Antibiotic Stewardship Program Experience in a Training and Research Hospital.

OBJECTIVES: Antibiotic Stewardship Programs (ASP) have been developed for the spread of rational antibiotic use. Our hospital is one of the first centers where ASP applications were launched in Turkey. In this study, we aimed to share our experience with ASP which has been applied in our hospital since 2013. METHODS: We adapted ASP to our hospital program from Centers for Disease Control and Prevention's ASP checklist. Revisions on surgical prophylaxis guidelines and practices were performed. Surgical prophylaxis was evaluated from hospital infection surveillance and antibiotic usage by point prevalence surveys. Antibiotic consumption indexes (ACI) were calculated from hospital pharmacy records. Rapid antigen detection test (RADT) for Group A beta-hemolytic streptococcus and influenza rapid antigen test were started to be used. Cumulative antibiotic susceptibility results were prepared annually. RESULTS: Surgical prophylaxis was started to be administered in the operating room within 60 min of incision. Third-generation cephalosporin usage for surgical prophylaxis could be restricted in all clinics but the duration could only be shortened in neurosurgery and general surgery. There was no statistically significant change in antibiotic usage rates and appropriateness between 2014 and 2018. ACI for the class J01 in adult wards was 80.5 daily defined doses (DDD) per 100 patient days in 2014 and reduced to 64.8 DDD per 100 patient days in 2018. 22.445 pediatric patients presenting with complaints of the upper respiratory tract were evaluated with RADT and 75.1% were treated without antibiotics. CONCLUSION: In this global antimicrobial resistance era, all hospitals should have motivated antimicrobial stewardship teams. Each hospital should establish its own stewardship program and often revise it. Improvement in rational antibiotic use is hard to achieve without multidisciplinary involvement.

Pain Symptoms in COVID-19.

OBJECTIVE: The clinical manifestations of COVID-19 range from mild symptoms to severe pneumonia and severe organ damage. When evaluated specifically for pain, the data so far have shown that myalgia, headache, and chest pain can be seen in patients at varying rates; myalgia and headache, especially, are among the initial symptoms. DESIGN: This retrospective chart review, followed by a descriptive survey design study, was carried out by examining patients afflicted with COVID-19. After discharge, patients were asked about the severity and the body region of their pain, their use of analgesics, their mood and mental health, and their overall quality of life. RESULTS: A total of 206 patients with a mean age of 56.24 ± 16.99 yrs were included in the study. Pain during COVID-19 was found to be higher compared with the preinfectious and postinfectious states. The most frequent painful areas were reported to be the neck and back before the infection, whereas the head and limbs during the infection. The most frequently used analgesic during infection was paracetamol. There was no relationship between the patients' pain and anxiety and depression; the quality of life was found to be worse in patients with persistent pain. CONCLUSIONS: This study showed that the head and limbs were the most common painful body regions during COVID-19. It was also found that pain can continue in the postinfection period.

Factors that Affect Postoperative Hydrocephalus Development in Aneurysmal Subarachnoid Hemorrhage: A Clinical Study.

AIM: Factors affecting the development of postoperative hydrocephalus patients who underwent surgery after aneurysmal subarachnoid hemorrhage were retrospectively assessed. MATERIAL AND METHODS: 201 cases, who underwent aneurysm surgery in our clinic after subarachnoid hemorrhage between 2008 and 2013, were retrospectively assessed. Twenty-one cases with hydrocephalus development were retrospectively examined according to their age, gender, history (hypertension, alcohol, and smoking), blood type, the number and size of aneurysms, aneurysm localization, the presence of ventricular hemorrhage, baseline-final neurological diagnosis, Fisher grading system, history of vasospasm and meningitis. The initial neurological course and Hunt-Hess, and also final neurological course of the patients were evaluated according to World Federation of Neurosurgical Societies (WFNS) Grading Scale. RESULTS: Age, history of hypertension, aneurysm localization, Hunt-Hess grading, vasospasm, meningitis and Glasgow Outcome Scale (GOS) are determinative factors in hydrocephalus development due to subarachnoid hemorrhage. It was detected that gender, alcohol and tobacco use, blood group, the size and the number of aneurysm, the presence of intraventricular hemorrhage and Fisher grading were not the determinative factors in the patients. CONCLUSION: In patients who underwent surgery for subarachnoid hemorrhage, risk factors for postoperative hydrocephalus should be determined and the patients with these risk factors should be closely monitored.

Evaluation of mild head injury in a pediatric population.

Approximately 5 million children present to emergency departments, seeking care for head injuries, each year, and 80% of these children are classified as cases of mild head injury. Due to the huge number of patients and low frequency of intracranial lesions in this group, obtaining a computed tomography scan for each and every patient is a significant economic problem. This study was conducted to identify the clinical parameters and the radiographic findings that may be associated with intracranial lesions in children with mild head injury. 421 patients, with a Glasgow Coma Scale score of 15 and without any focal neurological deficit, were studied. Intracranial lesion was noted in 37 cases (8.8%). Sensitivity of a plain radiogram was 43.2%, and specificity was 93%. An intracranial pathology was demonstrated in 28.9% of the patients with a linear skull fracture. The only clinical parameters associated with an increase in the frequency of detection of intracranial lesions were posttraumatic seizures and loss of consciousness. Age, sex, headache, vomiting and scalp lacerations were not associated with a higher frequency. Even when patients with a history of loss of consciousness or posttraumatic seizure were subtracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% neurosurgical intervention was required. Computed tomography is the gold standard in the evaluation of pediatric patients with mild head trauma, and every child who has experienced a head injury should undergo a cranial computed tomography evaluation, even if he or she appears in perfect health.

[Indications for computed tomography in patients with mild head injuries]. / Hafif kafa travmali olgularda bilgisayarli tomografi endikasyonlari.

BACKGROUND: To identify clinical parameters that may be associated with intracranial lesions in patients with mild head injuries, Glasgow Coma Scale (GCS) scores of 15 but without any focal neurological deficit. METHODS: All head trauma patients admitted to the emergency room within 3 months with GCS scores of 15 (n = 371) were evaluated. Patients with focal neurological deficits, penetrating or multiple traumas, gun shot wounds were not evaluated. RESULTS: Mean age of 222 male and 149 female patients was 22.4 years. Frequency of intracranial lesions detected in CT was higher in patients older than 60 years of age. A significant difference was not found between both genders. Detection rate of abnormalities was higher after motorway accidents. Loss of consciousness and post-traumatic fits were associated with higher rates of pathological sequelae. A significant difference was not found between patients with or without headache, nausea, and vomiting. Sensitivity and specificity of cranial x-ray were estimated to be 38.2% and 93.2% when compared with cranial CT respectively. CONCLUSION: The incidence of intracranial lesions in patients with mild head injuries, GCS scores of 15, younger than 60 years of age, and without any focal neurological deficits, loss of consciousness, post-traumatic fits, gun shot wound, and penetrating injury is 0.6%.