Surgical Antimicrobial Prophylaxis Compliance in Turkey: Data from the Prospective, Observational, Multicenter Survey Including 7,978 Surgical Patients.

Background: Surgical antimicrobial prophylaxis (SAP) is the peri-operative administration of antimicrobial agents. Compliance rates vary worldwide from 15% to 84.3%, with studies in Turkey not exceeding 35%. The aim of this multicenter study was to determine the rate of appropriate antibiotic class, timing, and duration as well as discharge prescriptions in Turkey. Thus, we aimed to determine the rate of full compliance with SAP procedures in our country Patients and Methods: This multicenter, prospective, observational, descriptive study was conducted in 47 hospitals from 28 provinces in seven different regions of Turkey. Patients over 18 years of age in all surgical units between June 6, 2022, and June 10, 2022, were included in the study. Results: Of the 7,978 patients included in the study, 332 were excluded from further analyses because of pre-existing infection, and SAP compliance analyses were performed on the remaining 7,646 cases. The antibiotic most commonly used for SAP was cefazolin (n = 4,701; 61.5%), followed by third-generation cephalosporins (n = 596; 7.8%). The most common time to start SAP was within 30 minutes before surgery (n = 2,252; 32.5%), followed by 30 to 60 minutes before surgery (n = 1,638; 23.6%). Surgical antimicrobial prophylaxis duration was <24 hours in 3,516 (50.7%) patients and prolonged until discharge in 1,505 (21.7%) patients. Finally, the actual proportion of patients compliant with SAP was 19% (n = 1,452) after omitting 4,458 (58.3%) patients who were prescribed oral antibiotic agents at discharge as part of a prolonged SAP. Conclusions: Surgical antimicrobial prophylaxis compliance rates are still very low in Turkey. Prolonged duration of SAP and especially high rate of antibiotic prescription at discharge are the main reasons for non-compliance with SAP.

Evaluation of chronic hepatitis B patients who voluntarily discontinued oral antiviral therapy: is there an answer to the controversial topic?

OBJECTIVE: The uncertain treatment duration for nucleos(t)ide analogues (NA) used in the treatment of chronic hepatitis B (CHB) is an important problem for both patients and physicians. The aim of this study was to evaluate the determinants of virologic relapse (VR) and the optimum time of treatment discontinuation in the follow-up of CHB patients who voluntarily discontinued treatment after virological suppression was achieved under NA use. METHODS: Data from 138 patients from 11 centers were included in this registry-based study. Factors associated with VR were investigated using multivariate Cox regression analysis. RESULTS: Ninety-nine (71.7%) of the patients were HBeAg (Hepatitis B e antigen) negative. During the 24-month follow-up period after treatment discontinuation, VR occurred in 58.7% (n = 81) of all patients and 57.6% (n = 57) of HBeAg-negative patients. The duration of NA treatment was significantly shorter (cutoff 60 months) in HBeAg-negative patients who later developed VR. In addition, the duration of virologic remission achieved under NA treatment was significantly shorter (cutoff 52 months) in those who later developed VR. In the Cox multivariate regression model of HBeAg-negative patients, having less than 60 months of NA treatment (HR = 2.568; CI:1.280-5.148; P  = 0.008) and the levels of alanine aminotransferase being equal to or higher than twice the upper level of normal at the beginning of treatment (HR = 3.753; CI:1.551-9.081; P  = 0.003) were found to be statistically significant and independently associated with VR. CONCLUSION: The findings of this study may provide clinical guidance in terms of determining the most appropriate discontinuation time for NA.

Testicular involvement of Brucellosis: A 10-year, multicentre study.

INTRODUCTION: The genito-urinary system is one of the most common areas of involvement in brucellosis. To present the epidemiological, clinical, and laboratory characteristics of patients with testicular involvement associated with brucellosis, together with the diagnostic and therapeutic approaches. METHODOLOGY: Patients followed up for brucellosis-related testicular involvement between January 2012 and November 2022 were included in the study. Brucellosis is defined as the production of Brucella spp. in cultures, or clinical symptoms together with the serum standard tube agglutination test titer of ≥ 1/160. Inflammation in scrotal Doppler ultrasonography was based on testicular involvement. RESULTS: A retrospective evaluation was made of the data of 194 patients with brucellosis-related testicular involvement. The rate of determination of testicular involvement in brucellosis was 2.57%. The most affected patients were determined in the 16-30 years age range. On presentation, brucellosis was in the acute stage in 83.7% of patients. The most common symptoms on presentation were swelling and/or pain in the testes (86.6%). In the patients where a spermiogram could be performed, oligospermia was determined in 41.7%, and aspermia in 8.3%. When the testicular involvement of brucellosis was evaluated, epididymo-orchitis was present at the rate of 55.7%, epididymitis at 27.3%, and testis abscess at 5.1%. CONCLUSIONS: Although epididymo-orchitis was the most frequently determined form of involvement in this study, there was also seen to be a significant number of patients presenting with epididymitis. Male patients presented with the clinical status of brucellosis should be questioned about swelling and pain in the testes to avoid overlooking testicular involvement.

