Molnupiravir compared to nirmatrelvir/ritonavir for COVID-19 in high-risk patients with haematological malignancy in Europe. A matched-paired analysis from the EPICOVIDEHA registry.

INTRODUCTION: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications. A caveat for molnupiravir is the mode of action induces viral mutations. Mortality rate reduction with molnupiravir was less pronounced than that with nirmatrelvir/ritonavir in patients without haematological malignancy. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, molnupiravir and nirmatrelvir/ritonavir were compared in a cohort of patients with haematological malignancies. METHODS: Clinical data from patients treated with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and severity of baseline haematological malignancy to controls treated with nirmatrelvir/ritonavir. RESULTS: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (interquartile range [IQR] 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 56.9% (n=66) of the patients had controlled baseline haematological malignancy, 12.9% (n=15) had stable disease, and 30.2% (n=35) had active disease at COVID-19 onset in each group. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of patients in the two groups were vaccinated (molnupiravir n=77, 66% vs. nirmatrelvir/ritonavir n=87, 75%), more of those treated with nirmatrelvir/ritonavir had received four vaccine doses (n=27, 23%) compared with those treated with molnupiravir (n=5, 4%) (P<0.001). No differences were detected in COVID-19 severity (P=0.39) or hospitalisation (P=1.0). No statistically significant differences were identified in overall mortality rate (P=0.78) or survival probability (d30 P=0.19, d60 P=0.67, d90 P=0.68, last day of follow up P=0.68). Deaths were either attributed to COVID-19, or the infection was judged by the treating physician to have contributed to death. CONCLUSIONS: Hospitalisation and mortality rates with molnupiravir were comparable to those with nirmatrelvir/ritonavir in high-risk patients with haematological malignancies and COVID-19. Molnupiravir is a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.

Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study.

BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. METHODS: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. FINDINGS: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04-1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05-1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4-30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. INTERPRETATION: Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. FUNDING: Scynexis.

Simultaneous Onset of Haematological Malignancy and COVID: An Epicovideha Survey.

Background: The outcome of patients with simultaneous diagnosis of haematological malignancies (HM) and COVID-19 is unknown and there are no specific treatment guidelines. Methods: We describe the clinical features and outcome of a cohort of 450 patients with simultaneous diagnosis of HM and COVID-19 registered in the EPICOVIDEHA registry between March 2020 to February 2022. Results: Acute leukaemia and lymphoma were the most frequent HM (35.8% and 35.1%, respectively). Overall, 343 (76.2%) patients received treatment for HM, which was delayed for longer than one month since diagnosis in 57 (16.6%). An overall response rate was observed in 140 (40.8%) patients after the first line of treatment. After a median follow-up of 35 days, overall mortality was 177/450 (39.3%); 30-day mortality was significantly higher in patients not receiving HM treatment (42.1%) than in those receiving treatment (27.4%, p = 0.004), either before and/or after COVID-19, or compared to patients receiving HM treatment at least after COVID-19 (15.2%, p < 0.001). Age, severe/critical COVID-19, ≥2 comorbidities, and lack of HM treatment were independent risk factors for mortality, whereas a lymphocyte count >500/mcl at COVID-19 onset was protective. Conclusions: HM treatment should be delivered as soon as possible for patients with simultaneous diagnosis of COVID-19 and HM requiring immediate therapy.

In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey.

BACKGROUND: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. METHODS: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. RESULTS: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). CONCLUSION: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis.

Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey.

BACKGROUND: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Investigation of the relationship of CO-RADS and CT patterns with laboratory parameters in COVID-19 patients and a new perspective on the total CT scoring system.

BACKGROUND: It is important to determine the correlation of the CO-RADS classification and computed tomography (CT) patterns of the lung with laboratory data. To investigate the relationship of CO-RADS categories and CT patterns with laboratory data in patients with a positive RT-PCR test. We also developed a structured total CT scoring system and investigated its correlation with the total CT scoring system. METHOD: The CT examinations of the patients were evaluated in terms of the CO-RADS classification, pattern groups and total CT score. Structured total CT score values were obtained by including the total CT score values and pattern values in a regression analysis. The CT data were compared according to the laboratory data. RESULTS: A total of 198 patients were evaluated. There were significant differences between the CO-RADS groups in terms of age, ICU transfer, oxygen saturation, creatinine, LDH, D-dimer, high-sensitivity cardiac troponin-T (hs-TnT), CRP, structured total CT score values, and total CT score values. A significant difference was also observed between the CT pattern groups and oxygen saturation, creatinine and CRP values. When the structured total CT score values and total CT score values were compared they were observed to be correlated. CONCLUSIONS: Creatinine can be considered as an important marker for the CO-RADS and pattern classifications in lung involvement. LDH can be considered as an important marker of parenchymal involvement, especially bilateral and diffuse involvement. The structured total CT scoring system is a new system that can be used as an alternative.

Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Impact of antimicrobial drug restrictions on doctors' behaviors.

BACKGROUND/AIM: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. MATERIALS AND METHODS: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. RESULTS: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had ≤5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). CONCLUSION: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.

Surgical site infection rates in 16 cities in Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).

BACKGROUND: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. METHODS: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. RESULTS: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). CONCLUSIONS: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.

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.

International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012.

BACKGROUND: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. METHODS: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. RESULTS: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). CONCLUSIONS: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.

Comparison of adefovir dipivoxil and pegylated interferon alpha-2a treatment in chronic hepatitis B patients.

OBJECTIVE: In this study, we aimed to evaluate the efficacy of pegylated interferon alpha 2a and adefovir dipivoxil treatment in chronic hepatitis B patients. METHODS: This study was performed on patients treated for chronic hepatitis B in the Infectious Disease Clinic of Eskisehir Osmangazi University between 01.09.2005 and 31.03.2008. A total of 30 patients aged between 18 and 65 years constituted the study group. One of patient groups received (10 HBeAg negative, 4 HBeAg positive) PEG-IFN alpha 2a at a dose of 180 µg/once a week, whereas the other group (11 HBeAg negative, 5 HBeAg positive) received daily oral doses of 10 mg ADV. Treatment responses were evaluated at week 48. RESULTS: Reductions in serum HBV DNA levels at the end of 48 weeks were 4.8 log10 copy/ml and 4.2 log10 copy/ml in HBeAg negative patients who received ADV or PEG-IFN alpha 2a, respectively. Biochemical response rates were 60% and 91% in PEG-IFN alpha 2a and ADV groups, respectively. Among HBeAg positive patients, reductions in serum HBV DNA levels were 3. 2 log10 copy/ml and 4 log10 copy/ml in ADV and PEG-IFN alpha 2a groups, at week 48, respectively. Biochemical response rates were 50% and 40% in PEG-IFN alpha 2a and ADV groups, respectively. No significant difference was determined in biochemical and virological responses in HBeAg positive and negative patients between PEG-IFN alpha 2a and ADV groups, at week 48. When both treatment groups were evaluated for side effects, it was observed that side effects were significantly common in PEG-IFN alpha 2a group. CONCLUSION: When we compared PEG-IFN alpha 2a and ADV treatment in both HBeAg positive and negative patients, biochemical and virological response rates at 48 weeks were similar.

Clinical and Epidemiologic Characteristics of Hospitalized Patients with 2009 H1N1 Influenza Infection.

Objective. 2009 H1N1 virus is a new virus that was firstly detected in April 2009. This virus spreads from human to human and causes a worldwide disease. This paper aimed to review the clinical and epidemiological properties of patients with 2009 H1N1 influenza who were hospitalized and monitored at Eskisehir Osmangazi University Faculty of Medicine Hospital. Setting. A 1000-bed teaching hospital in Eskisehir, Turkey. Patients-Methods. Between 05 November 2009-01 February 2010, 106 patients with 2009 H1N1 influenza, who were hospitalized, were prospectively evaluated. Results. Out of 106 patients who were hospitalized and monitored, 99 (93.4%) had fever, 86 (81.1%) had cough, 48 (45.3%) had shortness of breath, 47 (44.3%) had sore throat, 38 (35.8%) had body pain, 30 (28.3%) had rhinorrhea, 17 (16%) had vomiting, 15 (14.2%) had headache, and 14 (13.2%) had diarrhea. When the patients were examined in terms of risk factors for severe disease, 83 (78.3%) patients had at least one risk factor. During clinical monitoring, pneumonia was the most frequent complication with a rate of 66%. While 47.2% of the patients were monitored in intensive care unit, 34% of them required mechanical ventilation support. Conclusion. Patients with 2009 H1N1 influenza, who were hospitalized and monitored, should be carefully monitored and treated.

Several Cytokines and Protein C Levels with the Apache II Scoring System for Evaluation of Patients with Sepsis.

OBJECTIVE: We investigated whether determination IL-6, IL-8, IL-1beta and TNF-alpha at baseline, total protein C (PC) levels at time of admission and 48 hours after initiation could complement the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system to identify patients with sepsis, severe sepsis or septic shock for clinical outcome. MATERIAL AND METHODS: The study was carried out prospectively. 60 consecutive patients with sepsis, severe sepsis or septic shock were included. Blood samples were obtained at baseline and 48 hours after initiation. Cytokines and PC levels in plasma were measured with an enzyme-linked immunoabsorbent assay (ELISA). APACHE II score was calculated on admission. RESULTS: Baseline IL-6 levels and PC levels 48 hours after initiation were predictive of increased mortality (p=0.016, p=0.044 respectively). Baseline IL-6, IL-8 and TNF-alpha baseline levels correlate with the severity of physiologic insult, as determined by the APACHE II score. However, our multiple logistic regression analysis of these did not reveal any predictive value in combination with the APACHE II score. CONCLUSION: Determination of baseline IL-6 and PC 48 hours after initiation were of predictive value for prognostic evaluation of septic patients, but did not significantly increase predictive power of the APACHE scoring system to identify patients with sepsis for fatal clinical outcome.

