Can Some Viral Respiratory Infections Observed Before the Pandemic Announcement Be Related to SARS-CoV-2?

OBJECTIVE: There have been doubts that SARS-CoV-2 has been circulating before the first case was announced. The aim of this study was to evaluate the possibility of COVID-19 in some cases diagnosed to be viral respiratory tract infection in the pre-pandemic period in our center. MATERIAL AND METHODS: Patients who were admitted to our hospital's pulmonary diseases, infectious diseases, and intensive care clinics with the diagnosis of viral respiratory system infection within a 6-month period between October 2019 and March 12, 2020, were screened. Around 248 archived respiratory samples from these patients were analyzed for SARS-CoV-2 ribonucleic acid by real-timequantitative polymerase chain reaction. The clinical, laboratory, and radiological data of the patients were evaluated. RESULTS: The mean age of the study group was 47.5 (18-89 years); 103 (41.5%) were female and 145 (58.4%) were male. The most common presenting symptoms were cough in 51.6% (n = 128), fever in 42.7% (n = 106), and sputum in 27.0% (n = 67). Sixty-nine percent (n = 172) of the patients were pre-diagnosed to have upper respiratory tract infection and 22.0% (n = 55) had pneumonia, one-third of the patients (n = 84, 33.8%) were followed in the service. Respiratory viruses other than SARS-CoV-2 were detected in 123 (49.6%) patients. Influenza virus (31.9%), rhinovirus (10.5%), and human metapneumovirus (6.5%) were the most common pathogens, while none of the samples were positive for SARS-CoV-2 RNA. Findings that could be significant for COVID-19 pneumonia were detected in the thorax computed tomography of 7 cases. CONCLUSION: The negative SARS-CoV-2 real-time-quantitative polymerase chain reaction results in the respiratory samples of the cases followed up in our hospital for viral pneumonia during the pre-pandemic period support that there was no COVID-19 among our cases during the period in question. However, if clinical suspicion arises, both SARS and non-SARS respiratory viral pathogens should be considered for differential diagnosis.

Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey.

Candidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30 days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154-1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752-8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634-53.744, p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079-6.761, p = 0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057-6.439, p = 0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147-0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia.

COVID-19 Pandemic Action Plan of a University Hospital.

In December 2019, in Wuhan, China, scientists observed a sudden and sharp increase in the number of cases of pneumonia and acute respiratory distress syndrome of an unknown origin. By the end of January 2020, the outbreak had spread to Asia, Europe, America, and Australia. In this article, we have outlined the pandemic action plan of our university hospital.

The comparison of various disinfectants? efficacy on Staphylococcus aureus and Pseudomonas aeruginosa biofilm layers

Background/aim: Because biofilms are resistant to antibiotics and biocides, they usually cause chronic persistent infections, which are arduous to cure and have high mortality and morbidity. Our study aimed to investigate the efficiency of orthophthalaldehyde, peracetic acid, hydrogen peroxide, and sodium hypochlorite on Pseudomonas aeruginosa and Staphylococcus aureus biofilm layers and live microbial cells. Materials and methods: Biofilm layers were determined by crystal violet assay and live microbial cells were determined using a resazurin assay. Results: For Pseudomonas aeruginosa, sodium hypochlorite showed the most influential disinfection because it diminished 83.6% of the biofilm layer and decreased 99.7% of live microbial cells. For Staphylococcus aureus, hydrogen peroxide was determined the most active disinfectant with 80.3% reduction of the biofilm layer. Sodium hypochlorite was also determined to be the most efficient disinfectant with 99.8% reduction of live microbial cells. Sodium hypochlorite was the most influential disinfectant on biofilm layers and live microbial cells of both microorganisms. Conclusion: We concluded that if we use sodium hypochlorite at a high level as a disinfectant for both surfaces and medical equipment, it is beneficial to prevent infections related to biofilms. More studies about prevention of biofilm occurrence and standardization of the methods for investigating disinfectants? effects are necessary.

[Comparison of tigecycline and vancomycin activities in an in vitro biofilm model generated with methicillin-resistant Staphylococcus aureus]. / Tigesiklin ve vankomisin etkinliklerinin metisiline dirençli Staphylococcus aureus ile olusturulan in vitro biyofi lm modelinde karsilastirilmasi.

