High antibiotic resistance rates in Helicobacter pylori strains in Turkey over 20 years: implications for gastric disease treatment.

OBJECTIVE: Helicobacter pylori (Hp) eradication therapy is crucial for preventing the development of gastritis, peptic ulcers, and gastric cancer. An increase in resistance against antibiotics used in the eradication of Hp is remarkable. This meta-analysis aims to examine the resistance rates of Hp strains isolated in Turkey over the last 20 years against clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LVX), tetracycline (TET), and amoxicillin (AMX) antibiotics. BASIC METHODS: Literature search was carried out in electronic databases, by searching articles published in Turkish and English with the keywords ' helicobacter pylori ' or 'Hp' and 'antibiotic resistance' and 'Turkey'. That meta-analysis was carried out using random-effect model. First, the 20-year period data between 2002 and 2021 in Turkey were planned to be analyzed. As a second stage, the period between 2002 and 2011 was classified as Group 1, and the period between 2012 and 2021 as Group 2 for analysis, with the objective of revealing the 10-year temporal variation in antibiotic resistance rates. MAIN RESULTS: In gastric biopsy specimens, 34 data from 29 studies were included in the analysis. Between 2002-2021, CLR resistance rate was 30.9% (95% CI: 25.9-36.2) in 2615 Hp strains. Specifically, in Group 1, the CLR resistance rate was 31% in 1912 strains, and in Group 2, it was 30.7% in 703 strains. The MTZ resistance rate was found to be 31.9% (95% CI: 19.8-45.4) in 789 strains, with rates of 21.5% in Group 1 and 46.6% in Group 2. The overall LVX resistance rate was 25.6%, with rates of 26.9% in Group 1 and 24.8% in Group 2. The 20-year TET resistance rate was 0.8%, with 1.50% in Group 1 and 0.2% in Group 2. The overall AMX resistance rate was 2.9%, 3.8% between 2002-2011, and 1.4% between 2012-2021. PRINCIPAL CONCLUSION: Hp strains in Turkey exhibit high resistance rates due to frequent use of CLR, MTZ, and LVX antibiotics. However, a significant decrease has been observed in TET and AMX resistance to Hp in the last 10 years. Considering the CLR resistance rate surpasses 20%, we suggest reconsidering the use of conventional triple drug therapy as a first-line treatment. Instead, we recommend bismuth-containing quadruple therapy or sequential therapies (without bismuth) for first-line treatment, given the lower rates of TET and AMX resistance. Regimens containing a combination of AMX, CLR, and MTZ should be given priority in second-line therapy. Finally, in centers offering culture and antibiogram opportunities, regulating the Hp eradication treatment based on the antibiogram results is obviously more appropriate.

Pulmonary-specific quality of life and dyspnea among patients hospitalized for coronavirus disease 2019: Evaluation of patient groups 1, 3 and 6 months after discharge.

BACKGROUND: Shortand long-term lung damage after coronavirus disease 2019 (COVID-19) has been emphasized in many studies, but pulmonary-specific health-related quality of life (HRQOL) has been examined only in a limited capacity. OBJECTIVES: In this study, we aimed to assess pulmonary-specific HRQOL and dyspnea among patients hospitalized for COVID-19 by applying the St George's Respiratory Questionnaire (SGRQ) to patient groups 1, 3 and 6 months following discharge (groups T1, T3 and T6). MATERIAL AND METHODS: This cross-sectional study was conducted between April 2020 and December 2020 at a tertiary hospital in Turkey. A total of 345 patients with a definite diagnosis of COVID-19 were included in our research. RESULTS: Total SGRQ score was significantly lower in the T6 group than in the T1 group (p < 0.001). The SGRQ-Symptom score was similar in the T3 and T6 groups, while the T1 group had significantly higher values (p < 0.001). The SGRQ-Activity score was significantly lower in the T6 group than in the T1 and T3 groups (p = 0.001), while the SGRQ-Impact score was significantly higher in the T6 group compared to the other 2 groups (p < 0.001). When the patients were analyzed statistically in terms of dyspnea, the difference between the baseline and 6-month results was found to be statistically significant (p < 0.001). CONCLUSIONS: Although long-term consequences are still not fully known, the SGRQ scores and dyspnea outcomes of our patients show that pulmonary-specific HRQOL and dyspnea remain at a similar level from discharge until the 6th month after discharge. Studies with extended and longitudinal follow-up are required.

