Ertapenem plus meropenem combination treatment in carbapenem-resistant Klebsiella pneumoniae bacteremia: an analysis of 53 cases.

Herein, we aimed to describe the outcomes of patients with blood stream infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) who received ertapenem plus meropenem combination treatment (EMCT). A total of 53 patients with culture proven CR-Kp bacteremia treated with ertapenem + meropenem were included. The patients with secondary bacteremia due to urinary tract infection exhibited a significantly lower 1-month mortality (OMM), particularly in those with microbiological eradication and those with end-of-treatment success. Salvage EMCT resulted in 49% 1-month survival.

Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study.

BACKGROUND: Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS: This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS: Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS: Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study.

PURPOSE: In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). METHODS: Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status. RESULTS: Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, CONCLUSIONS: These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.

[Investigation of bacterial and viral etiology in community acquired central nervous system infections with molecular methods]. / Toplum kökenli santral sinir sistemi enfeksiyonlarinda bakteriyel ve viral etiyolojinin moleküler yöntemlerle degerlendirilmesi.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

Antibacterial resistance patterns and incidence of hospital-acquired Staphylococcus aureus bacteremia in a tertiary care educational hospital in Turkey: a perspective from 2001 to 2013

Background/aim: Staphylococcus aureus is an important nosocomial pathogen and a successful antimicrobial-resistance developer. In this study we retrospectively evaluated the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related S. aureus strains between 2001 and 2013. Materials and methods: Any patient in whom S. aureus was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72 h after hospital admission) was considered to have MCNB. Results: The methicillin-resistant S. aureus (MRSA) rate in 2001 was 73.8% whereas it was 36.2% in 2013. When the 2001-2003 and 2011?2013 periods were compared, resistance to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin decreased significantly (P < 0.05). When we evaluated the total S. aureus, MRSA, and methicillin-sensitive S. aureus (MSSA) bacteremia rates per 1000 days and 1000 patients, there was an increase in the 2004?2005 period, which was followed by a slight decrease until 2013 (P < 0.05). There was a plateau in MCNB-related S. aureus rates between 2008 and 2011. Conclusion: There was a decrease in overall S. aureus and MRSA bacteremia incidence as well as MRSA rates except for a plateau between 2008 and 2011. This steady decrease in the resistance rates is most probably due to the 2003 budget application and application of antimicrobial stewardship.

International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012.

BACKGROUND: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. METHODS: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. RESULTS: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). CONCLUSIONS: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.

[A rarely seen cause of brain abscess: neurotoxocariasis]. / Nadir görülen bir beyin apsesi etkeni: Nörotoksokariazis.

Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years-old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white matter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.

[Publication rates of Turkish medical specialty and doctorate theses on Medical Microbiology, Clinical Microbiology and Infectious Diseases disciplines in international journals]. / Ülkemizde Tibbi Mikrobiyoloji, Klinik Mikrobiyoloji ve Enfeksiyon Hastaliklari dallarinda yapilan tipta uzmanlik ve doktora tezlerinin uluslararasi dergilerde yayina dönüsüm oranlari

Writing a thesis is mandatory for getting a postgraduate medical degree in Turkey. Publication of the results of the thesis in an indexed journal makes the results available to researchers, however publication rate is usually low. The aim of this retrospective observational study was to investigate the publication rate of Turkish Infectious Diseases and Clinical Microbiology, Medical Microbiology specialty theses and Microbiology doctorate theses in international peer-review journals. On August 17th 2007, the thesis database of the Council of Higher Education of the Republic of Turkey (YOK) where all specialization and doctorate theses are recorded obligatorily, was searched for Infectious Diseases and Clinical Microbiology and Medical Microbiology specialty and Microbiology doctorate theses. Assuming that publication of a thesis would last at least six months, theses dated to February 2007 and after were excluded. The publication rate of those theses was found out by searching Science Citation Index-Expanded database for thesis author and supervisor between August 17-September 12, 2007. Chi-square test was used for statistical analysis. Our search yielded a total of 834 theses dated from 1997 to 2007, however 10 of them were excluded, since they were dated to February 2007 or after. It was found that the overall publication rate was 11.4% (94/824). The publication rates for Microbiology doctorate, Medical Microbiology and Infectious Diseases and Clinical Microbiology specialty theses were 13.7% (34/249), 10.7% (33/309) and 10.2% (27/266), respectively, with no statistical significance (p> 0.05). It was determined that nine (9.6%) of the 94 published theses belonged to 1997-2001 period, whereas 85 (80.4%) were in 2002-2007 period (p< 0.05). The probable reason for this increase was thought to be related with the updated criteria of YOK carried out in 2000 for academic promotions, nevertheless the publication rate of the investigated theses in international peer-review journals was still low. Thesis is an important part of specialty and doctorate education and necessitates intense work. The created knowledge usually contains important data about the country and the world. Publication of the theses supplies dissemination of new knowledge and completes the process of a scientific study. Solutions must be generated to promote the publication of specialty and doctorate theses.

