Changes in antimicrobial resistance and outcomes of health care-associated infections.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey.

BACKGROUND: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

Long-Term Symptoms and Quality of Life in Persons with COVID-19.

Objective: After three years since the first cases of COVID-19, many people suffer from post-COVID symptoms, reducing their quality of life. In this study, we aimed to evaluate the symptoms and prevalence of long COVID and its effect on the quality of life and also the effect of SARS-CoV-2 vaccine on the quality of life. Materials and Methods: Patients with COVID-19 between April 01, 2020, and December 31, 2021, were evaluated with a survey at least three and at most 12 months (mean 7.43±3.3 months) after diagnosis. Patients answered the questions face-to-face or via telephone interview. The survey included questionnaires on demographic features, current complaints, and complaints that persisted or developed after recovery, Short Form 36 Health Survey (SF-36), and European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) Scale. Results: The study was conducted with 521 participants, 81% complaining of post-COVID symptoms. The most common symptoms were fatigue and shortness of breath. Long COVID was found to significantly reduce the quality of life in both sub-dimensions of the scale. Compared to SF-36 Turkish population norms, all participants showed a significant decrease in quality of life subscales. Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was found to improve quality of life and reduce long-term COVID-19 symptoms. Conclusion: COVID-19 has significantly affected quality of life. Post-illness follow-up of people with COVID-19 is important to provide patients with medical, physical, and psychosocial rehabilitation support. SARS-COV-2 vaccine reduces the negative effects of COVID-19 on quality of life. For this reason, the community should be made aware of vaccination, and COVID-19 vaccination rates should be increased in the community.

Hepatitis A immunity in Yozgat, Turkey.

BACKGROUND: Since routine immunization could change the epidemiological profile of hepatitis A virus (HAV) infection in the future, it is important to determine the baseline immunity to HAV across Turkey. OBJECTIVE: The aim of this study was to determine the seroprevalence of hepatitis A among individuals 6 years of age and older in Yozgat, Turkey. DESIGN: Cross-sectional. SETTING: Community in central region of Turkey. PATIENTS AND METHODS: Questionnaires and blood specimens were collected and the presence of hepatitis A IgG antibodies against hepatitis A virus was determined quantitatively by ELISA. MAIN OUTCOME MEASURES: The rates of hepatitis A immunity by age group. SAMPLE SIZE: 1862. RESULTS: Immunity to hepatitis A was 79.1% (n=1473). The mean (SD) age was 17.1 (14.7) years in the nonimmune group and 37.8 (19.5) years in the immune group (P less than .001), and immunity increased with age. No significant difference in immunity rate was detected between gen.ders in children and adults. The seropositivity rate for subjects ages 6-19 years was lower than in subjects aged 20-96 years (52.2% versus 93.9%; P less than .001). CONCLUSION: A catch-up vaccination program is needed for persons aged 6-19 years in Yozgat. LIMITATIONS: Single region data which can not be generalized. For this reason, a multi-centered study that can reflect the whole country is recommended. CONFLICT OF INTEREST: None.

Hepatitis A immunisation need in nursing students in Turkey.

Hepatitis A is a worldwide vaccine-preventable infection. The aim of our study was to determine the serological status of hepatitis A virus (HAV) among first-year nursing students in Turkey. A sample of 423 students was used and immunoglobulin G antibodies against HAV were determined quantitatively by enzyme-linked immunosorbent assay on each. Overall, 84.6% had no immunity to HAV, making them at risk for HAV, and so susceptible to nosocomial transmission. Nursing students who work in high-risk wards must be vaccinated against hepatitis A.

Telbivudine attenuates gentamicin-induced kidney injury in rats.

Nephrotoxicity has been associated with nucleos(t)ide analogues other than telbivudine (LdT). This study investigated the potential effects of LdT and lamivudine (LAM) on renal function in an experimental rat model of gentamicin-induced acute nephrotoxicity. A total of 28 healthy Wistar albino rats were randomly divided into four experimental groups: negative control; positive control (PC); LdT; and LAM. Nephrotoxicity was induced by gentamicin in the LdT, LAM and PC groups. LdT and LAM were administered to two groups for 6 weeks starting on the ninth day. Blood samples were collected weekly and cystatin C levels were measured by ELISA. Animals were sacrificed on the 50th day and the kidneys were removed for histological examination. Serum cystatin C levels differed significantly between the LdT and LAM groups (P <0.007) and between the LdT and PC groups (P <0.001). Renal function was significantly improved in the LdT group at the start of antiviral treatment on Day 8 and at the end of treatment on Day 50 (P = 0.001 and 0.007). Glomerular injury, acute tubular necrosis and total injury score were significantly reduced in the LdT group relative to the PC and LAM groups upon histopathological examination. LdT was associated with significant improvements in renal function as measured by biochemical and histopathological methods. The acute kidney injury model data should be supported by clinical studies to suggest that LdT treatment may have advantages for patients with underlying chronic kidney disease receiving chronic hepatitis B treatment.

