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.

Choroidal thickness changes in post-COVID-19 cases.

PURPOSE: The current study aimed to evaluate the effects of the coronavirus disease 2019 (COVID-19) on choroidal thickness using enhanced depth imaging optical coherence tomography. METHODS: This study evaluated the right eyes from 41 post-COVID-19 cases (Group 1) and 41 healthy subjects (Group 2). Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. Post-COVID-19 cases were evaluated within 1 month after a diagnosis of COVID-19. Two experienced ophthalmologists measured the choroidal thickness at the subfovea, temporal, and nasal quadrants at 500-µm intervals up to 1500 µm from the fovea at seven different points. Moreover, central macular thickness and ganglion cell layer thickness were measured via OCT, after which both two groups were compared. RESULTS: Group 1 showed a significantly thicker choroid compared to Group 2 at the subfovea, 500 µm temporal to the fovea, 500 and 1000 µm nasal to the fovea (p=0.011, p=0.043, p=0.009, and p=0.019, respectively). Although other areas measured were also thicker in Group 1, the difference was not significant (p>0.05). Moreover, no significant difference in the central macular thickness and ganglion cell layer thickness were observed between the groups (p>0.05). CONCLUSION: Choroidal thickness was increased in post-COVID-19 patients, which might be related to inflammation associated with the pathogenesis of COVID-19.

Assessment of HCV-RNA test results and access rates to antiviral treatment in patients with anti-HCV positivity-a 10-year analysis.

BACKGROUND: Currently, hepatitis C virus (HCV) infection can be cured by direct-acting antivirals (DAAs). In this study, we aimed to find the rate of viremia among patients with a positive anti-HCV test and the rate of antiviral treatment given to viremic patients. We also aimed to reach patients with anti-HCV positivity but not tested for HCV-RNA, and patients, who were diagnosed with HCV-RNA positivity but received no treatment. METHODS: In this study, individuals tested for anti-HCV in Tokat Gaziosmanpasa University Research and Application Hospital in the period between January 2010 and January 2020 were reviewed retrospectively. Anti-HCV positive patients, who were not tested for HCV-RNA, and HCV-RNA positive patients, who did not receive treatment, were called for a follow-up visit in the outpatient clinic. RESULTS: : The prevalences of anti-HCV positivity and viremia among patients were 2.24% and 0.67%, respectively. A HCV-RNA test was ordered in 71.7% of the anti-HCV positive patients. Antiviral treatment was not given to 44.4% of the viremic patients. Of the patients, who were called for a follow-up visit in the outpatient clinic, 3.9% attended the visit. Of these patients, 0.8% were HCV-RNA positive and 0.7% received treatment. DISCUSSION: Although the rate of HCV-RNA testing was relatively high in patients with anti-HCV positivity, almost half of them did not receive treatment. We could reach only one-third of the patients, who were called for a follow-up visit, and only a few patients received treatment. Individuals with anti-HCV positivity should be referred to a specialist without delay and HCV-RNA testing should be performed immediately to achieve HCV elimination targets. The likelihood of difficulties in reaching patients later should be considered.

Real-World Data from Turkey: Is Sofosbuvir/Ledipasvir With or Without Ribavirin Treatment for Chronic Hepatitis C Really Effective?

BACKGROUND: In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. METHODS: Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. RESULTS: A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. CONCLUSION: The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.

Evaluation of Patients with Cystic Echinococcosis.

OBJECTIVE: Cystic echinococcosis (CE) is a globally prevalent zoonotic disease. METHODS: Demographic, clinical, laboratory, and follow-up data of patients between May 2009 and 2015 were retrospectively analyzed by screening data from a hospital automation system. RESULTS: A total of 238 (females, n=139 and males, n=99) patients with a mean age of 40.6±20.58 years were included. Less than half (40.8%) of the patients were living in the countryside. Hepatic involvement of CE was most frequently (72.2%) seen. A majority (75.6%) of the patients were symptomatic, but abdominal pain was the most frequently seen symptom. For diagnosis, in all patients, imaging modalities were used, while in 66% of the patients, serological methods were also employed. The patients received both medical and surgical treatments (78.5%, n=187), only surgical treatment (10.5%, n=25), or only medical treatment (8.8%, n=21). Surgical treatment was performed for patients with hepatic (n=139/176, 80.6%), pulmonary (n=78/94, 82.9%), splenic (n=7/9; 77.7%), and mesenteric (n=6/7, 85.1%) cysts, and patients cases with brain, bone, muscle, omentum, bladder, and adrenal cysts had undergone surgical intervention. CONCLUSION: Publication of regional data is important in terms of epidemiological considerations and may aid in the formulation of standard treatment approaches.