Retrospective Evaluation of Hepatitis C Awareness in Turkey Through Two Decades.

BACKGROUND/AIMS: Chronic hepatitis C (CHC) is the only viral infection that can be treated with oral antiviral agents. However, CHC awareness is a major barrier to the World Health Organization's target of eliminating hepatitis C virus (HCV) by 2030. Here, CHC awareness trends were analyzed in Hacettepe University Hospital, Turkey, between January 2000 and December 2017. MATERIALS AND METHODS: Central laboratory data were retrospectively analyzed for HCV test results (anti-HCV, HCV RNA, HCV genotype). After combining 548,141 anti-HCV test results, 395,103 cases were analyzed. The following two parameters were defined for CHC awareness: (1) the presence of HCV RNA results for anti-HCV positives and (2) the presence of a genotype result for HCV RNA positives. RESULTS: Anti-HCV positives were older than negatives (mean age-years ± SD, 59.4 ± 19.0 vs. 44.0 ± 18.9), and the positivity rate was higher in women than in men (1.4% vs. 1.0%). Anti-HCV positivity decreased from 3.1% to 0.6% from 2000 to 2015 and subsequently stabilized. The overall percentage of RNA testing among anti-HCV positives was 53.1% (range, 20%-70%), which stabilized at approximately 50% after 2010. The genotyping rate for RNA positives varied between 40% and 70%. The main genotype identified was genotype 1 (85.7%). CONCLUSION: In an ideal CHC awareness state, all anti-HCV positives should undergo RNA testing, and genotyping should be performed when RNA tests are positive. However, even in our referral center, the combined rate of RNA and genotype testing was only approximately 50% during the last 10 years.

[Evaluation of methicillin-resistant Staphylococcus aureus bacteremia and comparison of prognosis according to vancomycin MIC values: experience of the last ten years]. / Metisiline dirençli Staphylococcus aureus bakteriyemisinin incelenmesi ve vankomisin MIK degerlerine göre prognozun karsilastirilmasi: Son on yillik deneyim.

Hospital acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are important health problems. Mortality and morbidity rates associated with MRSA infections are increasing with mortality rates being higher for MRSA bacteremia than the other clinical presentations of MRSA infections. Initiation of treatment immediately and use of appropriate antibacterial agents may lead to better clinical outcomes in MRSA bacteremia. The aims of this study were to evaluate the treatment and clinical outcomes of patients with MRSA bacteremia in a tertiary care hospital in Ankara, Turkey. Two hundred forty seven MRSA strains isolated from blood cultures at Hacettepe University Faculty of Medicine, Clinical Microbiology Laboratory between January 2000-December 2010, were evaluated retrospectively. Demographic characteristics, duration of bacteremia, types and duration of antibiotic treatment, presence of other pathogens and all other necessary information were collected from patients' registry. One hundred eighty four patients who had clinically significant bacteremia were analyzed. The mean age of the patients was 55 ± 17 years, of them 44.6% were female and 55.4% were male. The median length of hospital stay was 61 days. The median duration for the development of MRSA bacteremia from the time of admission was 23 days. Overall mortality rate was 54.9%, and mortality rate due to MRSA bacteremia was 19%. The rate of treatment success was 81%. There were 3 (1.6%) patients with vancomycin MIC value of 0.5 mg/L, 140 (76.1%) patients with 1 mg/L and 41 (22.3%) patients with 2 mg/L. The median duration from the time of MRSA bacteremia detection to the time of death was shorter in unsuccessfully treated group than successfully treated group (7 days vs. 30 days, p< 0.001). Thirty days mortality rate was higher in unsuccessfully treated group than successfully treated group (94.3% vs. 50.7%, p< 0.001). The median time interval between positive and negative cultures was 9.5 days. Number of patients with MRSA bacteremia had been decreasing for the last five years (36 patients in 2006, 18 in 2007, 16 in 2008, 12 in 2009 and one in 2010). In multivariate logistic regression analysis, it was shown that, intubation (OR: 5.086, 95% CI: 2.094-12.351; p< 0.001) and malignancy (OR: 2.789, 95% CI: 1.185-6.564; p= 0.019) were independent risk factors for mortality. In this study, it was shown that mortality rate was high in MRSA bacteremia and high MIC value was not an independent risk factor for mortality. It was also noted that when there was no clinical response to vancomycin, the therapy should be changed immediately. To decrease MRSA bacteremia rates in the hospital adherence to rules of infection control and prevention proved to be important factors.

