Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: a prospective observational cohort study.

OBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.

Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study.

BACKGROUND: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. METHODS: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients' characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. RESULTS: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49-2.45). CONCLUSIONS: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

The Role of Pneumococcal Pneumonia among Community-Acquired Pneumonia in Adult Turkish Population: TurkCAP Study.

OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.

The "MICE" scoring system in differentiating the identical twins leptospirosis and hantavirus infection.

PURPOSE: To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. METHODS: The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed ("MICE" score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the "MICE" scoring system. RESULTS: Three cut-off values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/µL): ≤ 7500, 7500-15,000, and > 15,000; total bilirubin (mg/dL): ≤ 3, 3-10, and > 10; CRP (mg/dL): ≤ 5, 5-15, and > 15; creatinine (mg/dL): ≤ 1.5, 1.5-3, and > 3; CK (U/L): ≤ 500, 500-1000, > 1000. AUC was calculated as 0.964 at ROC analysis, while the most noteworthy cut-off point was obtained when MICE score was ≥ 3, exhibiting 93.5% sensitivity, 92.9% specificity, PPV 94.5% and NPV 91.5%. A test score ≥ 3 was regarded as positive. In addition, our patients were evaluated using other current scoring systems in addition to "MICE," and our scoring system exhibited a greater diagnostic power in our subjects. CONCLUSIONS: Leptospirosis and hantavirus infections can be accurately predicted by the MICE scoring system. Early diagnosis and rational treatment will also help to lower the mortality rates in these diseases.

Gastrointestinal and cutaneous anthrax: Case series.

INTRODUCTION: Anthrax is a zoonosis affecting herbivorous animals. Its agent is Bacillus anthracis and it is gram positive, aerobic or facultative anaerobic, immobile and has a capsule in the polypeptide structure. The incidence is gradually decreasing in the world and in our country. The disease is especially seen in areas where stock breeding is common. In this case series, 3 cases, one of them was mortal, took place after anthrax infected cow was eaten in February 2018 in Trabzon was shared. CASE PRESENTATIONS: In the first case, as a result of the animal's meat was eaten, gastrointestinal anthrax and associated sepsis were seen. This patient's blood culture was positive and she was died. Second case after contacting the patient who died, and third case after contacting the animal and eating its meat, diagnosed with cutaneous anthrax. Doxycycline treatment was started with cutaneous anthrax patients, these cases were recovered without any complications. CONCLUSION: We presented this article, to update our information about gastrointestinal anthrax and other anthrax types which are become a current issue again especially due to bioterrorism and also to keep it in mind in the differential diagnosis although it is rarely seen in our stock raising areas.

Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome.

Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

Carbonic anhydrase I-II autoantibodies and oxidative status in long-term follow-up of patients with Crimean-Congo haemorrhagic fever.

CONTEXT: Crimean-Congo haemorrhagic fever (CCHF) is a life-threatening acute febrile haemorrhagic disease. OBJECTIVE: This study was to measure levels of the oxidative stress biomarkers malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) and of CA I-II autoantibodies as biomarkers for autoimmunity and course of disease in patients with CCHF. METHODS: Seventy CCHF patients and 39 healthy control volunteers were included in the study. RESULTS: Serum MDA and TAS levels were significantly higher (p < .0001) and serum TOS and OSI levels were significantly lower (p < .0001) in both the acute period and at 6th-month follow-up in the CCHF patients compared to the healthy volunteers. CA II levels were significantly higher in the acute period compared to the healthy volunteers (p < .005) and were significantly lower at 6th-month follow-up (p < .05). CONCLUSION: Serum MDA and CA II autoantibodies appear to reflect oxidative stress status and disease progression in CCHF and may be used as biomarkers for oxidative stress and disease progression.

Individualized antibiotic therapy in patients with ventilator-associated pneumonia.

