interval [CI]: 0.609-0.836, p = 0.004 [AUC = 0.738, 95% CI: 0.613-0.863, p = 0.005]). The PNI threshold was 36.1 for ICU referral and mortality. The rates of female patients, hospitalization periods longer than 1 week, platelet apheresis replacement, diabetes mellitus, bleeding history, ICU admission, and mortality were significantly higher in patients with a PNI of lower than 36.1 (p < 0.05). CONCLUSION: PNI can predict ICU referral and mortality in patients admitted due to CCHF.

Rates of underreported needlestick and sharps injuries among healthcare workers in Turkey: in the light of Infection Control Committee data.

OBJECTIVE: Doctors and nurses are frequently exposed to needlestick and sharps injuries (NSIs) because of their work. It is estimated that NSIs are more common than the rates reported to Infection Control Committee. The purpose of this study was to determine the incidence and reporting rates of NSIs in our hospital. METHODS: After their consent forms were obtained for the questionnaire, 670 doctors and nurses were interviewed face-to-face by the Infection Control Committee nurse. The questionnaire consisted of 22 questions, and the answers were recorded. The questions were on demographic data and injuries. The data of NSIs, whose active surveillance was made in our hospital since 2005 and in the last 1 year, were also analyzed retrospectively. RESULTS: A total of 119 (17%) people out of 670 people who participated in the study had at least one NSI; 43 (36%) people of the 119 people were doctors and 76 (63.9%) people were nurses. The most common injuries among doctors were found in assistant doctors (60%). No statistically significant differences were detected between the doctors and nurses in terms of injury status (P = 0.398). The most common injuries were found in surgical clinics, and a significant difference was detected here when compared to other clinics. The data that 20 (17%) people of the 118 people who were injured by the NSIs reported the injury were obtained from the Infection Control Committee database. CONCLUSION: It is seen that injuries are high in surgical clinics and assistant doctors who have high work stress and workload. There were more injuries with sharp objects than the expected rates in our hospital although the reports were made very rarely. First of all, we should determine strategies, especially education, to reduce injuries, and then remove the obstacles to unreported injuries. The methods of clinics with a high rates of reporting needlestick and sharps injuries to the infection control committee should be examined and tried to be applied in our own clinics.

Is there a relationship between breastfeeding status and life style changes, eating behaviors, attitudes, and orthorexia nervosa tendencies of mothers? A web-based study.

AIMS: It was aimed to compare the breastfeeding status and healthy life style changes, eating behaviors, attitudes, and orthorectic tendencies of mothers. METHODS: All volunteered mothers who have a child between the ages of 0 and 2 were included in this cross-sectional study. Five hundred fourteen individuals were included. Five parted questionnaire and "ORTO-11" test and "Eating Attitude Test" were used. RESULTS: A statistically significant relationship was found between breastfeeding status and working status and professions of mothers. Mothers who did not breastfeed, skipped main meal more frequently, and smoking and occasional alcohol consumption was higher. The mean score of the participants on the ORTO-11 scale was 25.09 ± 4.80, EAT-40 scale mean score was 18.80 ± 10.42. High-risk in eating attitudes was found in 12.0% of all participants. It was observed that mothers who did not breastfeed were mostly in high-risk group in terms of eating attitude. CONCLUSION: Mothers who did not breastfeed were mostly in high-risk group in terms of eating attitude compared with breastfeeding mothers. It is of great importance that healthcare professionals organize trainings for increasing the general level of knowledge of mothers and provide healthy living and breastfeeding counseling.

Family planning practices and opinions on population growth of family planning healthcare providers in Turkey.

The purpose of this study was to investigate the opinions of health professionals (HPs) who provide family planning counselling (FPC) within the scope of primary health care services since they are perceived as role models by the society. The number of HPs providing family planning counselling in primary health services in Turkey was 43,000 and 40,000 of these individuals were invited to participate in this observational, cross-sectional study via e-mail and social media. There were 740 responders and all were included in the study. Physicians providing FPC within the scope of primary health care services consisted of 45.1% of the responders and the remaining were nurses. Among all HPs, 59.7% had insufficient awareness regarding Turkey's population growth. Most of the HPs (52.4%) believed that the ideal number of children was 2 or less. The abortion rate was 9.1% in all pregnancies of HPs. The rate of caesarean section was 56% in all live births. According to responses, 75.6% of all pregnancies experienced by HPs were planned. According to 42.1% of the HPs, abortion must be performed if there is a life-threatening situation for the mother or if the fetus has some abnormalities. The most common method of birth control used by married HPs between the ages of 18 and 49 was male condoms (39.9%), while the pull-out method ranked first in the general population (25.5%). It was found that HPs, who had different opinions and practices about family planning than the general population, had insufficient awareness regarding population growth. Increased awareness of demography and FPC among HPs will likely contribute to the quality of service and the general wellbeing of the population.