COVID-19: vaccination vs. hospitalization.

OBJECTIVE: Vaccination is the most efficient way to control the coronavirus disease 2019 (COVID-19) pandemic, but vaccination rates remain below the target level in most countries. This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols. SETTING: Inoculation in Turkey began in mid-January 2021. Sinovac was the only available vaccine until April 2021, when BioNTech was added. At the beginning of July 2021, the government offered a third booster dose to healthcare workers and people aged > 50 years who had received the two doses of Sinovac. Of the participants who received a booster, most chose BioNTech as the third dose. METHODS: We collected data from 25 hospitals in 16 cities. Patients hospitalized between August 1 and 10, 2021, were included and categorized into eight groups according to their vaccination status. RESULTS: We identified 1401 patients, of which 529 (37.7%) were admitted to intensive care units. Nearly half (47.8%) of the patients were not vaccinated, and those with two doses of Sinovac formed the second largest group (32.9%). Hospitalizations were lower in the group which received 2 doses of Sinovac and a booster dose of BioNTech than in the group which received 3 doses of Sinovac. CONCLUSION: Effective vaccinations decreased COVID-19-related hospitalizations. The efficacy after two doses of Sinovac may decrease over time; however, it may be enhanced by adding a booster dose. Moreover, unvaccinated patients may be persuaded to undergo vaccination.

A meta-analysis of antibiotic resistance rates in Pseudomonas aeruginosa isolated in blood cultures in Turkey between 2007 and 2017.

OBJECTIVE: The prevalence of Pseudomonas aeruginosa has remained stable in recent years, and resistant strains has increased dramatically. In this meta-analysis, we aimed to analyze the P. aeruginosa strains isolated from blood cultures in Turkey during the last 11 years and to reveal their antimicrobial susceptibility. METHODS: Data collected between 2007 and 2017 were divided into two groups as Group-1; 2007-2011 and Group-2; 2012-2017. The differences in antibiotic resistance rates between Group-1 and Group-2 were analyzed. The study data were included according to PRISMA criteria, then meta-analysis was performed. RESULTS: A total of 30 study data from 25 studies were included in the study. The prevalence rate of meropenem (MEM) resistance in P. aeruginosa in Turkey was 25.1% (95% Cl: 20.65-29.83) according to a meta-analysis of 637 isolates. MEM resistance rates in Group-1 and Group-2 were 23.4% (95% Cl: 18.34-28.99) and 29.3% (95% Cl: 21.23-38.23), respectively. The prevalence rate of imipenem (IMP) resistance in P. aeruginosa in Turkey was 26.8% (%95 Cl: 23.40-30.35) according to a meta-analysis of 1421 isolates. IMP resistance rates in Group-1 and Group-2 were 26.2% (95% Cl: 22.41-30.27) and 28.4% (95% Cl: 21.57-35.88), respectively. Ciprofloxacin (CIP) resistance rate was 27.04% (95% Cl: 21.88-32.52) in 1388 isolates. CIP resistance rates in Group-1 and Group-2 were 30.8% (95% Cl: 24.35-37.56) and 18.6% (95% Cl: 10.72-28.11), respectively. The prevalence rate of piperacillin-tazobactam (TZP) resistance in P. aeruginosa in Turkey was 29.2% (95% Cl: 21.058-38.088) according to a meta-analysis of 1030 isolates. TZP resistance rates in Group-1 and Group-2 were 26.1% (95% Cl: 17.76-35.31) and 38.2% (95% Cl: 18.48-60.27), respectively. CONCLUSION: There is a remarkable increase in resistance rates in P. aeruginosa to MEM and TZP in Turkey due to frequent use. Other antibiotics with antipseudomonal effect should be prioritized in the treatment of these infections.