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Background: Broad-spectrum empirical antimicrobials arc frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims: We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design: The study was a national, multicenter, retrospective. and single-day point prevalence study. Methods: This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results: A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age +/- standard deviation of the patients was 65.0 +/- 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (372%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005). presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein >10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p

Background/aim HIV infection increase the risk of serious disease resulting from common vaccine-preventable infections. Vaccinations are particularly important for HIV infected adults. We aimed to investigate the immunity rates against measles, mumps, rubella, hepatitis A, B, and tetanus in newly diagnosed HIV patients. Materials and methods Patients who admitted to outpatient clinics of three centers with newly diagnosed HIV infection, between 1 January 2015 and 31 June 2017 were included. Measles, mumps, rubella, varicella zoster virus, hepatitis A, hepatitis B, and tetanus antibody levels were measured by commercial diagnostic kits. Demographical and laboratory data of the patients were recorded. Results Five hundred and twenty-three patients were enrolled in the study. Of the patients 87% were male (n = 455) and the mean age was 38 ± 13 years. Serology was available for measles 74.2% (388/523), mumps 73.8% (386/523), rubella 77.8% (407/523), hepatitis A 88.5% (463/523), hepatitis B 97.7% (511/523), tetanus 8.6% (45/523), and VZV 79.9% (418/523). Seropositivity was 82% for measles, 75.6% for mumps, 92.1% for rubella. Of the patients whom all three of the components of the MMR vaccine was tested, 37.7% (127/337) were susceptible at least one and needed the vaccine. Mean age was lower in patients who are nonimmune to measles and mumps (p = 0.008). Younger patients were also nonimmune for hepatitis A, while older patients were nonimmune for hepatitis B. Conclusion In our study we found that rates of nonimmunity can increase up to one third of the patients even though there is a national vaccination program. Nonimmune individuals should be detected and vaccinated in line with recent guidelines and response should be monitored because of the possibility of impaired immunity and possible suboptimal response. National campaigns can be launched for adult immunization and physicians should be aware of the importance of adult immunization.

Candida species are responsible for 70-90% of invasive fungal infections in the intensive care unit. Early diagnosis and treatment is important in candidemia. Improper diagnosis and treatment increases mortality and morbidity significantly. Because of the late results of blood cultures and low sensitivity of the serological tests when used alone, molecular methods should be investigated in this field. In this study, the results of the Candida real-time polymerase chain reaction (Rt-PCR) test, which was studied from blood culture and whole blood, were compared in patients with high candidemia risk who were followed in the General Surgery Intensive Care and Anesthesiology and Reanimation Unit of Cukurova University Faculty of Medicine. It was aimed to investigate the practical utility of Candida RT-PCR test, which is a rapid diagnosis method in patients with suspected candidemia. In our study, 90 patients with high risk of candidemia according to the criteria determined according to the guidelines were evaluated prospectively. Urine, perineum, axilla, tracheal aspirate culture and two sets of blood cultures were obtained from the patients. Blood sample was also drawn into an ethylenediaminetetraacetic acid (EDTA) tube and stored at -40°C for later Candida Rt-PCR study. In Candida Rt- PCR, species-specific primers were used to distinguish species. Candida score (CS) of the patients was calculated. Forty one (45.5%) of the patients were female and 49 (55.5%) were male. The median age of the patients was 61.5 years. Candida was positive in blood culture in three (3.3%) of the patients included in the study, while Candida Rt-PCR was positive in 17 (18.9%). Candida species detected in the blood culture and Rt-PCR test were compatible with each other. Rt-PCR was significantly more positive (p= 0.006). Candida Rt-PCR positivity was significantly higher in patients receiving total parenteral nutrition (p= 0.028), malignancy (p= 0.021), and history of surgery in the last three months (p=0.003). The difference in CS between patients with PCR positive and PCR negative was statistically significant (p= 0.015). Our study was conducted in a high-risk population for candidemia and the results of Candida Rt-PCR was found to be more positive than blood culture. Rt-PCR positivity and blood culture positivity were associated with high CS. In the light of these data, it was thought that it would be appropriate to use molecular methods in the diagnosis and support them with CS, especially in patients with high risk of candidemia. Considering that blood culture, which is the gold standard for the diagnosis of candidemia, gives late results and is 50% positive, using faster diagnostic methods for candidemia is important to reduce mortality and morbidity. The fast and good results of Candida PCR method have shown that it can be used in diagnosis. However, lack of standardization of primers used in PCR tests may cause false positives. Additional studies are needed in this respect.