Impact of the empirical therapy timing on the clinical progress of septic shock patients.

AIM: To evaluate the effect of timing of antimicrobial therapy on clinical progress of patients with septic shock. MATERIALS AND METHOD: We included 204 adult patients diagnosed with septic shock according to Sepsis-3 criteria between March 2016 and April 2021. One-month survival was evaluated using univariate and logistic regression analysis. RESULTS: Antibiotic treatment was initiated within 1 h of the vasopressors in 26.4 % of patients. One-month mortality did not differ significantly between patients with and without empirical therapy coverage on etiological agents. Univariate factors that significantly affected one-month survival were starting antibiotics at the first hour, the unit where the case was diagnosed with septic shock, SOFA scores, qSOFA scores, and lactate level. In multivariate analysis, diagnosis of septic shock in the Emergency Service, SOFA score ≥11, qSOFA score of three and lactate level ≥4 were significantly associated with one-month mortality. CONCLUSION: Training programs should be designed to increase the awareness of septic shock diagnosis and treatment in the Emergency Service and other hospital units. Additionally, electronic patient files should have warning systems for earlier diagnosis and consultation.

Importance of Source Control in the Subgroup of Intra-Abdominal Infections for Septic Shock Patients: Analysis of 390 Cases.

Background: This study aimed to evaluate the epidemiology of septic shock (SS) associated with intraabdominal infections (IAI) as well as associated mortality and efficacy of early source control in a tertiary-care educational hospital. Methods: Patients who had SS with IAI and consulted by Infectious Diseases consultants between December 2013 and October 2022 during night shifts in our centre were analyzed retrospectively. Results: A total number of 390 patients were included. Overall, 30-day mortality was 42.5% on day 3, while day 14 and 30 mortality rates were 63.3% and 71.3%, respectively. Source control by surgical or percutaneous operation was performed in 123 of 390 cases (31.5%), and the mortality rate was significantly lower in cases that were performed source control at any time during SS (65/123-52.8% vs 213/267-79.8%, p<0.001). In 44 of 123 cases (35.7%), source control was performed during the first 12 hours, and mortality was significantly lower in this group versus others (24/44-54.5% vs 254/346-73.4%, p=0.009). On the other hand, female gender (p<0.001, odds ratio(OR)= 2.943, 95%CI=1.714-5.054), diabetes mellitus (p= 0.014, OR=2.284, 95%CI=1.179-4.424), carbapenem-resistant Gram-negative etiology (p=0.011, OR=4.386, 95%CI=1.398-13.759), SOFA≥10 (p<0.001, OR=3.036, 95%CI=1.802-5.114), lactate >3 mg/dl (p<0.001, OR=2.764, 95%CI=1.562-4.891) and lack of source control (p=0.001, OR=2.796, 95%CI=1.523-5.133) were significantly associated with 30-day mortality in logistic regression analysis. Conclusion: Source control has a vital importance in terms of mortality rates for IAI-related septic shock patients. Our study underscores the need for additional research, as the present analysis indicates that early source control does not manifest as a protective factor in logistic regression.

The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study.

This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020-15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639-16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137-20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528-404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592-88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469-707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164-75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360-548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229-112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509-20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.