[Evaluation of risk factors in patients with candiduria]. / Kandidürisi Olan Hastalarda Risk Faktörlerinin Degerlendirilmesi.

Urinary system infections are usually bacterial, however, fungal etiology, particularly Candida spp. are encountered in about 10% of these infections. C.albicans is still the most frequently isolated species in candiduria. This study was aimed to identify the risk factors of candiduria and to determine species distribution of Candida which cause candiduria in hospitalized patients. The study was carried out in a total of 93 hospitalized patients (68 female, 25 male; age range: 17-84 yrs, mean age: 59.5 ± 1.7 yrs) of which 50 presented with candiduria (case group) and 43 with bacteriuria (control group), between January 2009 to December 2009. The most frequently isolated species was C.albicans (n= 32; 64%), followed by C.glabrata (n= 13; 26%), C.tropicalis (n= 4; 8%) and C.krusei (n= 1; 2%). All of the isolates except one, were found susceptible to fluconazole and voriconazole by E-test (AB Biodisk, Sweden), however, C.krusei isolate was resistant to fluconazole and susceptible to voriconazole. The mean hospitalization period and the period of stay in intensive care unit (ICU) of the case group (9.56 ± 9.09 and 4.12 ± 7.05 days, respectively) were found statistically significant compared to control group (4.42 ± 3.71 and 0.53 ± 1.78, respectively) (p< 0.005). Nosocomial origin of infection was higher in control group (n= 45, 90%) than the case group (n= 30, 69.8%), (p= 0.014). The rate of antibiotic use prior to candiduria in the case group was detected significantly higher (n= 43; 86%) than the controls (n= 14; 32.6%) (p= 0.000). The most frequently used antibiotic prior to candiduria/bacteriuria was the quinolone group of agents both in case and control groups (42% and 21%, respectively). The other risk factors for candiduria found to be higher in the case group than the controls were as follows; presence of urinary system intervention (32% and 0, respectively; p= 0.000), catheter use (76% and 46.5%, respectively; p= 0.003) and immunosuppression history (24% and 9.3%, respectively; p= 0.041). However, there was no significant relationship between candiduria and history of surgical intervention, diabetes mellitus and renal failure (p> 0.05). In conclusion, rate of candiduria might be reduced by judicious antibiotic use, by implementation of guidelines for urinary catheter use, care and maintenance, and shortening the duration of ICU and hospital stay.

[Analysis of the risk factors in nosocomial urinary tract infections and effect of urinary catheter use on distribution of the causative agents]. / Nozokomiyal üriner sistem enfeksiyonlarinda risk faktörlerinin analizi ve üriner kateter kullaniminin etkenlerin dagilimi üzerine etkisi.

Nosocomial urinary tract infections (NUTI) which are usually in the first rank in health care associated infections, significantly influence mortality, morbidity, hospitalization period and cost. In this retrospective study, it was aimed to analyze the risk factors in NUTI and also to investigate the effect of urinary catheter application on the distribution of pathogens in patients with NUTI. The study included 1236 NUTI episodes in 1103 patients (age range: 18-95 years; 641 female, 462 male) between January 2000-December 2006. Diagnosis of NUTI was agreed according to CDC criteria. Asymptomatic UTI (urinary tract infection) and other UTIs were excluded and only symptomatic UTI was evaluated. Of NUTIs, 87.9% (1086/1236) were found to be associated with urinary catheter use. No statistically significant difference by means of age, gender and mean interval between admission date and date of determination of infection was determined between the two patient groups, with and without urinary catheter (p>0.05). However, catheter associated NUTI development was statistically significantly higher in intensive care unit patients than patients in other wards (p<0.001). Respiratory failure, unconsciousness, multiple trauma, surgery, central vascular catheter, tracheostomy, mechanical ventilation and peritoneal dialysis were observed more frequently in patients who developed catheter-associated NUTIs (p<0.001). Escherichia coil was isolated in 23.6%, Candida albicans in 18% and non-albicans Candida spp. in 11% of the NUTI episodes. When all Candida species were taken into consideration, they were the most frequent causative agents of NUTI. C. albicans was the most frequent agent in catheter-associated NUTI and E. coli in non-catheter-associated NUTI, their isolation rates being statistically significant (p=0.007 and p=0.005, respectively). No statistically significant difference was detected in the distribution of the other organisms in the two study groups. These data revealed that in urinary tract infections Candida species have replaced the first rank which was occupied by E. coli previously.