Patients with diabetes have an increased risk of severe acute respiratory infections, and vaccination is their life-saving option. This study aimed to investigate the interest and knowledge of patients about influenza, pneumonia, and COVID-19(coronavirus disease 2019) vaccines. Materials. We handed out a questionnaire to patients with diabetes who were admitted to the endocrinology clinic between April and August 2021. The questionnaire collected information on demographic data, knowledge about respiratory tract disease vaccines, and hesitancy about vaccines. Results. Four hundred twenty-four patients (female = 256, male = 168) enrolled in the study. In this study, 148 (34.9%) participants were vaccinated against pneumonia, 155 (36.6%) against flu, and 312 (73.6%) against COVID-19. In addition, antivaccination sentiment was recorded in 8.7% of patients with diabetes. We found that participants in the study primarily rely on doctors as the source of information about vaccines (doctor (46.7%), nurse (1.2%), television (8.7%), friend/neighbour (8.7%), and others (2.6%)). The rate of vaccination was statistically higher than the presence of comorbid diseases. Conclusions. We examined the vaccine awareness of patients with diabetes and investigated factors affecting it. İt was determined that vaccination awareness is affected by many factors, especially comorbid diseases and educational status. The study showed that patients primarily relied on doctors as their source of information for vaccination. Doctor-centered vaccination promotion programmes can increase the rate of vaccination.

International audience; BACKGROUND: Mucormycosis is an emerging aggressive mold infection. This study aimed to assess the outcome of hospitalized adults with rhino-orbito-cerebral mucormycosis (ROCM). The secondary objective was to identify prognostic factors in this setting. METHODS: This study was an international, retrospective, multicenter study. Patients’ data were collected from 29 referral centers in 6 countries. All qualified as "proven cases" according to the EORTC/MSGERC criteria. RESULTS: We included 74 consecutive adult patients hospitalized with ROCM. Rhino-orbito-cerebral type infection was the most common presentation (n = 43; 58.1%) followed by rhino-orbital type (n = 31; 41.9%). Twenty (27%) had acquired nosocomial bacterial infections. A total of 59 (79.7%) patients (16 in combination) received appropriate antifungal treatment with high-doses of liposomal amphotericin B. Fifty-six patients (75.7%) underwent curative surgery. Thirty-five (47.3%) required intensive care unit admission (27; 36.5% under mechanical ventilation). Hospital survival was 56.8%, being reduced to 7.4% in patients with invasive mechanical ventilation. A multivariate binary backward logistic regression model identified confusion at admission (OR 11.48), overlapping hospital-acquired infection (OR 10.27), use of antifungal treatment before diagnosis (OR 10.20), no surgical debridement (OR 5.92), and the absence of prior sinusitis (OR 6.32) were independently associated with increased risk for death. CONCLUSION: Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection.

Introduction The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

Introduction: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus (HCV) in the world. Aims: The aim of this study was to compare direct acting antivirals (DAAs) treatment of HCV for PWID and non-PWID in real life setting. Materials and methods: We performed a prospective, non-randomized, observational multi-center cohort study in 37 centers. All patients treated with DAAs therapy between April 1, 2017 to February 28, 2019 were included. In total, 2,713 patients were included in the study among which 250 were PWID and 2,463 were non-PWID. Besides patient characteristics, treatment response, follow-up and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: DAAs were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis.

Recently, Human Immunodeficiency Virus (HIV) infection has become a chronic infection that can be effectively managed by early diagnosis, regular follow-up and antiretroviral therapy. With the newly diagnosed cases each year, a cumulatively increasing number of patients become HIV-infected. HIV infection and AIDS are often diagnosed with comorbidities such as opportunistic infections or malignancies that are caused by immunosuppression. However, in individuals with risky sexual behaviors and / or appropriate clinical findings, despite an irrelevant chief complaint or presentation without AIDS-defining infections, suspicion of HIV infection is very important for the early detection of the disease. In this article, we aimed to present a case of acute HIV infection mimicking acute sinusitis in a 35-year-old male patient.

Introduction: In this study, it was aimed to obtain information about the perspectives of infectious diseases and clinical microbiology (IDCM) specialists on online education applications and web-based seminars, and their usage and utilization rates. Materials and Methods: In this descriptive, cross-sectional study, online survey responses of the IDCM specialists in who were members of Infectious Diseases Clinical Microbiology Specialty Society of Turkey (EKMUD) were evaluated. Results: A total of 184 IDCM specialists answered the survey questions. Of the participants, 77.2% thought that the pandemic disrupted post-graduate medical education and 84.8% thought that the pandemic disrupted pre-graduate medical education. Medical educators involved in education during the Coronavirus disease-2019 (COVID-19) pandemic reported that they mostly continued online education. Of the participants, 84.9% reported that they were able to use the internet in an effective way to gain access to information during the COVID-19 pandemic. Of the responders, 58.2% reported that they followed online training programs, such as web-based seminars and lectures, and 51.6% reported that these online programs contributed to their learning. Participants found online training programs such as web-based seminars and lectures useful in terms of learning competence, that online training programs provided people with gain in space and time, and that they found them more instructive because they gave them the chance to receive training in subjects of their interest. Participants reported that these programs provided learning competency in that these programs were more beneficial to the participants in view of place, the subject that they need/they are interested in and saving time for the trainer and the participants. Due to the COVID-19 pandemic, the participants mostly wanted the 2020 EKMUD congress to be held online. A total 92.9% of the participants reported that online congresses and seminars would decrease travel, participation and sponsorship costs. Only 24.5% of the participants considered that online congresses and seminars would be more effective in terms of social interaction and gaining information than face-to-face congresses. Conclusion: The IDCM specialists reported that online educational practices such as webinars were benefical. The rate of participation in webinars and online education practices were high during the COVID-19 pandemic.

