Changes in antimicrobial resistance and outcomes of health care-associated infections.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Relationship between chest computed tomography findings and clinical conditions of coronavirus disease (COVID-19): A multicentre experience.

AIMS: This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara. MATERIALS AND METHODS: Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated. RESULTS: Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients. CONCLUSIONS: Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

[Evaluation of Candida colonization in intensive care unit patients and the use of Candida colonization index]. / Yogun bakim ünitesinde yatan hastalarda Candida kolonizasyonunun degerlendirilmesi ve kolonizasyon indeksinin kullanilmasi

Parallel to the developments in the field of diagnosis and treatment, an increase in the incidence of fungal infections and the number of patients who are in the risk group for the development of opportunistic fungal infections have been observed in the recent years. Among the hospitalized patients, those most at risk in terms of fungal infections are intensive care unit (ICU) patients. The rate of Candida colonization of mucous membranes in hospitalized patients may reach to 80%, and this may predispose to the establishment of severe infections especially in patients under risk. The aim of this study was to evaluate the rate of Candida colonization and to use Candida colonization index in the intensive care unit patients in Ankara Training and Research Hospital, Ankara, Turkey. A total of 100 adult patients (46 female, 54 male; age range: 18-93 years, mean age: 65.28 ± 17.53 years) who were hospitalized for ≥ 7 days in the neurology (n= 56), anesthesia-reanimation (n= 24) and neurosurgery (n= 20) intensive care units between September 2008 to February 2009, were included in the study. Throat, nose, skin (axilla), urine, rectal swab cultures and additionally when necessary tracheal aspirates, drain and central vascular catheter cultures were taken weekly from each patient. Candida colonies were identified by using germ tube test, CHROMagar Candida Medium (Becton Dickinson, Germany) and ID 32 C (BioMeriux, France) yeast identification kit. Candida colonization index (CI) was calculated for each patient, and CI was defined as the ratio of the number of culture-positive distinct body sites to the total number of body sites cultured. Patients with CI > 0.2 were considered as Candida colonized. In our study, Candida colonization was found in 42 of 100 (42%) patients, of them 8 were heavily colonized (CI ≥ 0.50), and 34 were slightly colonized (C I < 0.50). The highest Candida colonization was detected in throat, urine and rectal swab samples, while none of the tracheal aspirate samples yielded Candida spp. growth. Invasive Candida infections subsequently developed in 21.4% (9/42) of the colonized patients, namely candidemia in five and Candida associated urinary tract infections in four cases. Our data indicated that, the number of colonized patients were higher in the surgical (anesthesia-reanimation and neurosurgery) intensive care units (p< 0.05), in patients staying in the ICU for longer periods (p= 0.000) and in patients with higher number of application of invasive instruments (p< 0.05) compared to those of non-colonized cases. Additionally Candida colonization emerged more often in patients with bacterial sepsis and in those exposed to broad spectrum antibiotics (p< 0.05). Use of broad spectrum antibiotics in the ICU, length of stay in the ICU and having central venous catheter were found as independent risk factors for Candida colonization. The sensitivity, specificity, positive and negative predictive values of colonization index for the detection of developing Candida infections in colonized patients were estimated as 100%, 64%, 21% and 100%, respectively. In conclusion, Candida colonization and Candida colonization index may be used as useful parameters to predict invasive Candida infections.

[Epidemiological and microbiological evaluation of nosocomial infections caused by Candida species]. / Candida Türlerine Bagli Nozokomiyal Enfeksiyonlarin Epidemiyolojik ve Mikrobiyolojik Açidan Degerlendirilmesi.