Daptomycin versus vancomycin in treatment of methicillin-resistant Staphylococcus aureus meningitis in an experimental rabbit model.

In this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of treatment, bacterial counts decreased significantly in both treatment groups compared to the control group (P < 0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits.

Hospital-acquired urinary tract infection point prevalence in Turkey: differences in risk factors among patient groups.

BACKGROUND: The aim of this study was to determine the point prevalence of nosocomial urinary tract infections (UTIs) and to investigate risk factors for pathogen type (E. coli vs. others) and extended-spectrum beta-lactamase (ESBL) positivity among nosocomial UTI patients. METHODS: A questionnaire consisting of 44 questions on demographic data and risk factors of UTI cases was sent to 51 tertiary care hospitals. Univariate and multivariate analyses were conducted. RESULTS: The overall prevalence of UTI was 1.82% (483/26534). The prevalence of UTI was higher in intensive care units (ICUs) with 6.77% versus 1.45% outside ICUs. Hospitals of the Ministry of Health (compared to university hospitals), hospitals in less developed provinces and hospitals with bed capacity < 500 had higher UTI prevalence. Patients without a urinary catheter were more likely to have received immunosuppressive therapy, current corticosteroid use, renal transplantation and uterine prolapsus and less likely to have another infection outside the urinary tract, as compared to catheterized patients. Among the 422 culture-positive patients, the most common pathogen was E. coli (45.5%). The risk factors increasing the likelihood of E. coli in urine culture were being female, history of urinary tract operation, no use of antibiotics in the preceding three months and infection outside the urinary tract. There were 247 patients with E. coli or Klebsiella spp. positive in culture. Among these, 61% (n=151) were ESBL- positive. Among patients having E. coli/Klebsiella positive in culture, antibiotic use in the preceding three months and history of urinary tract operation were the independent risk factors significantly increasing the risk of ESBL. CONCLUSIONS: The reasons underlying the high prevalence of nosocomial UTIs, and a better understanding of the risk factors might lead to improved control of these infections.

[Risk factors for gastrointestinal colonization by ESBL-producing Klebsiella pneumoniae and Escherichia coli in anaesthesiology and reanimation intensive care unit]. / Anesteziyoloji ve reanimasyon yogun bakim ünitesinde GSBL üreten Klebsiella pneumoniae ve Escherichia coli kolonizasyonu için risk faktörleri.

In this study it was aimed to investigate the risk factors for gastrointestinal colonization by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli in intensive care unit (ICU) of anaesthesiology and reanimation, Ege University Faculty of Medicine, Izmir, Turkey. This study was performed prospectively on adult patients hospitalized in ICU of anaesthesiology and reanimation and rectal swab cultures were performed in all patients in the first 48 hours of hospitalization and every one week until discharge or death. Samples were transported to the laboratory in Stuart transport medium and were cultured on two EMB agar plates (one including 4 mg/L ceftazidime) and incubated for 48 hours. E.coli and K.pneumoniae isolates were identified by conventional methods. Antibiotic susceptibility tests were performed by disc diffusion method on Mueller Hinton agar and interpreted according to CLSI guidelines. ESBL was confirmed by double disc synergy test. A total of 140 patients (49 female 91 male; age range: 18-83 years, mean age: 56.3 years) were evaluated, and 41 (29.3%) of the patients were found to be colonized with ESBL positive E.coli (n= 39) or K.pneumoniae (n= 2). The mean time for colonization was 11.15 ± 10.91 (range between 2-39) days. Age and gender of the patients and antibiotic consumption before or during the stay in ICU of anaesthesiology and reanimation were not found to be associated with colonization (p> 0.05). However length of ICU of anaesthesiology and reanimation stay in colonized patients was longer than non-colonized patients (27.59 ± 22.52 vs. 17.78 ± 11.74 days; p< 0.05). Infectious episodes developed in 22% (9/41) of the colonized cases and three of the nine strains were isolated from the blood cultures, five from the urine cultures and one from both blood and bronchoalveolar lavage cultures. ESBL-positive E.coli or K.pneumoniae colonization was found as an independent risk factor for the development of infection (9/41 vs. 4/99 cases; p= 0.002). Forward logistic regression analysis revealed that diabetes mellitus, immunosuppresive drug use and length of intubation were associated with ESBL-positive E.coli or K.pneumoniae colonization (p< 0.05). The results of this study indicated that the risk of development of infection was significantly high in intensive care patients colonized by ESBL positive E.coli and K.pneumoniae and the identification of the related risk factors was critically important for the establishment of effective control measures.