COVID-19 has become a major public health problem since December, 2019 and no highly effective drug has been found until now. Numbers of infected people and deaths by COVID-19 are increasing every day worldwide, therefore self-isolation and protection are highly recommended to prevent the spread of the virus and especially to protect major risk groups such as the elderly population and people with comorbidities including diabetes, hypertension, cancer, cardiovascular diseases and metabolic syndrome. On the other hand, young people without any secondary disease have died by COVID-19 as well. In this study we compared two male patients infected by COVID-19 at the same age and one of them was diagnosed with G6PD deficiency. Both COVID-19 and G6PD deficiency enhance the risk of hemolysis and thrombosis. Serum biochemistry, hemogram and immunological parameters showed that risk of hemolysis and thrombosis may increase in the G6PD deficient patient infected by COVID-19.

Introduction: In this study, it was aimed to obtain information about the perspectives of infectious diseases and clinical microbiology (IDCM) specialists on online education applications and web-based seminars, and their usage and utilization rates Materials and Methods: In this descriptive, cross-sectional study, online survey responses of the IDCM specialists in who were members of Infectious Diseases Clinical Microbiology Specialty Society of Turkey (EKMUD) were evaluated

Objectives: To describe the prevalence of risk factors in patients infected with hepatitis C virus (HCV). Materials and Methods: Patients who were aged >18 years visiting outpatient clinics and diagnosed as having HCV infection were enrolled in this cross-sectional, multicenter study conducted in 71 cities. Patient data on socio-demographic and clinical characteristics and pre-defined risk factors were collected. Results: Among 1,018 patients, 53.0% were women. The mean age was 57.2 +/- 14.3 years and 34.8% had been diagnosed as having HCV infection >10 years before enrollment. Almost half of the patients (45.5%) were diagnosed during their regular check-up visits, and only 16.8% were diagnosed because of signs or symptoms of HCV. Genotype 1 and sub-genotype 1 b were detected in 87.9% and 73.7% of the patients, respectively. At least one risk factor was present in 94.8% of the patients. The most frequently reported risk factor was major dental procedures (79.2%), followed by major surgical operations (56.9%) and minor surgical interventions (42.3%). Conclusion: Our results revealed that most of the patients with HCV infection underwent major dental procedures., AbbVie Inc. (North Chicago, IL, USA); AbbVie, This study was funded in full by AbbVie Inc. (North Chicago, IL, USA). Statistical analysis, writing support, and editing services in the development of this manuscript were provided by MONITOR CRO (Istanbul, Turkey) and funded by AbbVie. The authors also acknowledge the other participants of the EPI-C Study (protocol number 10-989) Team.

Severe acute respiratory syndrome coranovirus-2 (SARS-CoV-2) infection has become an important health-care issue worldwide. The coronavirus disease 2019 (COVID-19) has also raised concerns among patients with inflammatory rheumatic conditions and their treating physicians. There are emerging data regarding the potential risks of SARS-CoV-2 for this particular patient group. However, less is known with regard to the course of COVID-19 among patients receiving IL-17 inhibitors. The aim of the current article is to review the growing body of knowledge on the course/management of COVID-19 in patients with inflammatory rheumatic diseases by presenting a SARS-CoV-2 infected case with ankylosing spondylitis under secukinumab therapy. A 61-year old patient with ankylosing spondylitis who was on secukinumab therapy for 5 months admitted with newly onset fever and gastrointestinal complaints. After being hospitalized, she developed respiratory manifestations with focal pulmonary ground-glass opacities and multiple nodular densities in both lungs. The patient was tested positive for SARS-CoV-2 infection. Substantial clinical improvement was obtained following a management plan, which included tocilizumab, hydroxychloroquine, prednisolone and enoxaparin sodium. PubMed/MEDLINE and Scopus databases were searched by using relevant keywords and their combinations. The literature search revealed four articles reporting the clinical course of COVID-19 in seven rheumatic patients on secukinumab. The clinical course of SARS-CoV-2 infection was mild in most of these patients, while one of them experienced severe COVID-19. Interleukin-17 has been related to the hyperinflammatory state in COVID-19 and IL-17 inhibitors were presented as promising targets for the prevention of aberrant inflammation and acute respiratory distress in COVID-19. However, this hypothesis still remains to be proved. Further studies are warranted in order to test the benefits and risks of IL-inhibitors in SARS-CoV-2 infected individuals.