In vitro activity of tigecycline as a therapeutic option against multidrug-resistant Acinetobacter spp.

The study was performed to detect the in vitro activity of tigecycline in multidrug-resistant Acinetobacter isolates from patients in Hacettepe University Adult Hospital, Turkey. The microorganisms were isolated from clinical specimens of patients with respiratory and bloodstream infections. Thirty (66.7%) of the 45 inpatients were in ICUs. In vitro activity of imipenem, meropenem, ceftazidime, ciprofloxacin and aztreonam in 124 Acinetobacter species isolated was evaluated by microdilution test. Overall, 51 (41%) Acinetobacter spp. were found to be resistant to > or = 3 antibiotics belonging to different antimicrobial classes and defined as multidrug-resistant (MDR). Among the MDR Acinetobacter spp. 32 (62.7%) were Acinetobacter baumannii and 19 (37.3%) Acinetobacter lwoffii. In vitro activity of tigecycline against MDR isolates were studied by E-test. Each MDR isolate was also tested for metallo-beta-lactamase (MBL) production using CLSI guidelines. Forty-five (88.2%) of the isolates were found to produce MBL. The MIC90s of all antimicrobial agents tested except tigecycline were > or = 64 microg/ml whereas the MIC50, and MIC90 of tigecycline were found 1 microg/ml and 1.5 microg/ml, respectively. ERIC-PCR results revealed that bloodstream and respiratory isolates had nine and six different patterns, respectively. In conclusion, tigecycline has been shown to have potent in vitro activity against MDR Acinetobacter spp. and might be of therapeutic value in the treatment of infections due to MDR Acinetobacter spp., including those harbouring MBLs. Further clinical trials are needed to confirm the efficacy of tigecycline in the management of MDR Acinetobacter infections.

Prevalence and mechanisms of macrolide resistance in Streptococcus pyogenes in Ankara, Turkey.

From 2002 to 2003, a total of 381 consecutive S. pyogenes isolates were obtained from throat swabs (n = 337) and samples of pus (n = 31), sputum (n=10) and blood (n = 3) at Hacettepe University Hospital. The susceptibility of the isolates to erythromycin was tested by the agar dilution method. Erythromycin resistant strains were then tested for their MICs to azithromycin, clindamycin, and penicillin, their phenotype of resistance to macrolides-lincosamides-streptogramin B (MLSB) and for the presence of macrolide resistance genes. The rate of resistance to erythromycin was 6.8%. Constitutive (cMLSB), inducible (iMLSB), and M phenotypes of resistance were detected in 7.7, 30.8, and 57.7% of resistant strains, respectively. One strain had both cMLSB and iMLSB phenotypes. All M phenotypes carried the mefA gene, all iMLSB phenotype carried the ermTR gene, 1 isolate with cMLSB phenotype harboured the ermB gene, and 1 isolate with cMLSB phenotype carried both the ermB and mefA genes. One strain which showed cMLSB and iMLSB phenotypes harboured the ermB gene.

Clinical outcomes and therapeutic options of bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli.

This study was conducted to assess the clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. A total of 53 patients were included in the study. Forty-five patients (84.9%) received appropriate antibiotic therapy. Initial empirical treatment was appropriate in 12 patients, whereas the antibiotic was changed according to susceptibility results in the remaining 33 patients. Carbapenems were active against all strains and were the choice of therapy for 71.6% of patients. The 30-day mortality rate was 26.4%. The presence of diabetes mellitus and Intensive Care Unit stay at the time of bacteraemia were significantly associated with a poor outcome. The 'appropriateness' of the antibiotic regimen had no significant influence on survival.