Can patients who apply to tertiary care with headache for the first time be managed in primary care? - a cross-sectional study

Background/aim: Headaches are one of the most common neurological symptoms. They adversely affect daily life, reduces the workforce, and have high health costs. Managing this symptom in primary care will free up secondary and tertiary health services to better treat patients who need follow-up by specialists. In the present study, we aim to show the rate at which this problem can be solved in primary care for patients who applied tertiary care services with a headache for the first time. Materials and methods: Our research is a cross-sectional study of 207 patients who applied to the neurology clinics for the first time with headache. Two questionnaires were prepared by the researchers. IBM SPSS v: 21.0 was used for statistical analysis, and the level of significance was p < 0.05. Results: The opinions of the patients on the evaluability of headache in primary care were compared. Family physicians and neurologists gave similar responses about the disease management, at a rate of 96.6%, this was found to be statistically significant and shows strong agreement. Both groups of physicians thought that 70% of patients, on average, who applied to the neurology clinics with headache for the first time could be managed in primary care. However, only 9.2% of the patients share this opinion with physicians. Primary headache cases constitute most of the cases that are thought to be solved in primary care. It was revealed that the number of patients seeking primary care with this complaint was lower than expected. Conclusion: Patients with headache applied tertiary care instead of primary care for different reasons. Both neurologists and family physicians stated that most patients evaluated in tertiary care could be managed in primary care.

Global health emergencies during the pandemic and their solutions

In this review, we evaluated health care problems, which were not common before pandemic outbreak but have been common issues after its appereance and approaches to control pandemic considering its influences on people. We revised current health care developing approaches under the light of experience obtained throughout the pandemic so far. The aim is to be prepared in advance for possible upcoming pandemics. As in Covid 19 pandemics, such long lasting and widely affecting situations, durability is also very important together with flexibility and quickness. To provide durability, we need global policies taking the health to its center as well as health system policies.

Global threat of COVID 19 and evacuation of the citizens of different countries

Beginning from China on December 2019, COVID-19 epidemic has spreaded all over the world in a short period of time and has been a pandemic. In challenge with this pandemic quarantine technique has been used widely after tens of years. In the course of the pandemic, many countries evacuated their citizens from affected regions and combined the evacuation with quarantine process. Some examples of these countries who evacuated their citizens are Germany, Italy, Spain, and USA. In further times, during the course of pandemic, according to spread, other countries evacuated their citizens from these countries too. Despite being the origin of the pandemic, in later times Wuhan was also a place where people were evacuated to. Evacuation and quarantine have caused social and psychological impacts on people and some of them took place in mainstream media. In this review article, evacuation and quarantine processes as well as the society's reactions to these, have been compiled.

Predicting diabetic foot ulcer infection using the neutrophil-to-lymphocyte ratio: a prospective study.

OBJECTIVE: To investigate whether the neutrophil-to-lymphocyte ratio (NLR) may be used in the early stage risk assessment and follow-up in diabetic foot infection. METHODS: Over a five-year study, NLR values on admission and day 14 of treatment were matched with their laboratory and clinical data in a cohort study. Patients were followed-up or consulted in several clinics or polyclinics (infectious diseases). RESULTS: Admission time NLR was higher, in severe cases as indicated by both Wagner and PEDIS infection scores (severe versus mild Wagner score NLR 6.7 versus 4.2; p=0.04; for PEDIS score NLR 6.3 versus 3.6; p=0.03, respectively). In patients who underwent vascular intervention (12.6 versus 4.6; p=0.02); amputation indicated (9.2 versus 4.1; p=0.005) and healed afterwards (6.9 versus 4.3; p<0,001), when matched with others. NLR was also found to be correlated with duration of both IV antibiotic treatment (r=0.374; p=0.005) and hospitalisation (r=0.337; p=0.02). Day 14 NLR was higher in patients who underwent vascular intervention (5.1 versus 2.9; p=0.007) when matched to others. CONCLUSION: Patients with higher NLR values at admission had more severe diabetic foot infection, higher risk for amputation, need for long-term hospitalisation and aggressive treatment. However, they also have more chance of benefit from treatment.

Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women.

To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women. Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories. The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4-5-fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3.5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19.1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC-US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico-pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap-smear program could miss 45.9% of ≥CIN3 cases. The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings to have a high coverage rated screening program and is very effective compared to conventional pap-smear.

Serum sTREM-1 level is quite higher in Crimean Congo Hemorrhagic Fever, a viral infection.