Introduction: In this study, we aimed to determine the risk factors associated with inadequate empirical antibiotherapy (IEAT) and hospital-related mortality in elderly patients being treated for upper urinary tract infections (UTI). Materials and Methods: This study included individuals aged 65 years and over who were hospitalized after being diagnosed of communityacquired UTI or community-onset healthcare-associated UTI and followed-up in clinics and/or intensive care units (ICU) of 33 hospitals between March and September 2017. Results: A total of 525 patients (48% males; mean age: 76.46±7.93 years) were included in the study. Overall, 68.2% of the patients were hospitalized through the emergency department and 73.9% of patients were followed-up for pyelonephritis. Gram-negative, Gram-positive, and Gram-negative and positive mix growths were determined in 88%, 9.3%, and 2.7% of urine cultures, respectively. Fifty-six (10.7%) of the patients died. In multivariate analysis, the presence of chronic obstructive pulmonary disease [Odds ratio (OR): 2.278], age 85 years and over (OR: 2.816), admission to the ICU (OR: 14.831), and IEAT (OR: 2.364) were independent factors that significantly affected mortality. The presence of a urinary catheter, being followed-up in the ICU, benign prostate hypertrophy, use of antibiotics other than piperacillin-tazobactam and carbapenem were determined as independent factors that significantly affected IEAT (p

Background/aim The emergence of the coronavirus disease 2019 (COVID-19) outbreak has had an enormous emotional impact on some vulnerable groups, such as people living with human immunodeficiency virus (HIV) (PLHIV). This study was planned with the aim of assessing the anxiety levels of PLHIV and the sources of their anxiety. Materials and methods A web-based questionnaire was sent to PLHIV using the virtual snowball sampling method. The questionnaire included questions about sociodemographic status, information about HIV infection, and the Beck Anxiety Inventory (BAI). Additionally, some opinions of the participants about COVID-19 were asked. Results A total of 307 respondents, with a median age of 33 years, from 32 different cities, participated in the study. More than half of the respondents reported the belief that COVID-19 was not sufficiently well-known by the medical community and nearly 45% believed that they would have more complications if they contracted COVID-19. One-fourth of the participants had anxiety. Having a preexisting psychiatric disorder, perceiving that they were practicing insufficient preventive measures, not being sure about the presence of any individuals with COVID-19 in their environment, and living with a household member with a chronic disease were found to be the risk factors of PLHIV for having anxiety during this pandemic. The BAI scores were correlated with the patient-reported anxiety levels about the spread of COVID-19 in Turkey, acquiring COVID-19, transmitting COVID-19 to another person, and transmitting HIV to another person. Among the stated conditions, the most common concern was the spread of COVID-19 all over the country, while the least common was transmitting HIV to someone else. Conclusion The results revealed that a significant proportion of the sample had anxiety, and the findings were essential for developing evidence-based strategies for decreasing the anxiety of PLHIV, especially for those who had risk factors and to provide them with better health care during this pandemic or other pandemic-like crises.

Introduction: Although diabetic foot infections are polymicrobial, gram-positive microorganisms comprise the majority. Daptomycin is a novel agent in treating infections due to multidrug-resistant gram-positive pathogens. In this multicenter study, the outcomes of the daptomycin treatment were evaluated retrospectively in the treatment of diabetic foot infectious without osteomyelitis. Materials and Methods: Patients with diabetic foot infection without osteomyelitis and who received daptomycin treatment were included into the study. Sociodemographic characteristics of the patients, risk factors for methicillin resistant Staphylococcus aureus (MRSA), antimicrobial treatment, and the data of microbiological and clinical outcomes of the cases were registered in a standard form by eleven centers. Clinical success was defined as a combination of end-of-treatment laboratory parameters, clinical and microbiological responses. Results: A total of 46 patients (30 males, 16 females) were clinically evaluated for the outcome of daptomycin therapy. Mean age was 61.09 ± 11.82 years (31-81) and mean diabetes duration was 13 ± 8.2 years. The number of mild, moderate and severe infections identified according to the infection scoring system of the Infectious Diseases Society of America (IDSA) were 12 (26.1%), 25 (54.3%), and 9 (19.6%) respectively. Duration of daptomycin therapy was 17.5 ± 9.3 days and overall daptomycin success rate was 82.6% (n= 38). Two patients developed side effects. Conclusion: The clinical success rate of this study which assessed the efficacy of daptomycin in diabetic foot infections was 82.6%. Daptomycin can be safely used even in severe cases having had no success with previous antibiotic therapy.

Introduction: Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii. The disease is usually asymptomatic without any clinical signs in humans. Acute toxoplasmosis in pregnancy is important since it can lead to congenital anomalies. Materials and Methods: The aim of this study was to evaluate the knowledge level of physicians specialized in infectious diseases or obstetrics and gynaecology. A questionnaire about toxoplasmosis in pregnancy was prepared. The questions were including horizontal transmission rate, surveillance of serology and treatment. The questionnaires were filled by infectious diseases or obstetrics and gynecology specialists. Results: A total of 100 physicians (64 females, 36 males) filled out the questionnaire. Mean age was 35.7 ± 8.3 years. Sixty-four physicians were from infectious diseases, 36 were from gynaecology and obstetrics departments. The knowledge of possibility of congenital anomaly and transmission to the fetus were highest in the first trimester and third trimester were known by 88% and 83% of the participants, respectively. Conclusion: Management of toxoplasmosis in pregnancy is crucial to protect the fetus and pregnant woman from complications. It is generally hard to separate old and new infections and make desicion for treatment or termination of pregnancy.

