Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey.

The aim of this study was to investigate the incidence of acute kidney injury (AKI) and risk factors due to colistin use in patients infected with multidrug-resistant pathogens. This multicenter, retrospective, observational study was conducted in Turkey, at 5 different research and university hospitals. Cox regression analyses were performed, to determine independent predictors of AKI. From April 2012 to July 2014, a total of 216 patients aged between 18-94 years, treated with colistimethate sodium (CMS) were included in the study. The mean age of the patients was 60.3 ± 20.1 years. The overall incidence of AKI was 34.3% (74/216) at any time during treatment. Concomitant use of loop diuretics, baseline creatinine level, and CMS dosage were independently associated with AKI. According to our results, patients with higher baseline creatinine levels, or patients who had to use concomitant loop diuretics may need to be monitored more closely, and dose adjustment should be done promptly. More comprehensive studies are, however, still needed to evaluate the efficacy of low-dose colistin since higher doses tend to increase the risk of AKI.

Procalcitonin Level and Its Predictive Effect on Mortality in Crimean-Congo Hemorrhagic Fever Patients.

Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal disease which is endemic to Turkey. We aimed to investigate the procalcitonin levels and their prognostic value over fatality in CCHF patients. The sera were harvested from patients who were diagnosed with CCHF within the first 2 days of the onset of their symptoms. The patients were divided into 2 groups according to their survival status: fatal or non-fatal. The biochemical and hematological parameters were studied in the Biochemistry Laboratory of Sorgun City Hospital. The sera were stored at -80℃ until testing for procalcitonin, and the procalcitonin levels were assayed by ELISA at the Biochemistry Laboratory of Kirikkale University. Forty- eight patients were included in the study, with 8 and 40 patients in the fatal and non-fatal groups, respectively. While the procalcitonin level was high in all patients in the fatal group, the same was observed in 30 patients in the non-fatal group (75%). The mean value of procalcitonin was 1.12 ng/ml in the fatal group and was 0.21 ng/ml in the non-fatal group (P = 0.003). According to the results of our study, the procalcitonin levels in the first 2 days of the onset of the symptoms might be helpful for predicting fatality in CCHF patients.

[The epidemiology of malaria in Adana between 2002 and 2012]. / Adana'da 2002-2012 Yillari Arasinda Sitma Epidemiyolojisi.

OBJECTIVE: We aimed to evaluate the epidemiological data of malaria cases in Adana province of Turkey, between 2002 and 2012. METHODS: Active and passive surveillance results collected by the Malaria and Tropical Diseases Education and Research Center of the Adana Public Health Directorship were evaluated retrospectively. The patients were evaluated according to age group, gender, months, malaria species, and whether imported cases or not. RESULTS: Two hundred fifty-two patients were diagnosed with malaria during a period of 11 years. Among these patients, 148 (58.7%) were male and 104 (41.3%) were female. Plasmodium vivax was detected in 229 (90.9%) patients, and P. falciparum was detected in 23 (8.1%) patients. All P. falciparum cases and six of the P. vivax cases were of foreign origin. When the patients were evaluated according to age group, 203 (80.5%) were over 15 years of age, and it was statistically significant (p<0.05). CONCLUSION: Çukurova is an endemic region for malaria, and Adana is the largest city in the region. We believe that surveillance studies conducted without any interruption may prevent malaria from becoming a reemerging problem in this region.

[Acute Toscana virus infection in an anti-HIV positive patient]. / Anti-HIV pozitif bir hastada saptanan akut Toskana virus enfeksiyonu.