The optimal duration of the treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1 week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10 to 14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital's intensive care units between 1 January and 31 December 2015. Duration of antibiotic therapy was determined with 5 day clinical evaluation according to previously established criteria. Patients were divided into two groups depending on length of treatment, short (7-10 days) and long treatment (>10 days). Nineteen patients received 7 to 10 day antibiotic therapy, and 30 received >10 day antibiotic therapy. Demographic and clinical characteristics, Glasgow Coma Scale score, CPIS and the PaO2/FiO2 ratio at the time of diagnosis of VAP were statistically similar between the two groups (P>0.05). A second VAP attack occurred post-treatment in three patients receiving short-term treatment and in four receiving long-term treatment (P=0.561). The numbers of antibiotic-free days were 15.6±6.2 in the short-term treatment group and 8.3±7.5 in the long-term group (P<0.0001). One of the patients receiving short-term treatment died within 28 days after treatment, and four of the patients receiving long-term treatment (P=0.348) did so. The most commonly observed micro-organisms in both groups were Acinetobacterbaumannii and Pseudomonasaeruginosa. Short-term treatment can be administered in cases with early clinical and laboratory response started on VAP treatment by considering individual characteristics and monitoring fever, CPIS, the PaO2/FiO2 ratio, C-reactive protein and procalcitonin values.

Cost analysis and evaluation of nosocomial infections in intensive care units.

BACKGROUND/AIM: The purpose of this study was to evaluate nosocomial infections occurring in our hospital intensive care units (ICUs) and the risk factors for these, and to determine the effect of these infections on mortality and cost. MATERIALS AND METHODS: This retrospective study was performed via infection control committee surveillance data, ICU records, and information processing data between 1 January and 31 December 2013 at the Kanuni Education and Research Hospital. RESULTS: A total of 309 nosocomial infections were observed in 205 out of 566 patients. The density of nosocomial infections was 25.4 in 1000 patient days. Hospitalization was prolonged, and APACHE II and Charlson comorbidity scores were high in patients developing nosocomial infections (P < 0.001). Of the patients diagnosed with a nosocomial infection, 170 died. Infections were determined as the cause of death in 62 (36.5%) of the nonsurviving patients with a nosocomial infection. Acinetobacter baumannii was identified in 46 (74.2%) of the patients that died from nosocomial infections. The mean cost in patients developing a nosocomial infection was 15,229.30 Turkish lira (TL), compared to 9648.00 TL in patients without a nosocomial infection (P = 0.002). CONCLUSION: Regular infection control education sessions need to be held and the number of nurses needs to be increased in order to be able to reduce this high mortality, morbidity, and cost.

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study.

OBJECTIVE: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. MATERIALS AND METHODS: A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. RESULTS: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. CONCLUSION: Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.

The Importance of Supportive Care with Tranexamic Acid in Crimean-Congo Hemorrhagic Fever.

This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic factors, he was discharged in a healthy condition after 17 days of hospitalization with close monitoring and supportive care. Tranexamic acid was successfully used together with other supportive treatments.

The first Crimean-Congo hemorrhagic fever case in the winter season from Turkey.

Turkey is one of the countries in which Crimean-Congo hemorrhagic fever is frequently seen and most of the cases are reported between April and August. We describe the first case of Crimean-Congo hemorrhagic fever in the winter season, when Hyalomma tick activity is absent, from Turkey.

Crimean-Congo haemorrhagic fever presenting as epididymo-orchitis.

BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal disease caused by a tick-borne virus. OBJECTIVES: A 53-year-old man presented with fever and acute painful scrotal swelling simulating acute epididymo-orchitis. STUDY DESIGN: Based on the clinical and epidemiological findings, CCHF virus infection and epididymo-orchitis were suspected. This symptom, rarely reported in viral haemorrhagic fevers, was observed in this case. RESULTS: The diagnosis was confirmed by detection of the IgM antibody to CCHF virus and positive RT-PCR. CONCLUSION: We report the first case of imported CCHF presenting as epididymo-orchitis. This symptom is a rare complication of CCHF, and the clinician should consider this entity in the differential diagnosis of adults with epididymo-orchitis.

