Latent Tuberculosis Infection Management in Solid Organ Transplantation Recipients: A National Snapshot.

OBJECTIVE:  Latent tuberculosis infection (LTBI) screening is strongly recommended in the pre-transplant evaluation of solid organ transplant (SOT) recipients, although it remains inadequate in many transplant centers. We decided to investigate pre-transplant TB risk assessment, LTBI treatment, and registry rates in Turkey. MATERIAL AND METHODS:  Adult SOT recipients who underwent tuberculin skin test (TST) and/or interferon-gamma release test (IGRA) from 14 centers between 2015 and 2019 were included in the study. An induration of ≥5 mm on TST and/or probable/positive IGRA (QuantiFERON-TB) was considered positive for LTBI. Demographic features, LTBI screening and treatment, and pre-/post-transplant TB history were recorded from the electronic database of transplantation units across the country and pooled at a single center for a unified database. RESULTS:  TST and/or IGRA were performed in 766 (33.8%) of 2266 screened patients most of whom were kidney transplant recipients (n = 485, 63.4%). LTBI screening test was positive in 359 (46.9%) patients, and isoniazid was given to 203 (56.5%) patients. Of the patients treated for LTBI, 112 (55.2%) were registered in the national registry, and 82 (73.2%) completed the treatment. Tuberculosis developed in 6 (1.06%) of 563 patients who were not offered LTBI treatment. CONCLUSION:  We determined that overall, only one-third of SOT recipients in our country were evaluated in terms of TB risk, only 1 of the 2 SOT recipients with LTBI received treatment, and half were registered. Therefore, we want to emphasize the critical importance of pretransplant TB risk stratification and registration, guided by revised national guidelines.

Factors associated with progression of depression, anxiety, and stress-related symptoms in outpatients and inpatients with COVID-19: A longitudinal study.

It is known that there is an increase in the frequency of psychiatric disturbances in the acute and post-illness phase of coronavirus disease (COVID-19). Comorbid psychiatric symptoms complicate the management of patients and negatively affect the prognosis, but there is no clear evidence of their progress. We aimed to determine psychiatric comorbidity in inpatients and outpatients with COVID-19 and recognize the factors that predict psychiatric comorbidity. For this purpose, we evaluated patients on the first admission and after 4 weeks. We investigated psychiatric symptoms in outpatients (n = 106) and inpatients (n = 128) diagnosed with COVID-19. In the first 7 days after diagnosis (first phase), sociodemographic and clinic data were collected, a symptom checklist was constructed, and the Hospital Anxiety and Depression Scale (HADS) and the Severity of Acute Stress Symptoms Scale (SASSS) were applied. After 30-35 days following the diagnosis, the SASSS and the HADS were repeated. In the first phase, the frequency of depression and anxiety were 55% and 20% in inpatients, and 39% and 18% in outpatients, respectively. In the second phase, depression scores are significantly decreased in both groups whereas anxiety scores were decreased only in inpatients. The frequencies of patients reporting sleep and attention problems, irritability, and suicide ideas decreased after 1 month. Patients with loss of smell and taste exhibit higher anxiety and depression scores in both stages. Our results revealed that the rate of psychiatric symptoms in COVID-19 patients improves within 1 month. Inpatients have a more significant decrease in both depression and anxiety frequency than do outpatients. The main factor affecting anxiety and depression was the treatment modality. Considering that all patients who were hospitalized were discharged at the end of the first month, this difference may be due to the elimination of the stress caused by hospitalization.

Clinical characteristics of lung cancer patients with COVID-19: Retrospective case series.

INTRODUCTION: One of the patient groups adversely affected during the COVID19 pandemic is those suffering with cancer. The aim of this study was to evaluate the clinical characteristics and outcomes of lung cancer (LC) patients with COVID-19. MATERIALS AND METHODS: Three thousand seven-hundred and fifty hospitalized patients with a presumptive diagnosis of COVID-19 in a tertiary referral hospital between March 2020-February 2021 were retrospectively evaluated. Among them, 36 hospitalized COVID-19 patients with a history of primary LC were included in the study. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe disease. RESULT: Of the 36 patients included in the study, 28 (77%) were males and 8 (23%) were females. Median age was 67 years (min-max: 53-81 years). Six patients (17%) had a diagnosis of small cell LC, whereas 30 patients (83%) had a diagnosis of non-small cell LC. The most common symptoms were fever (n= 28, 77%), coughing and myalgia (n= 21, 58%) and dyspnea (n= 18, 50%). The most common radiological finding was ground glass opacity (GGO) (n= 30), of which 13 was bilateral and 17 was unilateral in distribution. Nearly 30% (n= 11) of LC patients with COVID-19 developed severe disease, 5% (n= 2) of the 36 patients were admitted to intensive care unit and all of these patients eventually expired. LC patients with COVID-19 and patchy consolidation on computed tomography of thorax (Th CT) on admission had a higher risk of developing severe disease in univariate (HR 2.41, 95%CI: 1.4- 4.4, p= 0.04) and multivariate Cox regression analysis (HR 0.48, 95%CI: 0.24-0.97, p= 0.03). CONCLUSIONS: Clinical characteristics, laboratory and radiographic findings were similar in LC patients with COVID-19 when compared with the general population, LC patients have a higher mortality rate than the general population, with a 5% mortality rate in our series. Our findings suggest that LC may be a risk factor associated with the prognosis of COVID-19 patients.