Today, the most common cause of bloodstream infections, which led to high mortality, prolonged hospitalization and increased costs are the intravenous catheters. Among the microorganisms associated with catheter infections, staphylococci took the first place and because of their biofilm-forming properties they cause serious problems in treatment and management of the patients. Although the drug of choice in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection is vancomycin, its effect on the bacterial biofilm is known to be low. Tigecycline, newly used in our country is a well tolerated glycylcycline antibiotic. In this study, we aimed to compare the efficacy of tigecycline and vancomycin in an in vitro MRSA biofilm model. The study consisted of 10 MRSA strains, which were detected as causative agents of catheter-related infections in our hospital. The methicillin resistance of the strains were performed by disk diffusion test with oxacillin (1 µg) disks and the biofilm forming capacity of the strains was evaluated using the Congo red agar method. The silicone disks with created biofilm layer were exposed to tigecycline (2 mg/ml) and vancomycin (2 mg/ml) for 24 hours and for 5 days 4-hours per day in a model of antibiotic lock therapy. The present study showed that, after incubating the silicon discs in antibiotic solution for 24 hours, colony forming unit counts of MRSA decreased from 10(5) cfu/ml to 510 cfu/ml in the tigecycline group and from 105 cfu/ml to 3.800 cfu/ml in the vancomycin group and remained the same in the control (10(5) cfu/ml) group (p< 0.001). In the antibiotic lock therapy model, incubation with antibiotics for 4 hours per day, yielded that the average growth was 1.800 cfu/ml in the tigecycline group and 8.700 cfu/ml in the vancomycin group, which was statistically significant (p< 0.001). No growth was detected in the tigecycline group (0 cfu/ml) while in vancomycin group number of colonies in second, thirth and fourth days were 2.000, 260, 80 cfu/ml, respectively, no growth was seen in the fifth day. From the first day until the fourth day tigecycline was statistically more effective than vancomycin (p< 0.001, p< 0.001, p< 0.001, p= 0.013, according to days respectively). As a result, it was determined that tigecycline showed a higher effect on MRSA biofilm layer created on silicon discs and the results suggested that tigecycline might be a good alternative in the treatment of catheter infections.

[Acute appendicitis and coinfection with enterobiasis and taeniasis: a case report]. / Akut apandisit ve enterobiyaz ile taeniyaz: bir olgu sunumu.

Parasites are rarely associated with inflammation of the appendix. Generally, parasites cause acute abdominal pain via blocking the gut lumen. In this article, we presented a case of appendicitis where Enterobius vermicularis was detected in the surgical specimen and Taenia was detected in the stool. A 31 year old male patient was admitted to the emergency room with severe abdominal pain, which has begun two days ago. On physical examination, tenderness was positive on palpation of the right lower abdominal quadrant and the patient was operated on with the diagnosis of acute appendicitis. Histopathological examination of the patient's appendectomy material revealed numerous parts of parasites resembling Enterobius vermicularis and slight mucosal erosion. On parasitological examination of the patient's stool, Taenia eggs and adult forms were determined. Antiparasitic therapy was started with niclosamide for taeniasis and albendazole for enterobiasis. Parasitic infections can mimic acute appendicitis clinically. Radiological and laboratory findings do not help to distinguish the diagnosis of acute appendicitis. In the histopathological examination of the appendix, the findings of acute inflammation of the appendix wall may not be defined. For patients with normal histopathological examination, screening for parasites should be done, and anti-parasitic treatment should be started after appendectomy.

Epidemiology and risk factors for invasive candidiasis.

The number of immunosuppressive patients has increased significantly in recent years. These patients are at risk for opportunistic infections, especially fungal infections. Candidiasis is one of the most frequent fungal infections determined in these immunosuppressive patients and its epidemiology has changed over the last two decades. Recently, new antifungal agents and new therapy strategies such as antifungal prophylaxis, secondary prophylaxis, and preemptive therapy have come into use. These changes resulted in the alteration of Candida species causing invasive infections. The incidence of Candida albicans was decreased in many countries, especially among patients with immunosuppressive disorders, while the incidence of species other than C. albicans was increased. In this review, incidence, risk factors, and species distribution of invasive candidiasis are discussed.

Evaluation of patients with zygomycosis.