The effectiveness of routine laboratory findings in determining disease severity in patients with Crimean-Congo hemorrhagic fever: severity prediction criteria.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal disease caused by a tick-borne virus from the Bunyaviridae family. OBJECTIVES: To determine the predictive criteria for severity among patients with CCHF based on clinical and laboratory findings. STUDY DESIGN: This retrospective study was conducted on patients with CCHF and hospitalized between June 2004 and August 2008 at Karadeniz Technical University, Turkey. Demographic characteristics, clinical findings and laboratory tests on admission of all patients with CCHF were investigated. RESULTS: A total of 152 patients with confirmed CCHF were investigated. Sixty-three (41.4%) of these patients were in the severe group. Laboratory findings using the ROC curve method and optimum diagnostic cut-off points for specific laboratory parameters in the severe group were; PLT: 90,000, Hb: 13.5 g/dL, PT: 13.1s, aPTT: 34 s, INR: 1, AST: 117U/L, ALT: 71U/L, AST/ALT: 1.62, LDH: 508 U/L, CK: 267 U/L and CRP: 0.59 mg/dL. At multivariable analysis, the risk for a severe clinical course in CCHF patients increased 2.59 and 3.93 times in the presence of platelet count and Hb below cut-off values, whereas the same risk increased 2.95, 2.92 and 3.47 times when the results for INR, AST and CRP, respectively, were above the predetermined cut-off values. CONCLUSIONS: A number of laboratory findings that can easily be measured at routine examination of patients hospitalized with a suspicion of CCHF are valuable and sensitive predictors. These parameters will contribute considerably to the design, practice and management of supportive treatment, blood and blood products replacement and intensive care services.

The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey.

BACKGROUND: The efficiency of ribavirin for treatment of Crimean-Congo hemorrhagic fever (CCHF) is unknown. In the literature, prospective randomized studies investigating the efficacy of ribavirin are not found. OBJECTIVES: To investigate the efficacy of ribavirin in treatment of patients with CCHF. STUDY DESIGN: In this prospective randomized cohort study 136 cases were included between June 2004 and August 2007. The diagnosis was confirmed in the CCHF reference laboratory of Refik Saydam National Hygiene Central Institute of the Turkish Ministry of Health. Patients either received ribavirin plus supportive treatment (Group A) (n=64) or only supportive treatment (Group B) (n=72). For the evaluation of efficacy of ribavirin, various parameters were compared between Group A and Group B. RESULTS: As well as the similarity of demographic features between the two groups, there were no statistical differences in incubation time; hospitalization time; patients requiring platelet replacement therapy; the time taken for platelet levels to return to normal levels and mortality. In Group B, the rate of tick contact was higher (p=0.03). In Group A, leukocyte levels took longer to return to the normal levels (p=0.02). CONCLUSION: In our study, there was no positive effect determined on clinical or laboratory parameters in CCHF patients treated with ribavirin, also it was observed that leukocyte levels took longer to return to normal (p=0.02) and, while not statistically significant, the longer period of hospitalization (p=0.09) needed was observed as a negative effect. Because of these reasons, it is thought that the use of ribavirin makes no significant contribution to the prognosis of the CCHF disease.

[A case of Brucella prostatitis misdiagnosed as prostate carcinoma]. / Prostat karsinomu ile karisan bir Brucella prostatiti olgusu.

Brucellosis is a major public health problem in Turkey and all over the world. Joint pain, night sweats, anorexia, weakness, loss of weight and headache are the basic symptoms of brucellosis and the illness can affect many organs. Genitourinary involvement is reported in 2-20% of cases, epididimoorchitis being the most frequent complication, however, prostatic involvement is far more uncommon. In this paper, a case of Brucella prostatitis misdiagnosed as prostate carcinoma has been presented. A 50-years-old man who was a microbiology laboratory staff has been admitted to our outpatient clinic with the complaints of joint pain, weakness, fever, urgency, difficulty and pain during urination. Since prostate specific antigen (PSA) was 23.6 ng/ml (normal value < 4 ng/ml) and free PSA (fPSA) was 3.89 ng/ml (normal value < 1 ng/ml), needle biopsy from the prostate was performed. Blood cultures performed by BACTEC 9200 (Becton Dickinson, Sparks, Md.) system yielded Brucella melitensis, and the pathological examination of the prostate biopsy revealed prostatic hyperplasia and prostatitis. Brucella standard tube agglutination titer was 1/320. Upon the diagnosis of Brucella prostatitis the patient was treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 months. During the follow-up period no complication was detected in the patient and the PSA level decreased to 1.57 ng/ml and fPSA to 0.43 ng/ml. This case was reported to withdraw attention to prostatic involvement during brucellosis. Elevated PSA values with the signs and symptoms of brucellosis in endemic areas should be evaluated accordingly and appropriate therapy should be initiated without any delay.