Infection prevention and control practice for Crimean-Congo hemorrhagic fever-A multi-center cross-sectional survey in Eurasia.

BACKGROUND: Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers. AIM: Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia. METHODS: A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016. RESULTS: Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23). CONCLUSIONS: Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.

Evaluation of tetanus antibody levels in adults in Yozgat, Turkey.

BACKGROUND/AIM: To assess the immune status against tetanus in relation to self-declared vaccination status among an adult population in Yozgat, Turkey. METHODS: Questionnaires and blood specimens were collected from 267 individuals over 18 years of age in Yozgat, Turkey. Antitetanus antibodies were determined quantitatively by enzyme-linked immunosorbent assay. RESULTS: Among the 267 subjects (mean age 43.4 ± 15.6; male:female, 133:134) 168 (62.9%) had protective level of tetanus antibody titers. There was a characteristic distribution of the tetanus antibody titers in different age groups as it dropped with increasing age. Protective immunity was obtained in 74.1% of urban and 47.9% of rural participants. The lowest immunity was observed among farmers (53.3%) and housewives (55.6%) when compared to other occupations. Protective antibody titers were detected in 25% of the individuals who had not finished any school, while the rate was 83.7% in those who had graduated from university. While the protection rate in women who had been vaccinated during pregnancy was 78.3%, this rate was 39.2% in nonvaccinated women. CONCLUSION: Our findings confirm that only 62.9% of the population is immunized against tetanus, with a lack of coverage in particular for the elderly and in rural areas. It is necessary to follow the recommendations for 10-year boosters for tetanus.

Pityriasis rosea: a natural history of pediatric cases in theCentral Anatolia Region of Turkey.

BACKGROUND/AIM: This study aimed to evaluate the demographic, clinical, and epidemiological features of pityriasis rosea (PR) in a cohort of 46 children in Yozgat, a city in the Central Anatolia Region of Turkey. MATERIALS AND METHODS: Forty-six children with PR were monitored at regular intervals (1, 2, 4, and 12 weeks) for 3 months from the time of diagnosis. A complete evaluation of the patient was performed at each visit. RESULTS: The average age of patients at time of diagnosis was 12 ± 3.9 years. Cases were most common in the winter (rainy, snowy months; n = 14, 31%). Fifteen patients had a medical history significant for the presence of upper respiratory tract infection, while skin PR manifestations were preceded by drug intake in a second group of 15 patients. The presence of a herald patch was observed in 78.3% of patients, most frequently on the trunk (n = 23). Pruritus occurred in 75% of patients. Median PR duration was 3 weeks (range: 1-20 weeks). CONCLUSION: The course of PR is similar in Turkish children and adults. The high prevalence of pruritus in children with PR in Turkey was also significant. Further evaluation of this finding comparing adults and children is now required.

A clinical evaluation of skin disorders of lower limb amputation sites.

Amputee patients commonly experience skin problems that may result in social, mental, and economic difficulties. The purpose of this study was to evaluate the incidence of dermatological disorders and identify potential causes and symptomatic patterns among a population of lower limb amputees. Seventy lower limb amputees were enrolled. Complete examinations were performed by a dermatologist, who diagnosed and documented any skin disorders observed and recorded demographic characteristics of each patient. Mycological and bacteriological swabs were collected from the skin at the amputation site for culture analysis. In patients with suspected disease, patch tests were performed. Of the 70 patients, 58 (82.9%) were male and 12 (17.1%) female. Vascular insufficiency due to diabetes (n = 38, 54.3%) and trauma (n = 16, 22.9%) were the most common reasons for amputation. Skin problems were observed in 49 (70%) cases, and positive allergen reactions occurred in 16 (45.7%) of the 35 contact dermatitis cases. Fungal infection occurred in two patients and bacterial infection in seven. Seventy percent of the lower limb amputee patients in this cohort exhibited skin problems. This high percentage indicates that skin problems may reduce patients' quality of life. A multidisciplinary approach to the treatment of patients who have undergone amputation and early recognition and treatment of symptoms are therefore of critical importance.