AIM: Zygomycosis is a severe angioinvasive infection caused by Zygomycetes. We retrospectively investigated 16 cases of zygomycosis. MATERIALS AND METHODS: The data of patients, who had been followed between 2004 and 2010 in 8 tertiary-care teaching hospitals, were reviewed. Demographic characteristics, underlying diseases, and clinical signs and symptoms of the patients, as well as diagnostic methods, data obtained by radiological imaging methods, and the therapies, were recorded. Therapeutic approaches, antifungal agents and duration of use, and the characteristics of the cases were identified. RESULTS: The study included 11 female and 5 male subjects. The most common symptoms and clinical signs were fever (n = 9) and retro- orbital pain (n = 7). Rhinocerebral zygomycosis was the most common form. The mean time elapsed for diagnosis was 14.26 + 13.96 (range: 2-52) days. Antifungal therapy was given to 15 patients (94%). In addition to antifungal therapy, 12 patients underwent surgical intervention 1 to 4 times. The mean duration of receiving antifungal therapy was 61.4 + 58.02 (range: 1-180) days. The median duration of treatment was 62.5 (range: 42-180) days in survivors. CONCLUSION: Zygomycosis is an infectious disease with high mortality despite antifungal therapy and surgical interventions.

[Investigation of the cases presenting to Dokuz Eylül University Hospital with tick bites]. / Dokuz Eylül Üniversitesi Hastanesi'ne Kene Tutmasi Yakinmasi ile Basvuran Olgularin Arastirilmasi.

OBJECTIVE: Determination of the properties of ticks, which are the vectors of many infectious diseases and the patients with tick bites are important for the prevention of these diseases. For tist reason, the purpose of this study is to determine the important properties of the cases presenting with tick bites to Dokuz Eylul University Hospital and of the removed ticks from the cases. METHODS: Two hundred seventy three of 294 patients, who presented with tick bites to Dokuz Eylül University Hospital, Izmir, were included in the study. Demographic parameters, symptoms related to tick borne diseases of the patients and the species and other characteristics of ticks removed from humans, also the tick population in the related habitat were investigated. RESULTS: Removed ticks were classified into five genera. The overwhelmingly dominant genera were Hyalomma and it comprised 52.4% of the collection. The majority of these ticks were nymphs. The majority (11.4%) of removed adult ticks were Rhipicephalus sanguineus (R. sanguineus). In most cases (60.7%) the ticks were removed from the patients by medical staff. CONCLUSION: There was no significant difference in removing ticks without damage between the health personnel and the patient or relatives (p=0.133).

Acute phase reactants predict the risk of amputation in diabetic foot infection.

BACKGROUND: prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and post-treatment levels of acute phase reactants in the outcome of patients with diabetic foot infections. METHODS: we collected data prospectively during minimum follow-up of 6 months in patients with infected diabetic foot ulcers hospitalized in Dokuz Eylul University Hospital between January 1, 2003, and January 1, 2008. After excluding patients who did not attend the hospital for follow-up visits regularly (n = 36), we analyzed data from 165 foot ulcer episodes. RESULTS: limb ischemia and osteomyelitis were much more frequent in patients who underwent amputation. Wagner grade, which assesses ulcer depth and the presence of osteomyelitis or gangrene, was higher in patients who needed amputation. Ulcer size was slightly larger in the amputation group. Baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, white blood cell counts, and platelet counts were significantly elevated in patients who underwent amputation. Albumin levels were significantly suppressed in the amputation group. Univariate analysis showed that a 1-SD increase in baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, and white blood cell counts and a 1-SD decrease in post-treatment albumin levels were significantly associated with increased risk of amputation. Post-treatment C-reactive protein level was strongly associated with amputation risk. CONCLUSIONS: circulating levels of acute phase reactants were associated with amputation risk in diabetic foot infections.

Evaluation of species distribution and risk factors of candidemia: a multicenter case-control study.

This study was planned to determine the risk factors of candidemia, and the most common Candida species causing bloodstream infections. A case-control study which included adult patients was conducted over a 1-year period at tertiary-care educational hospitals in Turkey. A total of 83 candidemia episodes were identified during the study period. Candida albicans was the most common species recovered (45.8%) followed by Candida tropicalis (24.1%) Candida parapsilosis (14.5%) and Candida glabrata which was isolated from only four (4.8%) patients. Presence of a urethral catheter (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.09-5.19; P = 0.02), previous use of antibiotics (OR 2.61; 95% CI 1.05-6.46; P = 0.03), RBC transfusions (OR 2.14; 95% CI 1.16-3.94; P = 0.01) and parenteral nutrition (OR 4.44; 95% CI 2.43-8.11; P < 0.01) were found as independent risk factors for candidemia. TPN (Total Parenteral Nutrition) was an independent risk factor for both C. albicans and non-Candida albicans Candida species (P < 0.001). Most of the risk factors were invasive procedures and former medications. We conclude that a great number of candidemia cases are preventable by means of reduction of unnecessary invasive procedures and the use of antimicrobials.