Carbapenem-resistant Gram-negative pathogens associated with septic shock: a review of 120 cases.

This study aimed to evaluate the influencing variables for outcomes in patients with septic shock having culture-proven carbapenem-resistant Gram-negative pathogens. It included 120 patients (mean age 64.29 ± 1.35 years and 58.3% female). The mean Sequential Organ Failure Assessment score during septic shock diagnosis was found to be 11.22 ± 0.43 and 9 ± 0.79 among the patients with mortality and among the survivors, respectively (P = 0.017). The logistic regression analysis showed that empirical treatment as mono Gram-negative bacteria-oriented antibiotic therapy (P = 0.016, odds ratio (OR) = 17.730, 95% confidence interval (CI): 1.728-182.691), Charlson Comorbidity Index >2 (P = 0.032, OR = 7.312, 95% CI: 5.7-18.3), and systemic inflammatory response syndrome score 3 or 4 during septic shock diagnosis (P = 0.014, OR = 5.675, 95% CI: 1.424-22.619) were found as independent risk factors for day 30 mortality. Despite early diagnosis and effective management of patients with septic shock, the mortality rates are quite high in CRGNP-infected patients.

Did the pandemic have an impact on influenza vaccination attitude? A survey among health care workers.

BACKGROUND: Health care workers' (HCWs) influenza vaccination attitude is known to be negative. The H1N1 epidemic had started in mid 2009 and made a peak in October-November in Turkey. A national vaccination campaign began on November 2nd, 2009. Despite the diligent efforts of the Ministry of Health and NGOs, the attitudes of the media and politicians were mostly negative. The aim of this study was to evaluate whether HCWs' vaccination attitudes improved during the pandemic and to assess the related factors. METHODS: This cross-sectional survey was carried out at the largest university hospital of the Aegean Region-Turkey. A self-administered questionnaire with 12 structured questions was applied to 807 HCWs (sample coverage 91.3%) before the onset of the vaccination programme. Their final vaccination status was tracked one week afterwards, using immunization records. Factors influencing vaccination rates were analyzed using ANOVA, t-test, chi-square test and logistic regression. RESULTS: Among 807 participants, 363 (45.3%) were doctors and 293 (36.6%) nurses. A total of 153 (19.0%) had been vaccinated against seasonal influenza in the 2008-2009 season. Regarding H1N1 vaccination, 143 (17.7%) were willing to be vaccinated vs. 357 (44.2%) unwilling. The number of indecisive HCWs was 307 (38.0%) one week prior to vaccination. Only 53 (11.1%) stated that they would vaccinate their children. Possible side effects (78%, n = 519) and lack of comprehensive field evaluation before marketing (77%, n = 508) were the most common reasons underlying unwillingness or hesitation.Among the 749 staff whose vaccination status could be tracked, 228 (30.4%) actually received the H1N1 vaccine. Some of the 'decided' staff members had changed their mind one week later. Only 82 (60%) of those willing, 108 (37%) of those indecisive and 38 (12%) of those unwilling were vaccinated.Indecisive HCWs were significantly younger (p = 0.017). Females, nurses, and HCWs working in surgical departments were more likely to reject vaccination (p < 0.05). Doctors, HCWs working in medical departments, and HCWs previously vaccinated against seasonal influenza were more likely to accept vaccination (p < 0.05). Being younger than 50 and having been vaccinated in the previous season were important predictors of attitude towards pandemic influenza vaccination. CONCLUSIONS: Vaccination rates increased substantially in comparison to the previous influenza season. However, vaccination rates could have been even higher since hesitation to be vaccinated increased dramatically within one week (only 60% of those willing and the minority of those indecisive were finally vaccinated). We speculate that this may be connected with negative media at the time.