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.

First year real life experience with tenofovir alafenamide fumarate: The pythagorean cohort.

Background and Aim: In chronic hepatitis B infection, antiviral therapy significantly reduces the incidence of complications. This study aimed to present real-life 12-month effectiveness and safety data for TAF. Materials and Methods: This Pythagoras Retrospective Cohort Study included patients from 14 centers in Turkiye. The study presents 12-month results of 480 patients treated with TAF as initial therapy or after switching from another antiviral drug. Results: The study shows treatment of about 78.1% patients with at least one antiviral agent (90.6% tenofovir disoproxil [TDF]). The rate of undetectable HBV DNA increased in both treatment-experienced and naive patients. In TDF-experienced patients, the rate of alanine transaminase (ALT) normalization increased slightly (1.6%) within 12 months, but the change was not statistically significant (p=0.766). Younger age, low albumin, and high body mass index and cholesterol were identified as risk factors for abnormal ALT after 12 months, but no linear relationship was detected. In TDF-experienced patients, renal and bone function indicators showed significant improvement three months after the transition to TAF and remained stable for 12 months. Conclusion: Real-life data demonstrated effective virological and biochemical responses with TAF therapy. After switching to TAF treatment, gains in kidney and bone functions were achieved in the early period.

COVID-19 infection during pregnancy: A retrospective study in a city in the Southeastern region of Turkey.

OBJECTIVES: To evaluate the maternal and fetal clinical outcomes in SARS-CoV-2 infected pregnant women during the whole period of the pandemic in a single province in the southeast of Turkey. METHODS: This retrospective study included patients who were screened from the medical registration system and found to be infected with SARS-CoV-2 virus during pregnancy. The demographic, clinical, laboratory, and radiological features of all the patients were obtained and compared between groups classified as severe-critical and mild-moderate disease severity. RESULTS: The mean age of all the cases was 29.0±5.3 years in the mild-moderate cases, and 30.1±5.5 years in the severe-critical cases. The rates of 3rd trimester, cesarean and premature birth, high body mass index (BMI), symptoms of cough and dyspnea, the presence of comorbidities, and hypothyroidism were significantly higher in the severe-critical cases than in the mild-moderate group. In the univariate analyses, BMI, dyspnea, cough, maternal complication rate, the neutrophil/lymphocyte ratio, the values of white blood cells, procalcitonin, high-sensitive C-reactive protein, D-dimer, ferritin, aspartate aminotransferase, and alanine aminotransferase were detected as significant risk factors. In the multivariate analysis, only procalcitonin was a significant factor. CONCLUSION: In the 3rd trimester of pregnancy, obesity and hypothyroidism were found to be risk factors for severe-critical cases of COVID-19 infection, and the clinical course was more severe with a higher rate of mortality in the recent period of the pandemic.

Intrapartum and Postpartum Reactivation of Hepatitis B in Pregnant Patients: a multicentre study / Reactivación intraparto y posparto de la hepatitis B en pacientes embarazadas: un estudio multicéntrico

Introduction: Changes in the immune system during pregnancy have been associated with reactivation of the hepatitis B virus in women chronic hepatitis B infection not receiving antiviral therapy. The aim of this study is to examine the development of intrapartum and postpartum hepatitis B reactivation in pregnant patients not being treated for chronic hepatitis B.Material and Methods: Pregnant women diagnosed with chronic hepatitis B and not receiving treatment between 2017 and 2022 in five centres in the east and southeast Turkey included in this study. In order to evaluate biochemical and viral reactivation from intrapartum and postpartum periods, patients with data for at least two periods were included in the study.Results: Evaluations were made on 171 pregnant women diagnosed with chronic hepatitis B. Reactivation occurred in 43 (25.2%) patients, in the postpartum period in 14 (32.35%) and in the intrapartum period in 29 (67.44%). Reactivation occurred most often in the 3rd trimester (n: 13, 30.2%). A significant increase was observed in the alanine aminotransferase levels of the patients with reactivation in the first trimester compared to 6 months prepartum and in the second trimester compared to the first trimester (p=0.038, p=0.039, respectively). The prepartum HBV DNA level (cut-off point =192 IU/ml) of patients with HBeAg negativity was found to have diagnostic power for reactivation of 0.684 (95% CI: 0.575-0.792, p=0.002) with 65.9% sensitivity and 68.6% specificity. Viral reactivation was observed in the first trimester in one patient and hepatitis B surface antibody was seen in the postpartum period.Conclusions: Asymptomatic viral reactivation occurred at the high rate of 25.1% in this series. To be able to identify reactivation as early as possible, pregnant patients should be followed up closely in the intrapartum and postpartum periods. (AU)