Introduction: Patients who have tetanus-prone wounds, diabetes mellitus, or chronic wounds are more likely to contract tetanus. In this study, we aimed to evaluate the tetanus immunization status of patients with diabetic foot wounds (DFW) and to determine factors that may predict insufficient immunity to tetanus. Materials and Methods: Patients who presented to our outpatient clinics with DFW were included. Tetanus antibody levels below 0.1 IU/ml were defined as “no reliable protection” and levels of 0.1 IU/ml and above were defined as “reliable protection”. Results: Ninety-one patients were enrolled in the study, 66 (72.5%) were male and the mean age was 62±11 years. Sixty-five (71.4%) of the patients had no reliable protection, while 26 (28.6%) had reliable protection. Age, duration of diabetes mellitus, education level, and residency status were significantly different between the immune and nonimmune groups in univariate analysis. In the multivariate logistic regression analysis, age ≥65 years [Odds ratio (OR): 8.33; 95% confidence interval (CI): 2.03-34.16], diabetes mellitus duration ≥11 years (OR: 6.52; 95% CI: 1.97-21.59), and lowest educational level (OR: 10.51; 95% CI: 1.61-68.52) were identified as independent predictors for insufficient tetanus immunity. Conclusion: We found that elderly patients and patients with lower education have a very low rate of immunity against tetanus. Therefore, tetanus vaccination should be conducted in elderly patients with DFW.

PubMedID: 30498901 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. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Daptomycin is the first member of cyclic lipopeptides came into use in the treatment of resistant gram-positive infections. It is shown to be a good option in the treatment of serious infections caused by gram-positive bacteria. Eosinophilic pneumonia may occur rarely during the use of daptomycin. In this paper we described 5 cases of daptomycin-associated eosinophilic pneumonia. Sudden onset of respiratory failure with tachypnea, tachycardia was observed, peripheral eosinophilia was detected in one patient. The symptoms usually resolved with supportive treatment and after discontinuation of the drug, but steroid treatment and mechanical ventilation was required in some patients. Eosinophilic pneumonia in the sudden onset of respiratory failure should be kept in mind during daptomycin treatment. [Cukurova Med J 2016; 41(2.000): 396-399]

Introduction: Prosthetic joints, increasingly used in recent years, raises the prosthetic joint infections which are important due to increased mortality, morbidity and cost. Appropriate treatment protocols according to the patient and sufficient time for treatment are vital. This study aimed at identifying the source of infection, microorganisms, risk factors, treatment strategies and prognose for the patient diagnosed with hip prosthetic joint infection and followed at our hospital and thereby contributing to future patient management. Materials and Methods: The files of patients admitted to our Clinical Microbiology and Infectious Diseases and Orthopedics inpatient and outpatient clinics, diagnosed with knee and hip prosthetic joint infection and treated and followed between 1998-2009 were respectively examined. Results: Mean age of the 88 patients of whom 57 were female (64.8%) was 58.8 ± 15.9. The most frequent reason of prosthesis insertion for the patients was trauma (n= 36) (40.9%) and the most frequent symptom was pain 80 (90.9%). The stages in the emergence of symptoms were as follows; early stage in 36 (40.9%) patients delayed stage in 18 (20.5%) and late stage in 34 (38.6%). Previous surgery at the same joint was associated with infection (p= 0.008). The most frequent isolated microorganisms in both discharge and perioperative cultures were coagulase negative staphylococcus. The discharge and perioperative cultures were consistent in 24 (53.3%) patients. The pathogen could not be isolated in 17 (19.3%) of the patients. The mean level of CRP and ESR were high. In the patients who underwent two-stage revision, good result rate was higher (75.9%) (p= 0.016). The total treatment time for hip and knee prosthetic joint infections in the patient with good results was longer (p< 0.001 and p< 0.001 respectively). Conclusion: Pathogen isolation in prosthetic joint infections is important since it determines the surgery method and antimicrobial treatment. In addition, a prolonged antimicrobial treatment accompanied by appropriate surgical method for the patient makes the eradication of infection possible.