A case of fever of unknown origin: co-existence of Kikuchi-Fujimoto disease and acute disseminated encephalomyelitis (ADEM).

It is believed that viral infections and the hyperimmune reaction due to these infections are involved in the etiology of Kikuchi-Fujimoto Disease (KFD), a rare cause of fever of unknown origin. Axillary lymphadenopathy and neurologic involvement are rare in KFD. We present a patient diagnosed with KFD histopathologically during an investigation of the origin of fever and axillary lymphadenopathy. Subsequently, incidental sinus aspergilloma was diagnosed radiologically in the patient and acute disseminated encephalitis developed during follow-up. This report aims to draw attention to the co-existence of KFD and Acute Disseminated Encephalomyelitis, two diseases of which the origins are not clear.

[Evaluation of antibiotic resistance patterns of Pseudomonas aeruginosa and Acinetobacter spp. strains isolated from intensive care patients between 2000-2002 and 2003-2006 periods in Dokuz Eylul University Hospital, Izmir]. / Izmir dokuz eylül üniversite hastanesi yogun bakim hastalarindan izole edilen Pseudomonas aeruginosa ve Acinetobacter spp. suslarinin 2000-2002 ve 2003-2006 yillarinda saptanan antibiyotik duyarlilik paternlerinin degerlendirilmesi.

Multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. infections are becoming an important problem all throughout the world as well as in our country. In this study, we evaluated the drug resistance rates of P. aeruginosa and Acinetobacter spp. in the intensive care units of Dokuz Eylül University Hospital, Izmir, Turkey. Since by the year 2003, antibiotic consumption is started to be controlled by infectious disease and clinical microbiology specialists according to antibiotic policies ruled by the government, the antibiotic resistance rates were evaluated in two periods (2000-2002 and 2003-2006). Seventynine P. aeruginosa and 89 Acinetobacter spp. isolated during January 2000-December 2002 and 66 P. aeruginosa and 48 Acinetobacter spp. isolated during january 2003-December 2006 were included to the study. All the isolates were from deep tracheal aspirate or bronchoalveolar lavage specimens. Susceptibilities of the isolates against meropenem, imipenem, piperacillin-tazobactam, cefepime, cefotaxime, ceftazidime, tobramycine and ciprofloxacin were determined by E-test (AB Biodisk, Sweden). The results indicated high antibiotic resistance rates. P. aeruginosa resistance rate for ceftazidime was 84%, cefepime 83%, carbapenemes 73%, ciprofloxacine 87% and piperacillin-tazobactam 88% while these rates were 98%, 95.6%, 87%, 100% and 100% for Acinetobacter spp., respectively. The data obtained in this study indicated that there were no decrease in the antibiotic resistance rates after 2003. In the year 2005, "Antibiotic use guideline" established in our hospital let the antibiotics used without infectious disease and clinical microbiology specialists consultation. The high antibiotic resistance rates may be attributed to the application of this antibiotic guideline leading to the uncontrolled use of antibiotics.

[The rate of inducible clindamycin resistance and susceptibilities to other antimicrobial agents in staphylococci]. / Stafilokokoklarda indüklenebilir klindamisin direnci ve diger antibiyotiklere duyarlilik oranlari.

Staphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics used by oral route such as erythromycin, clindamycin, trimethoprim-sulphamethoxazole (TMP-SMX) and quinolones are of value especially in the treatment of community acquired infections and resistance to those antibiotics may lead to therapeutic failure. Therefore in this study, susceptibility of staphylococci to TMP-SMX, rifampin, tetracycline, gentamicin, ciprofloxacin and vancomycin and the presence of inducible clindamycin resistance were investigated in two distinct university hospitals in Turkey. A total of 286 staphylococcus strains [184 Staphylococcus aureus, 102 coagulase negative staphylococci (CoNS)] were studied. Of the 90 hospital-acquired S. aureus, 44.6% were methicillin-resistant while all of the community acquired strains were methicillin-susceptible. All of the CoNS strains were isolated from nosocomial infections and 71.6% of them were resistant to methicillin. Inducible clindamycin resistance rate of CoNS strains (34.3%) was higher than that of S. aureus strains (7.1%) and the difference was statistically significant (p= 0.00001). Positive D-test among CoNS were significantly higher in S. hominis strains (p= 0.00001). Susceptibilities of S. aureus strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 56%, 59%, 56%, 56% and 99%, respectively. Susceptibilities of CoNS strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 73%, 72%, 39%, 40% and 46%, respectively. None of these strains were vancomycin resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive and negative S. aureus strains were found statistically significant. Although among CoNS isolates, no statistically significant difference was found between the resistance rates, D-test positive strains were determined to be more resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive S. aureus and CoNS strains were found statistically significant. It can be concluded that inducible clindamycin resistance should be tested for staphylococci during routine antibiotic susceptibility testing. According to the presented data, clindamycin still can be used empirically in methicillin-susceptible S. aureus infections in our region, however, the routine use of rapid, easy, reproducible and economic D-test for the determination of inducible clindamycin resistance in erythromycin resistant strains should be considered in clinical microbiology laboratories. Inducible clindamycin resistance must be anticipated carefully while considering therapeutic options especially for CoNS infections.

Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort.

OBJECTIVE: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. DESIGN: In this observational study, data were collected prospectively in 670 consecutive diabetic foot ulcer episodes in 510 patients examined between January 1999 and June 2008 and were used to evaluate potential predictors of amputation retrospectively. After exclusion of patients who did not come to the hospital for follow-up for a minimum of six months, data of 574 foot ulcer episodes were evaluated. RESULTS: Limb ischemia, osteomyelitis and presence of gangrene and ulcer depth, determined by the Wagner classification system, were the major independent predictors of overall and major amputations. Older age, presence of coronary artery disease, smoking and ulcer size were found to be associated with either overall or major amputations. Baseline levels of acute phase reactants (white blood cell count, polymorphonuclear leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and albumin) and decreased hemoglobin levels were associated with amputation risk. Multivariate analysis showed that one standard deviation increase in baseline CRP and ESR levels were independent predictors of overall and major amputations, respectively. CONCLUSIONS: The presence of limb ischemia, osteomyelitis, local and diffuse gangrene and ulcer depth were independent predictors of amputation. Baseline levels of ESR and CRP appeared to be helpful for clinicians in predicting amputation.

Risk of infection in health care workers following occupational exposure to a noninfectious or unknown source.

BACKGROUND: The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers. METHODS: The survey was conducted over a 6-year period at a university hospital in Turkey, using a questionnaire to elicit demographic and epidemiologic information. Serologic tests for HBV, HCV, and HIV were performed and repeated after 3 months. RESULTS: Of the 449 incidents, complete follow-up was achieved in 320 (71.3%), and no seroconversion was observed for HBV, HCV and HIV. Most of the incidents occurred in medical (34.7%) and surgical (25.4%) work areas. The most frequent type of exposure was percutaneous injury (94%), most commonly caused by handling of garbage bags (58.4%), needle recapping (16.5%), and invasive interventions (13.4%). CONCLUSION: Infection risk seems to be extremely low for HCV and HIV, because of low endemicity, and for HBV in groups immunized against HBV.

[Two cases of herpes encephalitis with normal cerebrospinal fluid findings]. / Olgu sunumu: beyin omurilik sivisi bulgulari normal olan iki herpes ensefaliti olgusu.

In this report, characteristics of two cases of Herpes simplex virus (HSV) encephalitis with normal cerebrospinal fluid (CSF) findings at the time of admission have been discussed and the current literature has been reviewed. The diagnosis of the cases (one was 23 years old male, and the other was 75 years old female patient) was made on the magnetic resonance imaging (MRI) findings concordant with HSV encephalitis, together with HSV-1 DNA positivity by polymerase chain reaction (PCR). Both of the patients were treated with acyclovir (3 x 750 mg/day) lasting for 15 days and 21 days, respectively. The first male patient recovered with mild neurological defects, whereas the second female patient died because of nosocomial pneumonia and septicemia. In conclusion, even the CSF findings are normal, in cases considered to be HSV encephalitis, MRI should be the first radiological diagnostic step and the diagnosis should be confirmed by the detection of HSV DNA in CSF by PCR.

