Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements.

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginning of the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginningof the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Les infections sur cathéter central sont l'un des problèmes les plus importants dans les unités de soins intensifs au niveau mondial. Un ensemble de soins dispensés en cas d'infections sur cathéter central a été introduit dans une unité de soins intensifs médicaux et chirurgicaux de 13 lits à Kocaeli (Turquie) en janvier 2010. Le degré d'application de l'ensemble de soins a été évalué du début du troisième trimestre 2010 jusqu'à juin 2013 et comparé aux taux d'infections sur cathéter central. Au cours de la période suivant l'intervention, parmi les 2196 patients ayant séjourné dans l'Unité des soins intensifs, 732 cathéters centraux posés pendant 4366 jours cumulés ont été soumis à observation. Le retour d'information fourni au personnel a permis de renforcer la culture de la sécurité du patient en unité de soins intensifs.Les taux d'infections sont restés nuls pendant les 38 mois ayant suivi la mise en oeuvre. Il existait une forte corrélation négative entre le degré d'application de l'ensemble de soins et les taux d'infections sur cathéter central. La mise en oeuvrede cet ensemble de soins concernant les cathéters centraux, associée à l’accent mis sur le degré d'application de toutes ses composantes et une culture de la sécurité du patient, a permis d'atteindre et de maintenir un taux zéro d'infection sur cathéter central dans cette unité de soins intensifs.

KPC-producing Klebsiella pneumoniae, finally targeting Turkey.

We report here the first identification of the worldwide spread of Klebsiella pneumoniae carbapenemase-2-producing and carbapenem-resistant K. pneumoniae clone ST258 in Turkey, a country where the distantly-related carbapenemase OXA-48 is known to be endemic. Worryingly, this isolate was also resistant to colistin, now considered to be the last-resort antibiotic for carbapenem-resistant isolates.

Analysis of cerebral toxoplasmosis in a series of 170 allogeneic hematopoietic stem cell transplant patients.

INTRODUCTION: Cerebral toxoplasmosis is a rare but fatal complication in hematopoietic stem cell transplant patients, which mostly is caused by reactivation of latent disease. METHODS: In this study, we report an analysis of cerebral toxoplasmosis in a series of 170 allogeneic stem cell transplant patients during a 30-month period at our institution. RESULTS: Among these allogeneic stem cell transplant patients, 5 were diagnosed with cerebral toxoplasmosis by brain magnetic resonance imaging and polymerase chain reaction of Toxoplasma gondii DNA. The incidence of cerebral toxoplasmosis was found to be 2.94%. CONCLUSION: Mortality rate is known to be very high in cerebral toxoplasmosis; therefore, it is life saving to diagnose the disease in the early stages and start treatment promptly, especially in high-endemic countries like Turkey.

Is family screening necessary in brucellosis?

Brucellosis is an endemic disease in Turkey. Simultaneous infections among family members consuming infected dairy products have been reported. The most frequent signs and symptoms are nonspecific, and most human cases remain unrecognized. We aimed to screen family members of index cases with brucellosis. A questionnaire including demographical and epidemiological data was obtained. All cases were tested by slide agglutination tests (Rose Bengal test). Seropositive ones were further tested by tube agglutination tests (Wrigth test). In the index cases, Brucella antibody titers of > or = 1:160 with and without clinical symptoms and 1:80 with clinical symptoms were considered positive and the household members were enrolled into the study. Twenty-eigth index cases were identified among a total of 110 family members. Among family members, 90 (82%) were seronegative whereas 20 were seropositive. Among seropositive cases, 12 were asymptomatic and 8 were symptomatic. The most frequent symptoms of the index cases were fever, headache and arthralgia. Symptomatic cases were treated and asymptomatic ones followed up without therapy for a period of 6-12 months and none developed brucellosis. In conclusion, family members of the patients with brucellosis are under the increased risk of brucellosis because of a common source. Therefore, it can be considered that family screening may lead to early diagnosis of the disease and to the prevention of the complications.