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Abstract Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation. Results It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use. Conclusions In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses.

Peritoneal dialysis (PD) peritonitis has been decreasing in frequency in recent years. However, it still causes significant morbidity and mortality. Nearly 1%–6% of all peritonitis attacks result in death. Hospitalizations, loss of PD access, and intravascular catheter insertion for hemodialysis are some examples of morbidity. Approximately 15%–20% of the infectious mortality of PD patients is attributed to peritonitis. The responsible pathogens are usually Gram-positive bacteria, but unusual pathogens may be present. Prognosis is worse when Gram-negative and fungal pathogens are involved. We report a case of Serratia liquefaciens peritonitis due to defiance of hygienic practices which presented with severe abdominal pain and fever and led to loss of PD access.

INTRODUCTION: This study aimed to measure NT levels in serum and BAL fluid to determine the diagnostic and prognostic value of NT in sepsis. METHODS: This descriptive, cross-sectional study included intensive care patients over the age of 18 who underwent IMV and blood and BAL sampling at admission. Forty-five patients were analyzed retrospectively as those with sepsis and without sepsis RESULTS: Serum and BAL NT concentrations were statistically significantly higher in patients with sepsis. The diagnostic power of serum and BAL NT were 85.8% and 76.1%, respectively. Serum NT and CRP were found as independent risk factors for sepsis. Using these two biomarkers together yielded a diagnostic value of 93.3%. BAL NT correlated with CPIS. Serum NT level was significantly higher in sepsis patients who developed septic shock than in those who did not. DISCUSSION AND CONCLUSION: Serum NT had comparable diagnostic value in sepsis to the widely used biomarker, procalcitonin. Combined use with CRP increases the diagnostic value, specificity, and sensitivity of serum NT in sepsis. Serum NT can also be used as a prognostic indicator and may be predictive of the rapidly developing processes that lead to shock. Despite the lower value of BAL NT for the diagnosis of sepsis, its correlation with clinical pulmonary infection score suggests that it may indicate disease severity in ventilator-associated pneumonia.

Introduction: This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and clinical course and outcome of Coronavirus disease-2019 (COVID-19). Materials and Methods: In this single-center, prospective study, patients with COVID-19 were divided into three groups with uncomplicated disease, mild pneumonia, and severe pneumonia. Cases were compared in terms of clinical and laboratory findings as well as serum 25(OH)D levels on hospital admission. Patients were also grouped according to their COVID-19-related outcomes and then compared in terms of 25(OH)D levels. Results: The median serum 25(OH)D levels of the COVID-19 and control groups were 16 (11-23) ng/ml and 21.5 (18-25) ng/ml, respectively (p

Purpose: To describe a patient whose retinal findings suggestive of tick-borne disease but evaluations led to early diagnosis and treatment of human immunodeficiency virus (HIV) infection. Observation: A young patient presented with bilateral uveitis, branch retinal artery occlusion and retinal findings suggestive of infective/inflammatory etiology. Laboratory evaluations revealed that the patient was positive for co-infection with Rickettsia conorii and Bartonella henselae. On further investigation, the patient tested positive for HIV infection. The patient was treated with doxycycline as well as highly active anti-retroviral therapy (HAART) to control both opportunistic infections as well as HIV infection. Conclusion and Importance: Patients with HIV infection are at risk for multiple, simultaneous opportunistic co-infections, including those with tick-borne diseases. Keywords: Tick-borne disease, Rickettsia, Bartonella, HIV, Ocular, Retina, Occlusive vasculitis, Chorioretinitis

Introduction: A higher percentage of sustained virologic response (SVR) has been reported with the introduction of direct-acting antivirals (DAAs) to the treatment of hepatitis C in recent years. However, there are still relatively limited data on the effectiveness and safety of the use of DAAs in hemodialysis patients. The aim of this study was to evaluate the efficacy and safety of chronic hepatitis C treatment with paritaprevir/ritonavir/ombitasvir and dasabuvir (3D) in hemodialysis patients. Materials and Methods: Hemodialysis patients who were treated with 3D regimen between July 2016 and October 2018 were evaluated retrospectively. Patients coinfected with hepatitis B or human immunodeficiency virus and those with cirrhosis were excluded. Serum hepatitis C virus (HCV) RNA and alanine aminotransferase levels of the patients were recorded after one and three months of therapy. SVR was defined as negative HCV RNA at three months after cessation of HCV treatment. Any drug-related alterations in clinical or laboratory findings during the treatment period were evaluated as side effects. Results: Fifteen patients who were treated with the 3D regimen during the study period were included. Genotype 1b and 1a were detected in 12 and three patients, respectively. Ribavirin was added to treatment for genotype 1a-infected patients. Hemoglobin levels were reduced in two of the three patients who received ribavirin. One patient had macular rash and another patient complained of fatigue. No serious side effects were observed. At the end of treatment, a low level of HCV RNA (63 IU/ml) was detected in only one patient. At the end of treatment, HCV RNA negativity was achieved in 12 out of 13 patients whose HCV RNA quantitation data were available. End-of-treatment success rate was 92%. SVR was achieved in all of the patients at three-months after treatment cessation (100% SVR12). Conclusion: This study shows that the 3D regimen is safe and effective in the treatment of hemodialysis patients infected with hepatitis C.

Brucellosis is a multisystemic disease that rarely leads to a fatal outcome. While reticuloendothelial system organs are mostly affected, peritonitis and posthepatitic cirrhosis are also complications of brucellosis, though they are very rare. Brucella spp. can also trigger immunological reactions. We report a case of brucellosis with peritonitis, renal failure and leucocytoclastic vasculitis caused by Brucella melitensis, which led to a fatal outcome. Brucellosis should be considered in the differential diagnosis of vasculitic diseases, especially in endemic areas.