Introducción: Los cambios en el sistema inmunológico durante el embarazo se han asociado con la reactivación del virus de la hepatitis B en mujeres con infección crónica por hepatitis B que no reciben terapia antiviral. El objetivo de este estudio es examinar el desarrollo de la reactivación de la hepatitis B intraparto y posparto en pacientes embarazadas que no reciben tratamiento para la hepatitis B crónica.Material y Métodos: Mujeres embarazadas diagnosticadas de hepatitis B crónica y que no recibieron tratamiento entre 2017 y 2022 en cinco centros del este y sureste de Turquía incluidos en este estudio. Para evaluar la reactivación bioquímica y viral de los períodos intraparto y posparto, se incluyeron en el estudio pacientes con datos de al menos dos períodos.Resultados: Se evaluaron 171 gestantes con diagnóstico de hepatitis B crónica. La reactivación ocurrió en 43 (25,2%) pacientes, en el puerperio en 14 (32,35%) y en el intraparto en 29 (67,44%). La reactivación ocurrió con mayor frecuencia en el tercer trimestre (n: 13, 30,2%). Se observó un aumento significativo en los niveles de alanina aminotransferasa de las pacientes con reactivación en el primer trimestre en comparación con los 6 meses preparto y en el segundo trimestre en comparación con el primer trimestre (p = 0,038, p = 0,039, respectivamente). Se encontró que el nivel de ADN del VHB antes del parto (punto de corte = 192 UI/ml) de pacientes con HBeAg negativo tenía un poder diagnóstico para la reactivación de 0,684 (IC del 95 %: 0,575-0,792, p = 0,002) con una sensibilidad del 65,9 % y una sensibilidad del 68,6 %. % especificidad. Se observó reactivación viral en el primer trimestre en una paciente y se observaron anticuerpos de superficie contra la hepatitis B en el período posparto.Conclusiones: La reactivación viral asintomática ocurrió en la alta tasa de 25,1% en esta serie. ... (AU)

Re-infection in COVID-19: Do we exaggerate our worries?

BACKGROUND: Protective long-term immunity following coronavirus disease 2019 (COVID-19) is unclear. The study evaluated the relationship between the vaccination status and risk factors in the re-infection of patients with a diagnosis of COVID-19 who reported to the Public Health Management System in a province in south-eastern Turkey. METHODS: Patients with positive results for the severe acute respiratory syndrome coronavirus 2 by the real-time reverse transcription polymerase chain reaction (RT-PCR) test in respiratory samples were defined as confirmed cases. Reinfection was diagnosed in cases with COVID-19 real-time RT-PCR positivity, with or without COVID-19-like symptoms, in at least 90 days after the first infection/disease. RESULTS: A total of 58 811 patients with the diagnosis of COVID-19 from March 11, 2020, to August 31, 2021, were included in the study. Re-infection was detected in 421 (0.7%) of all patients. The mean age of the cases was 38.0±16.0 years, and 51% of them were female. Eight (2.0%) of the cases resulted in death due to re-infection. No hospitalization or mortality was observed in fully vaccinated patients. Additionally, none of the mortal cases had completed the vaccination schedule. CONCLUSIONS: We are concerned that the re-infection rates and mortality may increase due to new variant strains. Vaccination is the greatest weapon against progression to critical illness in re-infections, even with existing mutations. Therefore, it is important for those without a full vaccination schedule to be vaccinated, even if they have been previously infected.

Predictors of Severity and Mortality in COVID-19: A Retrospective Study from Batman, Turkey.

Objective: It is increasingly important to identify risk factors for COVID-19-associated mortality to provide access to early treatment. This study aimed to investigate the relationship between COVID-19 severity and laboratory data and demographic characteristics of hospitalized patients and to identify factors predicting mortality in COVID-19. Materials and Methods: The study is a retrospective and single-center study. Data of 1298 COVID-19 patients confirmed by a positive real-time polymerase chain reaction test for COVID-19 and treated at the hospital were retrospectively analyzed. Study patients were divided into three groups based on the clinical severity of disease: the mild-moderate group (n:954) and the severe (n:310) and critical (n:34) groups. Demographic characteristics, underlying diseases, and laboratory findings were compared between groups. Results: Multivariate logistic and ordinal logistic regression analysis revealed that male gender, old age, diabetes mellitus, coronary artery disease, cerebrovascular event, malignancy, chronic obstructive pulmonary disease, chronic renal failure, chronic hepatitis B, and Alzheimer's disease/dementia/Parkinson's disease (among neurological diseases) were independently associated with and significantly increased the development of severe disease and mortality. Conclusion: The COVID-19 pandemic continues to be a significant health problem affecting all of humanity. Determining risk factors for COVID-19 severity and mortality are critical for classifying critical cases at the time of initial diagnosis, establishing appropriately specific treatment protocols, and ensuring access to early treatment.