WOS: 000373443300012 PubMed ID: 26927460 Introduction: This study was aimed to determine the relationship between vitamin D and soluble vitamin D receptor (VDR) levels and brucellosis, a common infection in Turkey, in which the cellular immune system is important in the course of the disease. Methodology: Patients who had been followed up in the Department of Infectious Diseases and Clinical Microbiology of Cukurova University Medical Faculty, having been diagnosed with brucellosis and who had no brucellosis treatment before, were enrolled in the study along with healthy controls. The participants' vitamin D and soluble VDR values were recorded. Laboratory parameters of patients and controls, clinical findings, and disease course of brucellosis patients were also noted. Results: The mean age of the 86 brucellosis patients, of whom 38 (44.2%) were males and 48 (55.8%) were females, was 40.9 +/- 18.4 years. Complicated course of brucellosis rate was found to be 29.1%. Vitamin D and VDR levels were lower in brucellosis patients at the time of diagnosis compared to control group. For males, vitamin D and VDR levels were higher in the control group than in the patient group. In males, VDR levels were higher than in females. A significant difference was not found between clinical forms of the disease and vitamin D and VDR levels. Conclusions: Vitamin D and VDR levels were shown to be significantly lower in brucellosis patients before treatment compared to the control group. These results suggest that vitamin D could be involved in the pathogenesis of the disease.

Akut karaciğer yetmezliği (AKY) altta yatan hastalığı olmayan kişilerde bile oldukça zor yönetilen bir ölümcül durumdur. Bu olguda, transplantasyonun bir seçenek olmadığı kolestatik fulminant hepatit için tedavi önerisini paylaşmak istedik. Otuz altı yaşında orak hücreli anemisi (OHA) ve glukoz 6 fosfat eksikliği olan bir hasta sarılık ve ateş ile başvurdu. Yatış sırasında, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), total bilirubin, direk bilirubin ve INR seviyeleri 335 mg/dl, 430 mg/dl, 30 mg/dl, 18 mg/dl ve 1,2 idi. HBsAg pozitif ve HBV DNA 64.000.000 IU/ml idi. Üçüncü haftada ALT, AST, total bilirubin ve direk bilirubin seviyeleri yükselerek 270 mg/dl, 460 mg/dl, 71 mg/dl ve 47 mg/dl oldu. Uluslararası normalleştirilmiş oran (UNO) uzaması eşlik etti ve ensefalopati gelişti. Entekavir 1x1 mg ve taze donmuş plazma tedavisi başlandı. Hasta kötüleşmeye devam etti ve MELD skoru 38 olarak hesaplandı. Iki kez plazmaferez uygulanması sonrasında ALT, AST, total bilirubin, direk bilirubin ve UNO seviyeleri 30 mg/dl, 90 mg/dl, 9 mg/dl, 4 mg/dl, 1,2'ye düştü. Genel durumu düzelen hasta taburcu edildi. Karaciğer transplantasyonunun tedavi seçeneği olmadığı hastalarda veya transplantasyon beklenen durumlarda plazmaferez tedavide düşünülebilir. Acute liver failure (ALF) is a fatal and challenging disease even for patients without underlying diseases. In this paper, we aimed to share our opinion about a treatment option for cholestatic fulminant hepatitis where transplantation is not an option. A 36-year-old male with sickle-cell anemia (SCA) and G6PD deficiency presented with jaundice and fever. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin and international normalized ratio (INR) levels were 335 mg/dl, 430 mg/dl, 30 mg/dl, 18 mg/dl and 1.2, respectively at the admission. HBsAg was positive. Hepatitis B virus (HBV) DNA was 64.000.000 IU/ml. On the third week of admission, ALT, AST, total bilirubin and direct bilirubin levels increased up to 270 mg/dl, 460 mg/dl, 71 mg/dl and 47 mg/dl, respectively. INR prolongation accompanied. Hepatic encephalopathy developed. Entecavir 1x1 mg and fresh frozen plasma was started. The condition of the patient continued to deteriorate and, MELD score was 38. After two sessions of plasmapheresis, ALT, AST, total bilirubin, direct bilirubin and INR levels decreased to 30 mg/dl, 90 mg/dl, 9 mg/dl, 4 mg/dl, 1.2, respectively. The patient was discharged eventually. Plasmapheresis can be thought as treatment for patients in whom liver transplantation is not an option or for patients pending transplantation.

PubMedID: 28628458 In 2016, Rickettsia sibirica mongolitimonae was diagnosed for a man in Turkey. He had been bitten by a Hyalomma marginatum tick, from which PCR detected rickettsial DNA. Sequence analysis of the DNA identified R. sibirica mongolitimonae. Immunofluorescence assay of patient serum indicated R. conorii, which cross-reacts. PCR is recommended for rickettsiosis diagnoses. © 2017, Centers for Disease Control and Prevention (CDC). All rights reserved.