In vitro activity of ertapenem and other carbapenems against extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae clinical isolates in a tertiary care center in Turkey.

OBJECTIVE: To evaluate the in vitro effect of ertapenem, imipenem and meropenem in clinical isolates of extended-spectrum beta-lactamase (ESBL)-producing strains of Escherichia coli and Klebsiella pneumoniae. DESIGN/METHODS: We studied 82 consecutive clinical isolates of ESBL-producing E. coli (n = 49) and K. pneumonia (n = 33) between February 2006 and September 2007. The minimum inhibitory concentration for each carbapenem was determined using the agar dilution method. RESULTS: Eighty two consecutive microorganisms from sterile sites were evaluated. A total of 48.8% of patients had a history of surgical intervention, 78.0% needed urinary catheterization, 57.3% required vascular access and 40.3% mechanical ventilation; and 70.7% had a history of ICU stay. High resistance rates were shown for both E. coli and K. pneumoniae against cefepime (81.7%), ciprofloxacin (50.9%), tetracycline (75.0%), co-trimoxazole (47.4%), and gentamicin (48.7%). In addition, most K. pneumoniae and E. coli isolates were susceptible to amikacin (78.3%) and piperacilline-tazobactam (91.5%). Meropenem and imipenem showed activity against 100% of the isolates. Ertapenem showed activity against 100% of K. pneumoniae isolates, against 95.9% of E. coli isolates and against 97.5% of the 82 ESBL-producing microorganisms. Two E. coli isolates showed ertapenem resistance. CONCLUSION: In recent literature, carbapenems were the most active antimicrobial agents against ESBL-producing Enterobacteriaceae, as in our study. This is the first study on the in vitro activity of ertapenem against ESBL-producing E. coli and K. pneumoniae conducted in Turkey. In view of the serious infections caused by ESBL-producing microorganisms, therapeutic interventions are still problematic in serious clinical conditions. Ertapenem may be a good choice for treatment, with the additional advantage of being a once a day regimen.

Brucellosis: a retrospective evaluation of 99 cases and review of brucellosis treatment.

This retrospective study was performed in two university hospitals between January 2002 and 2006. Ninety-nine brucellosis patients were included in the study. These patients were classified as acute (91), chronic (4) and relapse (4) according to their clinical presentations and serological tests. Brucella bacteria were isolated in the blood of 17 (17.2%) cases. The most frequent symptom and clinical sign was fever. The osteoarticular complications were found in 17 patients (17.2%). Four of them were complicated with epidural abscess the same time. Two (2.2%) had meningitis, two (2.2%) had epididymoorchitis, three (3.3%) had skin rashes and one (1.1%) had hepatitis. Three of the acute brucellosis patients were pregnant. Rifampin and doxycycline combination therapy had been administered to most of the patients with acute and relapse brucellosis. However, complicated and chronic brucellosis cases were given different treatment combinations. This study reviews brucellosis therapy choices.

The prevalence of extended-spectrum beta lactamase-producing Escherichia coli and Klebsiella pneumoniae in clinical isolates and risk factors.

OBJECTIVE: To determine the prevalence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli), risk factors of ESBL-producing strains and antimicrobial susceptibility pattern of ESBL-producing and non producing strains. METHODS: The study took place at the Faculty of Medicine, Osmangazi University, Eskisehir, Turkey from March to November 2002. We evaluated 100 K. pneumoniae and 100 E. coli strains isolated from various clinical specimens, as well as the patients from whom these strains were isolated. The double-disk synergy test was performed on the isolates for the detection of ESBL. We visited the patients with a growth of E. coli or K. pneumoniae or both from their clinical specimens in their wards if they were hospitalized, while the outpatients with a growth of these microorganisms were evaluated from their hospital records. RESULTS: The prevalence of ESBL-producing K. pneumoniae was 47% and E. coli was found as 12%. The ESBL-producing isolate rates were 50% (14/28) in intensive care units, 36.1% (35/97) in wards and 13.3% (10/75) in outpatients. Foley catheter (p<0.001), intravenous catheter (p<0.001), central venous catheter (p=0.002), intubation (p<0.001), surgery (p<0.001) and mechanical ventilation (p=0.002) were found as the risk factors for the acquisition of E. coli and K. pneumoniae with ESBLs. CONCLUSION: In our study, the prevalence of ESBL-producing isolates was high. The results of the study suggest that an antimicrobial policy and early removal of interventional apparatus be of importance for the control of ESBL-producing K. pneumoniae and E. coli.