Voriconazole-induced neuropathy.

BACKGROUND: Fungal infections are common and life threatening among immunosupressive patients. Rare side effects may occur related to the use of voriconazole, which is the drug of choice in invasive aspergillosis. PATIENTS AND METHODS: Neuropathy was determined through clinical and electromyographic findings during the course of voriconazole therapy in 2 patients developing invasive aspergillosis. RESULTS: Since examinations revealed no neuropathy capable of ascription to any other cause and improvement followed the cessation of the drug, this suggested that neuropathy may be linked to voriconazole use. CONCLUSION: Neuropathy may be seen as a side effect during voriconazole treatment. Voriconazole-induced side effects should be borne in mind and patients carefully monitored during its use.

[Isolation of Brucella melitensis from ejaculate culture of a brucellosis patient with epididymoorchitis]. / Ejekülat kültüründe Brucella melitensis üretilen epididimoorsitli bir bruselloz olgusu.

Brucellosis is a significant public health problem particularly in developing countries. People are frequently infected through milk, milk products, urine and pregnancy material of animals with brucellosis. Epididymoorchitis is the most frequent genitourinary complication of brucellosis and is often unilateral. In this report, a 35 years old male patient who was diagnosed as epididymoorchitis based on clinical presentation, laboratory findings and imaging techniques, has been presented. Brucella melitensis was isolated from blood, bone marrow and ejaculate cultures of the patient. The patient was treated with rifampicine and doxycycline combination therapy for six weeks and no complication has developed in the one year follow-up period. In areas where brucellosis is endemic, such as our country, Brucella infection should be considered in the differential diagnosis of epididymoorchitis and in addition to blood and bone marrow cultures, ejaculate cultures should also be evaluated.

Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization.

BACKGROUND: Intravascular catheters are integral to the practice of modern medicine. Potential risk factors for catheter-related bloodstream infection (CRBSI) include underlying disease, method of catheter insertion, and duration and purpose of catheterization. The administration of parenteral nutrition (PN) through intravascular catheters increases CRBSI risks. The purpose of this study was to evaluate the risk factors of CRBSI in patients with PN administration. METHODS: This study was conducted at the Karadeniz Technical University Hospital between October 2003 and November 2004. All the patients to whom PN was administered through intravascular catheters were prospectively monitored for the presence of CRBSI and risk factors. RESULTS: During the study period, 111 intravascular catheters through which PN was administered were monitored for a total of 1646 catheter-days. CRBSI was determined in 31 cases, a CRBSI rate of 18.8 per 1,000 catheter-days. When risk factors affecting CRBSI were investigated using logistic regression, an increase in APACHE II score (OR, 1.10; 95% CI, 1.01-1.21; p = .012), prolongation of catheterization (OR, 1.08; 95% CI, 1.02-1.14; p = .004), catheterization in emergent conditions (OR, 5.45; 95% CI, 1.20-24.82; p = .016), and poor patient hygiene (OR, 4.38; 95% CI, 1.39-13.78; p = .019) were all determined to be independent risk factors. Proper implementation of hand hygiene and maximal barrier precautions during the insertion of catheters reduced CRBSI levels (OR, 0.28; 95% CI, 0.09-0.88; p = .003 and OR, 0.26; 95% CI, 0.08-0.93; p = .017, respectively). CONCLUSIONS: It was concluded that the duration of catheterization should be shortened; that the intravascular catheter, which is inserted in urgent situations, should be removed as soon as possible; and that maximal sterile barrier precautions should be taken and due attention should be paid to hand hygiene.