27th International Congress of the Transplantation-Society (TTS) -- JUN 30-JUL 05, 2018 -- Madrid, SPAIN WOS: 000444541201323 … Transplantat Soc, Soc Espanola Trasplante, Soc Madrilena Trasplante

27th International Congress of the Transplantation-Society (TTS) -- JUN 30-JUL 05, 2018 -- Madrid, SPAIN WOS: 000444541201322 … Transplantat Soc, Soc Espanola Trasplante, Soc Madrilena Trasplante

PubMedID: 30192362 AIM: To determine the microbiological etiology in critically ill neurosurgical patients with nosocomial meningitis (NM) and to show the impact of Gram-negative rods and the differences between patient characteristics and the clinical and prognostic measures in Gram-negative and Gram-positive meningitis. MATERIAL and METHODS: In this prospective, single-center study, we reviewed all adult patients hospitalized during a 12-year period and identified pathogens isolated from post-neurosurgical cases of NM. Demographic, clinical, and treatment characteristics were noted from the medical records. RESULTS: Of the 134 bacterial NM patients, 78 were male and 56 were female, with a mean age of 46±15.9 and a median age of 50 (18-80) years. One hundred and forty-one strains were isolated; 82 (58.2%) were Gram-negative, 59 (41.8%) were Grampositive. The most commonly isolated microorganism was Acinetobacter baumannii (34.8%). Comparison of mortality data shows that the patients who have meningitis with Gram-negative pathogens have higher mortality than with Gram-positives (p=0.034). The duration between surgery and meningitis was shorter in Gram-negative meningitis cases compared to others (p=0.045) but the duration between the diagnosis and death was shorter in Gram-positive meningitis cases compared to Gram-negatives (p=0.017). Cerebrospinal fluid protein and lactate levels were higher and glucose level was lower in cases of NM with Gram-negatives (p values were respectively, 0.022, 0.039 and 0.049). CONCLUSION: In NM, Gram-negative pathogens were seen more frequently; A. baumanni was the predominant pathogen; and NM caused by Gram-negatives had worse clinical and laboratory characteristic and prognostic outcome than Gram-positives. © 2018 Turkish Neurosurgical Society.

International Liver Congress (ILC) -- APR 11-15, 2018 -- Paris, FRANCE WOS: 000461068601206 … European Assoc Study Liver

WOS: 000448996200004 Background: The aim of the present study was to evaluate microorganisms isolated from foot ulcers of patients with diabetes, resistance profile and establish their relationship with amputation. Methods: The study included 51 patients with diabetes who were admitted due to foot ulcer. The ulcers were evaluated according to the Wagner-Meggitt classification system. The specimens obtained by deep-tissue biopsy, aspiration biopsy and/or samples of pus from purulent lesions were sent for culture. Empiric antibiotic was started after collection of samples for culture. Antibiotic therapy was modified according to antibiotic susceptibility test results. The data were analyzed using the SPSS 20 software. Results: Twelve females and 39 males were included in the study. The mean age of the patients was 63.1 +/- 10.9 years, and duration of diabetes was 16.9 +/- 6.9 years. Forty-six patients underwent amputation. The rate of amputation increased with the increasing Wagner grade (P = 0.002). Neuropathy was found in 98% of the patients and in all patients that underwent amputation. About 97% of patients with osteomyelitis had undergone amputation, and these relationships were significant statistically (P = 0.022). The most commonly isolated bacteria were as follows in order of frequency: E. faecalis 28 (13.5%); S. aureus 23 (11%); S. epidermidis 18 (8.6%). Poly microbial infection was detected in 54 of a total of 138 episodes of our patients. The rate of ciprofloxacin resistance was 35% in S. aureus and 40-74% in Gram-negative bacteria. The rate of clindamycin resistance was 47% in S. aureus. Conclusions: In our study, the most commonly isolated microorganisms exhibited a high rate of antibiotic resistance.

WOS: 000436365200003, PubMed: 29924770, Background: Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug-drug interactions associated with antimicrobials among hospitalized patients. Material/Methods: This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged (3) 18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex (R) online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. Results: Potential drug-drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237-3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943-1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035-3.1564) were independent risk factors for developing drug interactions. Conclusions: Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides.

WOS: 000394253800016, PubMed ID: 28151863, The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB). We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion. The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases. Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.

Giriş: Diyabetik ayak infeksiyonları polimikrobiyal infeksiyonlar olmasına karşın, bu olgularda gram-pozitif mikroorganizmalar çoğunluğu oluşturmaktadır. Daptomisin, çoklu ilaca dirençli gram-pozitif patojenler için yeni bir ajandır. Bu çok merkezli çalışmada, daptomisin ile tedavi edilen diyabetik ayak infeksiyonu olan olgular retrospektif olarak değerlendirilmiştir.Materyal ve Metod: Diyabetik ayak infeksiyonu olup osteomiyeliti olmayan ve tedavide daptomisin alan hastalar çalışmaya dahil edildi. Sosyodemografik özellikler, metisiline dirençli Staphylococcus aureus (MRSA) için risk faktörleri ve olguların tedavi verileri standart bir formla kaydedildi. Çalışmaya 11 merkez katıldı. Klinik başarı, tedavi sonu laboratuvar parametreleri ile klinik ve mikrobiyolojik yanıtların bir kombinasyonu olarak tanımlandı.Bulgular: Daptomisin tedavisinin sonunda toplam 46 (30 erkek, 16 kadın) hasta klinik olarak değerlendirildi. Ortalama yaş 61.09 ± 11.82 yıl ve ortalama diyabet süresi 13 ± 8.2 yıl idi. "Infectious Diseases Society of America (IDSA)" infeksiyon skorlamasına göre tanımlanan hafif, orta ve şiddetli infeksiyon sayıları sırasıyla 12 (%26.1), 25 (%54.3) ve 9 (%19.6) idi. Daptomisin tedavisinin süresi 17.5 ± 9.3 gün ve genel daptomisin başarı oranı %82.6 (n= 38) idi. İki hastada yan etki gelişti. Sonuç: Diyabetik ayak infeksiyonlarında daptomisin etkinliğini değerlendiren bu çalışmada klinik başarı ortalama %82.6 olarak bulunmuştur. Daptomisinin, daha önceki antibiyotik tedavisi ile başarısız olan ağır olgularda bile güvenli bir şekilde kullanılabileceğini düşünüyoruz, Daptomycin in the Treatment of Diabetic Foot Infections without Osteomyelitis; A Multicenter Study