Members of triggering receptor expressed on myeloid cells (TREM) family are known as immunmodulators in several infectious or noninfectious inflammatory disorders. The information about their role in viral infections is very limited. To enlighten if there is a relation between soluble TREM-1(sTREM-1) and a viral infection, Crimean Congo Haemorrhagic Fever (CCHF), we investigated the levels of sTREM-1 in the sera of 39 CCHF patients both at admission and at recovery and compared with 40 healthy controls by using microELISA technique. Statistical analysis was made by using Statistical Package for Social Sciences (SPSS) for Windows 20 programme. Value of P < 0.05 was accepted as significant for statistical analyses. Median sTREM-1 level was higher in CCHF group when compared to the control group (1,961 vs. 151.1 pg/ml, respectively; P < 0.001). In CCHF patients, sTREM-1 levels were significantly decreased at recovery compared to initial level measured at hospital admission (1,961 vs. 948 pg/ml, respectively; P = 0.019). ΔsTREM-1 is correlated with ΔCRP, ΔWBC, and ΔPlt. We found that serum levels of sTREM-1 higher than 405.9 pg/ml existed as a cut off point for differentiating CCHF patients and control group with a sensitivity of 94.9% and specifity of 87.5%. It is proved that sTREM-1 is increased and correlates with the clinical and laboratory findings in CCHF, a viral infection characterized by activation of inflammation. This finding may lead new studies to enlighten the pathogenesis of infections developing by activation of inflammatory cascades and high level cytokine releases, especially. J. Med. Virol. 88:1473-1478, 2016. © 2016 Wiley Periodicals, Inc.

Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study.

BACKGROUND: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. METHODS: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. RESULTS: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality. CONCLUSIONS: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.

Apheresis training in Turkey.

Continuing education and standardization are of utmost importance in apheresis science as every field in medicine. Especially, the last 5 years witnessed remarkable progress in apheresis science in Turkey, both in terms of increased numbers of therapeutic apheresis centers, therapeutic apheresis procedures performed per year, and also in terms of quality and standardization. This brief report summarizes the current status of apheresis training in Turkey and milestones of its development.

Hematopoietic cell transplantation activity of Turkey in 2014: Ongoing increase in HCT rates.

Hematopoietic cell transplantation is an established treatment option with curative potential for a variety of clinical conditions. The last decade especially witnessed a remarkable increase in HCT activity in Turkey. In 2014, 696 pediatric and 2631 adult (total 3327) HCT were performed in Turkey. Corresponding transplant rates per 10 million inhabitants for autologous-HCT and allogeneic-HCT were 226 and 202, respectively. Total HCT procedures in Turkey increased 177% in the last 5 years and 791% in the last 14 years. This report focuses mainly on HCT activity of Turkey in 2014 based on the national HCT registry and presents a general picture of national HCT activity.

Hand carriage of Candida occurs at lesser rates in hospital personnel who use antimicrobial hand disinfectant.

BACKGROUND: The hands of hospital personnel are considered to be important for colonization and infection of patients with Candida spp. The aim of this study was to evaluate the effectiveness of different hand disinfectants in reducing the carriage of Candida species on the hands of hospital personnel. METHODS: A controlled study was conducted at Duzce University School of Medicine Hospital. Eighty hospital personnel were included in the trial. Subjects were divided into 4 groups according to hand hygiene procedures: group 1, hand rubbing with alcohol-based solution; group 2, hand washing with 4% chlorhexidine gluconate; group 3, hand washing with 7.5% povidone-iodine; group 4, hand washing with plain soap and water. The hands of all participants were tested by culture with the broth wash technique. RESULTS: Hand carriage of Candida spp. was lower in the 4% chlorhexidine gluconate group (10.5%, p = 0.006), in the 7.5% povidone-iodine group (18.7%, p = 0.043), and in the alcohol-based hand rub group (21.1%, p = 0.048) compared to the group washing hands with plain soap and water (50%). CONCLUSIONS: The use of hand disinfectant containing antimicrobial agents is more effective than hand washing with water and soap in reducing carriage of Candida on the hands of hospital personnel. It is recommended that hospital personnel use an antimicrobial hand disinfectant in units where there is a high risk of Candida infection.

Change in Hepatitis B Surface Antibody Titers After Chemotherapy in Patients With Hematological Malignancies.

Background The change in hepatitis B surface antibody (anti-HBs) titers after chemotherapy (CT) in patients with hematological malignancy, affecting factors, and its clinical implications have not been sufficiently understood. Therefore, we aim to evaluate the change in anti-HBs titers and hepatitis B virus reactivation (HBVr) after CT. Methods This retrospective study enrolled patients with hematological malignancies who received CT between 2013 and 2021. All patients were followed up for HBVr and a change in anti-HBs titers for one year. Results Overall, 192 patients were included. In total, 33.9% of the patients were anti-HBs (+) and 26% of the patients were anti-HBc (+) ± anti-HBs (+). Hepatitis B virus (HBV) prophylaxis was given to 35 (70%) of 50 Anti-HBc (+) patients. Tenofovir disoproxil fumarate and entecavir prophylaxis were initiated in 25 (71.4%) and 10 (28.6%) patients, respectively. A significant decrease was found in anti-HBs titers of all patients (p=0.017). A significant decrease was also found in anti-HBs titers of HBc IgG (+) patients and those who received four or more courses of CT (p=0.025; p=0.041). HBVr was not diagnosed in any of the patients. Conclusion Chemotherapeutic agents administered for hematological malignancy have serious immunosuppression effects. In these patients, anti-HBs titers may decrease or become negative one year after CT. Anti-HBs titer before CT or its change after CT may not constitute a risk for HBVr patients who received HBV prophylaxis in line with current guidelines and these recommendations.