Pattern of systemic antibiotic use and potential drug interactions: Evaluations through a point prevalence study in Ankara University Hospitals.

Background/aim: Most of the hospitalized patients are on a number of drugs for comorbidities and/or to prevent nosocomial infections. This necessitates a careful consideration of drug interactions not only to avoid possible toxicities but also to reach the highest efficiency with drug treatment. We aimed to investigate drug interactions related to systemic antibiotic use and compare three different databases to check for drug interactions while characterizing the main differences between medical and surgical departments. Materials and methods: This point prevalence study covered data on 927 orders for patients hospitalized between June 3 and 10, 2018 in Ankara University Hospitals. Systemic antibiotic use and related drug interactions were documented using UptoDate, Drugs, and Medscape and comparisons between the departments of medical and surgical sciences were made. Results: The number of orders, or the number of drugs or antibiotics per order were not different between the medical and surgical sciences departments. A total of 1335 antibiotic-related drug interactions of all levels were reported by one, two, or all three databases. UptoDate reported all common and major interactions. Pantoprazole was the most commonly prescribed drug and appeared in 63% of all orders. Among 75 different molecules, ceftriaxone and meropenem were the two most prescribed antibiotics by the surgical and medical departments, respectively. Conclusion: A dramatic variance existed amongst antibiotics prescribed by different departments. This indicated the requirement for a centralized role of an infectious diseases specialist. Especially for the hospitalized patient, prophylactic coverage with at least one antibiotic brought about a number of drug interactions. A precise evaluation of orders in terms of drug interactions by a clinical pharmacist (currently none on duty) will reduce possible drug-related hazards.

Nosocomial pneumonia caused by water-born Legionella pneumophila in a pediatric hematopoietic stem cell transplantation recipient for thalassemia major.

BACKGROUND: Nosocomial pneumonia caused by Legionella pneumophila serogroup 2-14 occurred in a 7-year-old patient following allogeneic hematopoietic stem cell transplantation for thalassemia major. CASE: The patient was diagnosed with nosocomial Legionella pneumophila by polymerase chain reaction (PCR) examination of the bronchoalveolar lavage and culturing Legionella pneumophila serogroup 2-14 from the patient`s room faucet water. Legionella pneumophila was eradicated from our hospital`s water distribution system by superheating and chemical eradication methods (hyper-chlorination and hydrogen peroxide). We did not detect any other case after this event. CONCLUSION: Early recognition of contamination of the hospital water system with Legionella proves the importance of prevention in new cases.

Risk factors for infection development after transrectal prostate biopsy and the role of resistant bacteria in colonic flora.

INTRODUCTION: In this study, we aimed to identify risk factors for the development of infectious complications after prostate biopsy and to investigate the role of intestinal colonization of bacteria that are resistant to prophylactic antibiotics. METHODOLOGY: A total of 168 patients who had undergone transrectal prostate biopsy (TRPB) under ciprofloxacin and gentamycin prophylaxis were included in the study. Stool cultures and subsequent antibiotic susceptibility testing were performed in all patients before the start of antibiotic prophylaxis. RESULTS: Of the 168 patients, 17 (10.1%) developed urinary tract infection (UTI), while 6 (3.57%) developed sepsis within seven days after biopsy. Ciprofloxacin-resistant bacterial colonization was detected in 81 (48.2%) of the patients. None of the patients with ciprofloxacin-sensitive bacteria in intestinal flora developed a UTI. The colonization of intestinal ciprofloxacin-resistant bacteria increased UTI risk significantly after TRPB (p < 0.0001). Urolithiasis history, presence of permanent urinary catheterization, hospitalization history for more than 48 hours in the last year, and recent antibiotic usage significantly increased UTI risk after TRPB. CONCLUSIONS: Development of an infection was more frequent in patients with resistant bacterial colonization. We hope to guide more comprehensive studies designed to find a standard prophylactic regimen for TRPB that can be used all over the world.

An Unexpected Fatal CCHF Case and Management of Exposed Health Care Workers.

Crimean-Congo hemorrhagic fever (CCHF) is a tick borne viral disease which can also be transmitted by direct contact with blood or tissue specimens of infected animals or humans. We present a fatal case of CCHF, who was diagnosed after death, and describe the post-exposure management plan for the health care workers (HCWs) involved in her care. In total of 52 HCWs were involved in the patient's care and they were stratified into risk groups. Overall, 20 HCWs were grouped in high and intermediate risk groups, including the HCW with needle stick injury. High and intermediate risk groups were offered post exposure prophlaxis (PEP) with ribavirin. Fourteen of 20 HCWs started PEP, however 10 ceased after negative CCHF-PCR results. Negative CCHF-PCR results were reported for all HCWs at the 5th day of exposure. Side effects with PEP developed in 5 of HCWs and were mainly gastrointestinal complaints which reversed after drug discontinuation. All HCWs were followed for 14 days both clinically and with laboratory tests. None of the HCWs developed CCHF. PEP with ribavirin can be considered as a safe option in protection.