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%.

[Evaluation of Infections in Intensive Care Units: A Multicentre Point-Prevalence Study]. / Yogun Bakim Ünitelerindeki Enfeksiyonlarin Degerlendirilmesi: Çok Merkezli Nokta Prevalans Çalismasi.

Infection control is a top priority for hospitals, especially in intensive care units (ICU). In intensive care units, prevalence of infection is estimated to be 30% worldwide, which is a major cause of morbidity and mortality. Many factors are known to increase the risk of infection in ICU patients. Since each of these may lead to different infections, it is important to recognize and identify predisposing factors for early diagnosis and treatment. The regional health care-associated infections (HCAI) prevalence and distribution of risk factors are important strategies in infection control. In this regard, the aim of this point prevalence study was to obtain data related to infections, the prevalence of HCAI among these infections, the epidemiology, agents and antibiotics used among adult ICU patients in the university hospitals, training and research hospitals and public hospitals located in eight of the cities of our region. In the light of these data, we aimed to review and emphasize the guidelines on HCAI prevention. The study included adult ICU patients followed up in nine hospitals in the Eastern and South-eastern Anatolia Regions of eight different cities (Sivas, Erzurum, Mardin, Batman, Diyarbakir Elazig, Van, Adiyaman) in Turkey. Of the hospitals six were university hospitals, one was training and research hospital, and two were public hospitals. The number of beds ranged from 358 to 1418. A specific day was determined on which the researchers concurrently carried out a prospective surveillance in all adult intensive care unit patients. The researchers collected data and recorded the demographic characteristics (age, gender), underlying diseases, length of hospital stay, presence of invasive intervention (urinary catheter, central venous catheter, external ventricular drainage, mechanical ventilator, presence of risk factors such as burn, trauma and surgery, number of infection cases, type of infection (hospital-acquired, community-acquired), type of microorganisms and whether polymicrobial or monomicrobial, which antibiotics were administered, and duration of antibiotic treatment. Our study assessed data of 429 inpatients in the adult ICU of nine hospitals in eight different cities. There were a total of 881 intensive care beds in these hospitals, and 740 (84%) beds were occupied. Of the study group 49.7% was male with a mean age (min-max) of 64.08 ± 18.78 (2-97) years. The point prevalence of HCAI was 21.7% (n= 93). Of the patients who were followed-up 182 (42.4%) presented infections. Of these infections, 21.4% were diagnosed as community-acquired pneumonia, 18.6% were ventilator-associated pneumonia (VAP), 16.3% were communityacquired urinary tract infection (UTI), and 16.3% were bloodstream infection. In addition, the most commonly administered antibiotics in the study group were piperacillin/tazobactam, carbapenem, quinolone and ceftriaxone, respectively. The most common types of HCAI were community-acquired pneumonia (10.7%), ventilator-associated pneumonia (8.9%) and bloodstream infections (8.2%). The mean length of hospital stay was 32.05 ± 66.85 (1-459) days and the mean duration of antibiotic therapy in patients with HCAIs was 7.76 ± 7.11 (1-41) days. The most widely accepted method to handle infection is to carry out active, prospective and patient-based surveillance studies on a regular basis, and to take control measures and arrange appropriate treatment in the light of the data obtained. We attribute the high prevalence of HCAI in our region to lack of personnel, lack of materials, inappropriate use of antibiotics, insufficiency of physical conditions, and little support for infection control committees. In conclusion, we emphasize that it is of importance to work closely with the hospital administration to take measures and that necessary assistance is provided.

Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group. In the same period patients, who were hospitalized in the same ward and did not have CRKP growth were selected as the control group. It was determined that no glycopeptides and steroids use nor tracheostomy as protective factors would be employed in terms of non-development of CRKP. Mechanical ventilation, tracheostomy, urinary catheter presence, central venous catheterization, nasogastric tube placement, advanced age, acute renal insufficiency, total parenteral nutrition, carbapenem, glycopeptide, and piperacillin tazobactam were all detected as risk factors in terms of CRKP infection development. As a result, rational usage of antibiotics for preventing infections developing with CRKP should be targeted.