Nosocomial infections due to candida species are increasingly gaining importance. In this study, we aimed to determine the risk factors associated with nosocomial candida infections and also to determine the species and antifungal sensitivity of candida strains. Candida spp. strains isolated from the clinical specimens of 92 patients who were hospitalized in Ankara Research and Training Hospital between May 2008 and September 2009 were prospectively included in the study. The demographic features, clinical and laboratory findings of the patients were recorded. Identification and antifungal sensitivities of the candida species were determined by VITEC 2 Compact System (BioMeriéux, France). Invasive candida infection was determined in 79 (85.9%) and candida colonization was found in 13 (14.1%) of the patients. Types of candida infections were as follows; urinary tract infection in 57 (72.1%), candidemia in 26 (32.9%), surgical site infection in 6 (7.5%) and intraabdominal infection in 3 (%3.8) patients. According to the univariate analysis, being female gender, duration and rate of hospitalization in the intensive care unit, use of linezolid, prolonged duration of urinary catheterization and total parenteral nutrition and the duration of central venous catheterization were found significantly higher in the urinary tract infection group. In candidemia group, carbapenem use, rates and periods of central venous catheterization and total parenteral nutrition were detected higher which were statistically significant. In multivariate analysis for urinary tract infections female gender (Odds ratio: 3; 95% CI: 1.25-7.17) and prolonged stay (p= 0.031) in intensive care unit; for candidemia use of total parenteral nutrition (OR: 16.25; 95% CI: 2.07-127.35) were found as independent risk factors. A total of 114 Candida spp. Strains were isolated from the clinical specimens. The most common isolated species were C.albicans (n= 62, 54.4%), C.glabrata (n= 16, 14%) and C.tropicalis (n= 13, 11.4%). While the resistance rates of Candida spp. To fluconazole and flucytosine were 2.6% and 1.7% respectively, there was no resistance to voriconazole. The rate of isolates with amphotericin B MIC values > 1 µg/ml was 4.4%. Consequently, the restricted use of central venous catheter and shortening the length of stay in intensive care unit may prevent the development of invasive candida infections. The local surveillance of antifungal resistance in candida strains might aid to the decision of empirical antifungal therapy.

Real-World Data from Turkey: Is Sofosbuvir/Ledipasvir With or Without Ribavirin Treatment for Chronic Hepatitis C Really Effective?

BACKGROUND: In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. METHODS: Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. RESULTS: A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. CONCLUSION: The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.

Risk factors for linezolid-associated thrombocytopenia and negative effect of carbapenem combination.

INTRODUCTION: Linezolid is a synthetic antimicrobial agent with a broad spectrum of activity against virtually all Gram-positive bacteria. Although linezolid is generally well tolerated, the prolonged use of linezolid can lead to myelosuppression, including neutropenia, thrombocytopenia, and anemia. The aim of this study was investigating the risk factors for thrombocytopenia in patients who received linezolid therapy. METHODOLOGY: This retrospective study was performed on patients who received linezolid therapy between July 2007 and December 2017. Thrombocytopenia was defined as either a platelets count of < 100×109/L or a 25% reduction from the baseline platelet count. RESULTS: A total of 371 patients, (198 (53%) male and 173(47%) female were included into the study. Mean duration of therapy was 12.81 ± 5.19 days. Linezolid-induced thrombocytopenia was detected in a total of 111 patients. Using the univariate analysis advanced sex, serum urea concentration, baseline platelet level and low eGFR value were found to be risk factors for linezolid associated thrombocytopenia (p < 0.05). According to a multivariate analysis, patients undergoing carbapenem treatment combination therapy (p = 0.003) and with a baseline platelet level of < 200×109/L (p = 0.00) were found to have a high risk of developing thrombocytopenia. CONCLUSIONS: Several factors may influence of linezolid associated thrombocytopenia. Platelet count should be monitored during therapy and thrombocytopenia should be kept in mind in patients with baseline platelet level of < 200×109/L, low eGFR, linezolid-carbapenem combination therapy.

Evaluation of the increase in invasive device associated infections in cardiovascular surgical intensive care unit.

INTRODUCTION: Infections related to the use of invasive instruments leads to the risk of treatment difficulties, prolonged hospitalization, increased health care costs, and increased mortality and morbidity rates. The present study examines the results of an infection surveillance study that showed an increased incidence of infections related to the use of invasive instruments in the cardiovascular surgery intensive care unit of the Ankara Training and Research Hospital and mitigating measures were taken following the surveillance program. METHODOLOGY: Compared with previous surveillance data, an increase was observed in the incidence of infections related to the use of invasive instruments in cardiovascular surgery intensive care unit (CVS-ICU) during the first six months of 2014. A research team was formed comprising one infectious diseases and microbiology specialist, one cardiovascular surgeon, and two infection-control nurses. Patient data was collected. The compliance of the surgeons, nurses, and other health care professionals to the infection control measures was evaluated. RESULTS: The rate of ventilator-associated pneumonia was 8.20% and the rate of catheter-associated urinary tract infection was 4.47% in the CVS-ICU. There were missing or inadvertent practices regarding antibiotic prophylaxis, asepsis and antisepsis and isolation measures in patient preparation and patient care before and after the operations. The rate of inappropriate antibiotic as prolonged use was 72%. CONCLUSIONS: It is one of the basic tasks to take appropriate measures to prevent outbreaks of hospital infections. It is possible to prevent an outbreak of hospital infections only by the accurate analysis of data and establishing strict infection control procedures.

Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey.

OBJECTIVES: Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. METHODS: Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. RESULTS: 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n=31, 83.8%). Mean (SD) age of the patients was 45.92±20.16years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. CONCLUSIONS: Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients' influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients.

Seroprevalence of Hepatitis A Virus Antibodies among the Patients with Chronic Hepatitis B in Turkey.

BACKGROUND: Hepatitis A virus (HAV) can cause significant pathology in patients with chronic hepatitis B virus (HBV), however, HAV can be prevented by vaccination. The aim of this study was to determine the implication of vaccination against HAV vaccine in patients with chronic hepatitis B. MATERIALS AND METHODS: The seroprevalence of anti-HAV IgG antibodies was investigated in the patients with chronic hepatitis B. Anti-HAV IgG antibodies were detected by commercially available ELISA kit. RESULTS: A total of 673 patients (354 males, 319 females with age range of 17-78 years) with chronic hepatitis B were included the study. Hepatitis A virus seropositivity rate was 34% in the patients younger than 20 years, 79% in the age group of 20 to 29 years, and 100% after 35 years of age. DISCUSSION: Hepatitis A virus vaccination may be recommended for young adult patients with chronic hepatitis B in Turkey. HOW TO CITE THIS ARTICLE: Tulek N, Ozsoy M, Moroglu C, Sonmezer MC, Temocin F, Ertem GT, Erdinc FS. Seroprevalence of Hepatitis A Virus Antibodies among the Patients with Chronic Hepatitis B in Turkey. Euroasian J Hepato-Gastroenterol 2015;5(2):95-97.

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study".

BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available.

[Case report: subdural hemorrhage in neurobrucellosis]. / Olgu raporu: subdural kanama ile seyreden nörobrusellozis.

In this report, a 49-year-old female patient who were diagnosed as neurobrucellosis by the clinical, bacteriologic and serologic findings, has been presented. The case deserved presentation and discussion since it presented with subdural hemorrhage which is a rare complication of neurobrucellosis.

Adverse events following rabies post-exposure prophylaxis: a comparative study of two different schedules and two vaccines.

OBJECTIVE: Due to lack of effective treatment for rabies, post-exposure prophylaxis becomes very important. In this study, we investigated side effects developed in patients following administration of rabies post-exposure prophylaxis. METHODS: A total of 1685 patients were vaccinated. 265 patients (15.7%) administered the Essen regimen with equine rabies immunoglobulin and 1420 patients (84.2%) administered Zagreb regimen. 761 (45.2%) patients were vaccinated with a verocell vaccine; Verorab and 924 patients (54.8%) were vaccinated with Abhayrab. RESULTS: All side effects were higher in female patients than those of males. The patients with chronic illness also had significantly, increased side effects; headache (12.4%), pain at site of administration (11.3%), and arthralgia (10.5%) compared to the patients without chronic illness. We grouped the patients in three as; 0-15 years, 15-60 years, and 60 years and above. In the first group; fever (21.2%), vomiting (2.4%) and coughing (2.1%); in the second group (15-60 years), headache (8.8%), arthralgia (6.7%) were significantly increased compared to the other groups. Side effects are significantly higher with schema of 2-1-1 and Abhayrab trade mark vaccine, particularly following the first doses. DISCUSSION: Second generation rabies vaccines are safe, effective and cheaper than HDCV. When fatality of rabies disease is considered, occurring side effects can be tolerated.

Mortality indicators in pneumococcal meningitis: therapeutic implications.

BACKGROUND: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. METHODS: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers. RESULTS: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). CONCLUSIONS: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.