Effects of community-acquired infections on fever, leukocyte count and the length of stay in elderly. A cross-sectional study of 240 cases.

OBJECTIVE: To evaluate the relationships between community acquired infections in elderly cases (> or =65 ages) not living in a nursing home and factors such as, fever and white blood cell (WBC) counts; age, gender and the presence of underlying chronic diseases as compared to the length of stay. METHODS: We conducted this study in Dokuz Eylul University Hospital in Turkey as a defining cross-sectional research covering a 5-year period between January 1999 and December 2003. The data of 240 elderly cases were investigated, forms, which includes gender, existence of chronic diseases, fever, WBC counts, diagnosis, applied treatment and prognosis were prepared, and results were presented. RESULTS: The most frequently encountered infections were urinary system infections (35.4%), acute gastroenteritis (17.9%), pneumonia (15.9%) and soft tissue infections (13.3%). We observed that WBC counts were significantly elevated, parallel with high fever (p=0.021). In elderly cases we determined the existence of underlying disease and that living in the community lengthens the hospital staying periods (p=0.001). It was determined that elderly patients with an elevated WBC are 2.02 times more likely to have a temperature of 38.3 degrees C or higher compared with patients with a normal temperature (p<0.05). CONCLUSION: There was a strong association between leucocytosis and high fever in elderly cases. However, the absence of fever and leucocytosis in 78 (32.5%) of our cases, makes it hard for us to decide whether there was an infection or not. The most frequently encountered infections in elderly cases living in the community were similar to those living in nursing homes. These cases must be followed in the geriatric wards of hospital or geriatric hospitals whenever possible.

Nosocomial bloodstream infections associated with Candida species in a Turkish University Hospital.

In recent years, a progressive increase in the frequency of nosocomial candidaemia has been observed, especially among the critically ill or immunocompromised patients. The aim of this study was to evaluate the trend in incidence of candidaemia together with potential risk factors in an 850-bed Turkish Tertiary Care Hospital in a 4-year period. A total of 104 candidaemia episodes were identified in 104 patients. The overall incidence was 0.56 per 1000 hospital admissions and the increase in incidence of candidaemia from 2000 to 2003 was found to be statistically significant (P = 0.010). Candida albicans was the most common species (57.7%) and non-albicans species accounted for 42.3% of all episodes. The most common non-albicans Candida sp. isolated was C. tropicalis (20.2%) followed by C. parapsilosis (12.5%). The most frequent risk factors possibly associated with the candidaemia were previous antibiotic treatment (76.9%), presence of central venous catheter (71.2%) and total parenteral nutrition (55.8%). Our results show the fact that the incidence of candidaemia caused by non-albicans species is frequent and increasing significantly, although the most common isolated Candida species were C. albicans and further investigations are necessary to evaluate the mechanisms of increasing incidence of candidaemia caused by non-albicans species.

Infectious disease consultations and antibiotic usage in a Turkish university hospital.

OBJECTIVES: The aim of this study was to investigate the various features of infectious disease (ID) consultations and the usage of antibiotics in a Turkish university hospital. METHODS: A total of 395 consultation requests were recorded during a three-year period. RESULTS: The departments most frequently requesting the consultation services of the ID department were Orthopedics (29.6%), Neurology (18.5%), Cardiology (11.8%) and Internal Medicine (10.4%). The main reasons were for diagnosis of unexplained fever (42.3%) and for antibiotic modification according to culture results (18%). Diagnoses made by the ID consultant were pneumonia (16.7%), urinary tract infections (9.3%), bone and joint prosthesis infections (9.1%) and in 15.7% of the investigated patients, no infectious focus was determined. It was recognized that the use of antibiotics had already been initiated in the great majority of patients (67.1%) before the consultation request. While the current therapy was changed in 57.4% of these patients, antibiotics were not necessary for 9.8%. CONCLUSIONS: Since the most common diagnoses were respiratory and urinary tract or bone and joint prosthesis infections, the ID specialists should have detailed knowledge of these problems. Usage of antibiotics without ID consultation was prevalent, therefore a continuous educational program is a necessity for healthcare workers in the hospital.