Linezolid in the treatment of methicillin-resistant staphylococcal post-neurosurgical meningitis: a series of 17 cases.

BACKGROUND: Linezolid is a bacteriostatic antibiotic with good cerebrospinal fluid penetration. The aim of this study was to evaluate the efficacy of linezolid in methicillin-resistant staphylococcal (methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS)) meningitis. METHODS: We extracted data and outcomes for all adult patients (age > 18 y) with culture-proven MRSA or MRCoNS meningitis treated with linezolid between January 2006 and September 2010 in our hospital. Demographic, clinical, and laboratory data and predisposing factors, as well as information on response to treatment and outcome were obtained by regular visits. RESULTS: A total of 17 cases (9 MRCoNS, 7 MRSA, and 1 MRCoNS and MRSA mixed) fulfilled the inclusion criteria. All patients had hospital-acquired meningitis and had undergone neurosurgery. Cumulative microbiological success on day 5 was 88%. There was 1 staphylococcal meningitis-related death. There were no severe adverse events. CONCLUSIONS: Our experience with linezolid suggests that it can be an alternative for the treatment of MRCoNS- and MRSA-related meningitis.

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs.

BACKGROUND: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. METHODS: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. RESULTS: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. CONCLUSIONS: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

[Mucormycosis: retrospective evaluation of 12 cases]. / Mukormikoz: 12 olgunun retrospektif degerlendirilmesi.

Mucormycosis is a rare and often fatal invasive fungal infection. Disseminated or pulmonary forms are common in patients with immune deficiency while rhinocerebral form is common in diabetes mellitus. The aim of this study was to evaluate retrospectively the adult mucormycosis cases which were followed up in our hospital between 2007-2010. The cases were evaluated in terms of demographic characteristics, underlying diseases, laboratory, clinical and treatment results. A total of 12 mucormycosis cases (6 were male; age range: 18-74 years; mean age: 50.83 ± 18.27 years) were evaluated. Ten of the 12 cases had definitive diagnosis of invasive fungal infection according to EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria whereas two had possible mucormycosis. Six cases had rhinoorbital, four had rhinocerabral, one had pulmonary and one had rhinocerebral and pulmonary mucormycosis. Fever (n= 10; 83%), edema in face (n= 8; 67%) and eyes (n= 6; 50%) were the most common symptoms and findings. Mycologic culture was performed in ten cases and was found positive in five cases (four cases had Rhizopus spp. one case had Mucor). In two cases direct microscopy revealed mycelium but culture did not yield any pathogen. Two cases had concomitant Aspergillus spp. growth. Overall mortality rate was determined as 50% (6/12). All of the cases received antifungal therapy (liposomal amphotericin B and posaconazole or itraconazole), however, surgical intervention was applied to five cases. Mean duration of antifungal treatment was 60.8 ± 47.4 days. Mortality rate was lower in cases who received concomitant surgical therapy, but the difference was not found statistically significant (2/5 vs. 4/7, p> 0.05). Hematologic diseases (n= 6) and diabetes mellitus (n= 3) were the most common underlying diseases in mucormycosis cases. Voriconazole prophylaxis applied to three cases with hematologic diseases was detected as a risk factor. Development of mucormycosis in those cases who were under voriconazole prophylaxis, deserves attention. Since this is the largest 3-years series of adult mucormycosis cases reported from a single center and includes the first cases treated with posaconazole, the results of this evaluation may aid to the management of patients with mucormycosis.

[Comparative evaluation of in vitro activities of carbapenems against gram-negative pathogens: Turkish data of COMPACT study]. / Karbapenemlerin Gram-Negatif Patojenlere Karsi In Vitro Aktivitelerinin Karsilastirmali Degerlendirmesi: COMPACT Çalismasi Türkiye Verisi.

The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest® strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC50 of doripenem against Pseudomonas spp. Was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC90 of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gramnegative pathogens, mostly Acinetobacter spp., MIC50 was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.