Real-world diagnostic value of a nationwide standardized COVID-19 triage chart in Turkey.

BACKGROUND: Effective triage is critical during the coronavirus disease 2019 (COVID-19) pandemic. An appropriate triage plan is crucial to direct suspected COVID-19 cases to a designated area, in order to separate such patients from other patients and staff. OBJECTIVES: To report the diagnostic value of the "Possible Coronavirus Disease 2019 (COVID-19) Case Questioning Guide for Outpatients", a nationwide standard triage chart, and of the individual questions within the triage chart for detecting COVID-19 in patients admitted to our hospital. MATERIAL AND METHODS: A total of 39,681 outpatients admitted to our hospital between April 1 and April 30, 2021, underwent triage questioning. The triage chart consisted of 3 symptom questions and 4 contact and travel questions. Patients who responded "yes" to at least 1 question were referred to the pandemic area; others were considered low-risk and did not undergo routine COVID-19 polymerase chain reaction (PCR) test. RESULTS: Briefly, 3529 outpatients were referred to the pandemic area; among them, 1055 were PCR-positive. Among 36,152 low-risk patients, 94 were PCR-positive. The sensitivity of the triage chart was 91.82%, specificity was 93.58%, positive likelihood ratio was 14.30, and negative likelihood ratio was 0.09. Triage questions were in moderate agreement with PCR results (Cohen's Kappa: 0.429, p < 0.0001). The diagnostic value of the triage chart was mainly attributed to the questions regarding possible COVID-19 infection symptoms rather than contact history. However, the questions included in the triage chart had none to slight agreement with the PCR test results in the pandemic outpatients. CONCLUSIONS: The triage chart has high sensitivity and specificity for discriminating possible COVID-19 cases in all outpatients, but has unsatisfactory diagnostic value for predicting PCR positivity in pandemic outpatients. Therefore, the current triage chart should be used accordingly, i.e., to define possible COVID-19 cases rather than PCR-positive cases. Further studies regarding COVID-19 triage for possible and PCR-positive cases should also focus on the individual diagnostic value of less prevalent symptoms.

Bacteria Causing Community-Acquired Urinary Tract Infections and Their Antibiotic Susceptibility Patterns in Outpatients Attending at a State Hospital in Turkey.

Introduction Clinicians should know the frequency and resistance patterns of bacteria that cause urinary tract infections (UTI) to provide patients with appropriate treatment and antibiotic management. However, the frequency of culture reproducing organisms and resistance patterns change in each community. Therefore, these data must be determined locally to make better treatment decisions. Herein, we aimed to determine the frequency of UTI-causing agents and current antimicrobial resistance profiles in outpatients attending our hospital. Methods This retrospective descriptive study included three hundred eight outpatients attending under the diagnosis of UTI between March and October 2020 who had a positive urine culture for bacterial growth. Age, sex, laboratory tests, urinalysis results, microorganisms grown in urine culture, and antibiograms were evaluated from the patients' medical records. Data were analyzed using SPSS version 23.0 (IBM Corp., Armonk, NY) for Windows. Results In urine culture results, Escherichia coli (E. coli) and Klebsiella species are the most commonly detected agents. The growth in 71 (23%) of the 308 cultures was extended-spectrum beta-lactamase (ESBL) positive. In the E. coli growths, the susceptibility rates to fosfomycin, gentamicin, nitrofurantoin, trimethoprim-sulfamethoxazole, and ampicillin were 95.2%, 90.3%, 95.3%, 76.8%, and 49.3%, respectively. The susceptibility of Klebsiella species to gentamicin was as high as 93.7%, similar to that of E. coli, whereas its susceptibility rates to fosfomycin, trimethoprim-sulfamethoxazole, and nitrofurantoin were lower than those of E. coli (76.1%, 48.4%, and 68.4%, respectively). Of the 71 ESBL-positive growths, 52 were E. coli (17.3% of all UTIs), and 14 were Klebsiella species (4.6% of all UTIs). Of the ESBL-positive strains, 88.7%, 81%, and 76.1% were susceptible to fosfomycin and nitrofurantoin, respectively, and 64.9% and 45.7% were sensitive to cefoxitin and trimethoprim-sulfamethoxazole. Conclusion UTIs are among the most common causes of hospital admission and infections for which empirical antibiotic administration is initiated. The increasing rates of ESBL positivity and resistance to antibiotics such as ampicillin, cephalosporins, trimethoprim-sulfamethoxazole, and quinolones, especially in E. coli and Klebsiella strains, which are the most common pathological agents of UTI in our region, have limited the use of these treatments. However, the high susceptibility of E. Coli growths to fosfomycin and nitrofurantoin and susceptibility of Klebsiella growths to gentamicin may make these antibiotics stand out as suitable options for the empirical treatment of UTI in our setting.

[Evaluation of the epidemiological, clinical and laboratory findings in continuous ambulatory peritoneal dialysis related peritonitis attacks]. / Sürekli ayaktan periton diyalizi ile iliskili peritonit ataklarinda epidemiyolojik, klinik ve laboratuvar bulgularinin degerlendirilmesi.

The aims of this study were to assess epidemiological features, clinical outcomes, laboratory findings, causative organisms and treatment approach for continuous ambulatory peritoneal dialysis (CAPD) -related peritonitis cases. A total of 50 patients (35 male, 15 female; age range: 18-83 years, mean age: 49 +/-17 years) with CAPD related peritonitis treated in Infectious Diseases and Clinical Microbiology Department of Ankara Training and Research Hospital between February-July 2006 were enrolled into this study. Demographic characteristics, symptoms, physical examination findings and laboratory parameters of patients were recorded and evaluated at the baseline, 48 hours and at the end of treatment. Fifty six peritonitis episodes occurred during the study period, and overall incidence of peritonitis was calculated as 1.6 episodes/patient-year. The most common presenting symptoms were cloudiness of the peritoneal dialysis fluid (100%), abdominal pain (98%), nausea (74%) and vomiting (54%). Abdominal tenderness and rebaund (100%) were the most common physical examination findings. Increased levels of C-reactive protein, erythrocyte sedimentation rate and procalcitonin were detected in 88%, 94% and 42% of the patients, respectively. The mean white blood cell count of peritoneal dialysate fluids was 905/mm3 (170-17900/mm3) in 56 episodes. In direct microscopic examination of peritoneal fluid samples with Gram stain, positivity was detected in 10 (18%) of the attacks, in which eight yielded gram-positive cocci and two gram-negative bacilli. The rate of culture positivity was 74% in the peritonitis episodes, and no microorganism was isolated from the cultures of 26% of the episodes. The most frequently isolated microorganisms were coagulase-positive staphylococci, followed by Staphylococcus aureus (n:4) and E. coli (n:4) with the rates of 7% of each, Enterococcus spp. (n:3), Klebsiella spp. (n:3) and Pseudomonas spp. (n:3) with the rates of 5% of each, and Streptococcus spp. (n:1), diphtheroid bacillus (n:1) and Candida albicans (n:1) with the rates of 2% of each. Eightyfour percent of patients were successfully treated with intraperitoneal cefazolin and gentamicin empirically. Three of the patient's CAPD therapy was converted to hemodialysis, while two patients have died. As a result, since peritonitis is still the major complication of CAPD despite the technological developments, the informations about causative microorganisms and their antimicrobial susceptibilities would be helpful for the early and accurate treatment of peritonitis.