Sandfly fever is an infectious disease transmitted to people through sandfly bites. It usually takes three days and causes chills, high fever, headache, nausea-vomiting and myalgia. The causative agent, namely sandfly fever virus (SFV), is a member of the Bunyaviridae family, Phlebovirus genus. Toscana virus (TOSV) is a serotype of SFV, as so Sicilian and Naples viruses. Seroprevalence studies have demonstrated that SFV infections which have mild symptoms or asymptomatic, can be overcome. Studies concerning TOSV infections in Turkey are limited to a small number of regional seroprevalence surveys, blood-donor screening studies and detection of viral RNA in previously collected cerebrospinal fluid samples of suspected meningoencephalitis patients in whom no causative agents were identified. In this report from Turkey, the first acute case of TOSV infection diagnosed in a patient with HIV seropositivity, was presented. A 42-year-old male patient was admitted to Numune Research and Training Hospital Adana, Turkey with high fever, headache and malaise. The patient who lived in an area near to a forest in Istanbul, had no contact history with ticks, mosquitoes and other animals. He stated that he had had the symptoms before arriving to Adana. The patient was hospitalized due to leucopenia, anemia, and thrombocytopenia accompanying high fever. Serum samples were sent to National Arbovirus and Viral Zoonotic Diseases Unit of the Turkish Public Health Institute, for the detection of Crimean-Congo haemorrhagic fever (CCHF) virus and SFV. Western Blot test was run to confirm the presence of anti-HIV antibodies detected twice with ELISA. In the following days, the patient's fever and symptoms decreased, and thrombocyte levels increased. Although CCHF virus PCR and ELISA IgM tests as well as SFV IgM and IgG immunofluorescence antibody (IFA) tests were negative, real time reverse transcriptase PCR test yielded a positive result for TOSV. SFV IgG antibodies against Toscana and Naples viruses were found to be positive in the serum sample collected at the end of a three-week follow-up. Even though TOSV infection is usually known to have an asymptomatic clinical course, it may rarely lead to serious manifestations like meningoencephalitis. In our country where SFV is endemic, TOSV should be considered in the differential diagnosis of patients presenting with high fever and meningoencephalitis symptoms.

[Investigation of reduced vancomycin susceptibility in methicillin-resistant staphylococci]. / Metisiline Dirençli Stafilokoklarda Azalmis Vankomisin Duyarliliginin Arastirilmasi

The first Staphylococcus aureus strain with reduced susceptibility to vancomycin was reported from Japan in 1996, and since then an increasing numbers of cases had been reported from various countries. Along with the unfeasibility in the identification of these strains with routine laboratory methods, the use of glycopeptid antibiotics in infections due to these strains may result in therapeutic failure. The aim of this study was to investigate the prevalence of vancomycin intermediate staphylococcus (VIS) and heterogenous VIS (hVIS) strains with the use of agar screening, macro E-test, and population analysis profile (PAP-UC; population analysis profile-area under the curve) methods. A total of 148 methicillin-resistant staphylococcus strains isolated from different clinical samples (48 tracheal aspirate, 48 blood, 39 wound swabs, eight urine, two cerebrospinal fluid, two pleural fluid, one catheter tip sample) between November 2007 and May 2009, were included in the study. Of the isolates 107 were identified as S.aureus and 41 were coagulase-negative staphylococci (CNS; 23 Staphylococcus epidermidis, six Staphylococcus haemolyticus, five Staphylococcus chromogenes, three Staphylococcus hominis and four others) by API Staph kit (bioMerieux, USA). Methicillin resistance has been determined by standard disk diffusion method with oxacillin (1 µg) and cefoxitin (30 µg) disks, according to "Clinical and Laboratory Standarts Institute (CLSI)" guidelines. For the identification of VIS and hVIS strains, brain-heart infusion agar plates containing 6 µg/ml vancomycin (BHI-V6) were used for screening. The suspected VISA/hVISA strains which grew in this agar were further tested by macro E-test and PAP-AUC methods. Total VIS and hVIS rates among the tested isolates, were found as 3.4% (5/148) and 1.4% (2/148), respectively. These rates for CNS strains were 9.8% (4/41) and 2.4% (1/41), and for S.aureus strains were 0.9% (1/107) ve 0.9% (1/107), respectively. In the evaluation of the seven patients who were infected with VISA/hVISA strains, it was detected that all had history of use of glycopeptid antibiotics except one whose history was not reached, and all were hospitalized in intensive care units, except one who had an infected knee prosthesis. Since macro E-test and PAP-AUC methods could not be performed for all of the isolates, there was a probability that our resistance rates did not reflect the real results, nevertheless VIS and hVIS prevalence that we found in our study, seemed to be higher than those data reported previously from our country. In conclusion, since the number of VISA/hVISA strains may increase in time, surveillance for vancomycin resistance in methicillin-resistant staphylococci should be carried out in hospitals periodically.