Immunity of nursing students to measles, mumps, rubella, and varicella in Yozgat, Turkey.

Measles, mumps, rubella, and varicella (MMRV) are vaccine-preventable diseases. The aim of this study was to determine the vaccination status of first-year nursing students in Turkey. The sample used was 180 students and immunoglobulin G antibodies against MMRV viruses were determined quantitatively by enzyme-linked immunosorbent assay. Immunity rates to MMRV were 82.8%, 83.3%, 98.3%, and 100%, respectively. The results of this study showed that all of the students were immune to varicella and 32.8% of the students were not immune to at least 1 of the viruses covered by the measles, mumps, and rubella vaccine.

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.

AIM: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS: The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS: A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS: Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

Early use of ribavirin is beneficial in Crimean-Congo hemorrhagic fever.

We evaluated the effect of early use of ribavirin on outcomes of patients at a secondary care hospital. The study included patients who were hospitalized between 2005 and 2010 at the Infectious Diseases Department of Kastamonu Dr. Münif Islamoglu Hospital in the Kastamonu Province of Turkey. In total, 342 confirmed cases of Crimean-Congo hemorrhagic fever (CCHF) were included in the study. The overall case fatality rate was 2.9%. In multivariate analysis, the patients that were admitted to the hospital within 2 days after onset of symptoms (odds ratio [OR]=5, confidence interval [CI] 0.31-0.86) and received oral ribavirin (OR=0.12, CI 0.05-0.26) were less likely to become more severe cases and less likely to be transferred to the tertiary care centers. Having vaginal bleeding was a significant parameter for transfer.

Ocular surface culture changes in patients after septoplasty.

AIM: To investigate the interrelationships between pre- and postoperative microbiological changes by taking samples from both eyes of 40 patients who underwent septoplasty due to septal deviation. MATERIALS AND METHODS: Forty patients diagnosed with septal deviation who underwent a septoplasty operation under general anesthesia were enrolled in this study. The study was conducted on 40 patients who met the inclusion criteria and attended follow-up visits. One day before the operation and 48 h after the operation, cultures were taken individually from the conjunctivas and puncta of both eyes and sent to the microbiology laboratory. RESULTS: Patients who were candidates for nasal surgery due to their symptoms and clinical examination results were randomly selected and 40 of these completed the study. No statistically significant differences in bacterial growth were observed between the eyes before the operation (P > 0.05). There were, however, statistically significant differences between the eyes in terms of bacterial growth in the postoperative period (P < 0.05). Pathogenic bacterial cultures were grown in 47 eyes in the postoperative period, and this finding was statistically significant. In the eye cultures, the most commonly isolated pathogens were S. epidermidis, and S. aureus. CONCLUSION: Although the indicated microorganisms isolated from the patient groups were grown in cultures, there were neither clinical symptoms nor signs related to ocular infections.

Knowledge levels regarding crimean-congo hemorrhagic Fever among emergency healthcare workers in an endemic region.

BACKGROUND: In this study, we aimed to determine knowledge levels regarding Crimean-Congo hemorrhagic fever (CCHF) among emergency healthcare workers (HCWs) in an endemic region. METHODS: A questionnaire form consisting of questions about CCHF was applied to the participants. RESULTS: The mean age was 29.6 ± 6.5 years (range 19 - 45). Fifty-four (49.5%) participants were physicians, 39 (35.8%) were nurses and 16 (14.7%) were paramedics. All of the participants were aware of CCHF, and 48 (44%) of them had previously followed CCHF patients. Rates of the use of protective equipment (masks and gloves) during interventions for patients who were admitted to the emergency service with active hemorrhage were 100% among paramedics, 76.9% among nurses and 61.1% among physicians (P = 0.003). Among 86 (78.9%) HCWs who believed that their knowledge regarding CCHF was adequate, 62 (56.9%) declared that they would prefer not to care for patients with CCHF (P = 0.608). CONCLUSIONS: The use of techniques to prevent transmission of this disease, including gloves, face masks, face visors and box coats, should be explained to emergency room HCWs, and encouragement should be provided for using these techniques.