PubMedID: 28743652 Objectives In recent years, carbapenem-resistant Klebsiella pneumoniae (CRKP) have become an important threat to hospitalised patients. This study aimed to identify the genetic mechanisms of carbapenem resistance in CRKP isolated from patients in a Turkish centre. Methods During 2013–2014, a total of 98 K. pneumoniae isolated from patients at Çukurova University Balcalı Hospital (Adana, Turkey) determined phenotypically as resistant to carbapenems were screened genotypically for the presence of carbapenemase enzymes by multiplex PCR. Results Of the 98 patients for whom genetic investigation was made, 93 (94.9%) were adults, 56 (57.1%) were male and 81 (82.7%) were diagnosed as infected. The mean and median age were 51.8 ± 20.5 years and 55 years (range 1–89 years), respectively. The nosocomial infection rate was 87.8% (86/98). The mortality rate was 41.8% (41/98). Fifty-eight patients (59.2%) were admitted to intensive care units. Of the 12 non-nosocomial infections, 5 (41.7%) originated from the inpatient clinic of the urology department. The mean and median hospital length of stay (LOS) were 20.7 ± 20.8 days and 17 days (range 0–90 days), respectively. The most common carbapenemase gene detected was blaOXA-48 (74.5%), followed by blaVIM (45.9%) and blaSME (37.8%). The blaNDM gene was detected in 20 isolates (20.4%). The most effective antibiotics were tigecycline and colistin, with susceptibility rates of 87.5% and 74.3%, respectively. Conclusions Multiple resistance mechanisms were present in CRKP isolates in Turkey. Most of the isolates harboured blaOXA-48, blaVIM and blaSME genes; meanwhile, the rate of 20.4% for blaNDM is alarming. © 2017 International Society for Chemotherapy of Infection and Cancer

Purpose: We aimed to evaluate the clinical features and genotypic distribution of chronic HBV patients. Materials and Methods: The patients with chronic HBV infection were evaluated retrospectively. Biochemical tests, HBV DNA, viral genotyping in the serum samples and liver biopsy results of the patients were evaluated. The properties of the patients who were divided into two groups as Hbe ag positive and Hbe ag negative were compared. Results: HBV genotype D was found in all of the 58 patients (100%) included in the study. The mean age of the patients was found to be 40 (18-71) years. 34 (58.6%) of the patients were male and 24 (41.4%) were female. The number of Hbe ag positive patients was found to be 13 (22%) and the number of Hbe ag negative patients was found to be 45 (78%). Conclusion: HBV genotype is a parameter that may affect the mode of transmission and prognosis of the disease and the rates of treatment response. Thus, information related with the HBV genotypes in a region or country is a significant epidemiological finding because it will provide significant predictions related with the dynamics of dissemination of the virus and the rates of treatment response. Amaç: Kronik hepatit B tanılı hastaların klinik özellikleri ve genotipik dağılımlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kronik hepatit B tanısı ile Ocak 2011 ve Ocak 2012 tarihleri arasında Enfeksiyon Hastalıkları polikliniğine başvuran hastalar retrospektif olarak değerlendirilmiştir. Hastaların serum örneklerinde bakılan biyokimyasal testler, HBV DNA ve viral genotipleme testleri ve ayrıca karaciğer biyopsisi ile histopatolojik evreleme sonuçları gözden geçirildi. Hbe ag pozitif ve negatif olmak üzere iki gruba ayrılan hastaların özellikleri karşılaştırıldı. Bulgular: Çalışmaya dahil edilen 58 hastanın hepsinde (100%) HBV genotip D tespit edildi. Hastaların yaş ortalaması 40 (18-71) idi. Hastaların 34' ü (58.6%) erkek, 24'ü (41.4%) ise kadındı. Hbe ag pozitif hasta sayısı 13 (22%), Hbe ag negatif hasta sayısı ise 45 (78%) idi. Sonuç: HBV genotipleri, hastalığın bulaş yolunu, seyrini ve verilen tedaviye yanıt oranlarını etkileyebilecek bir parametredir. Dolayısıyla bir bölgedeki veya ülkedeki HBV genotiplerinin bilinmesi, virusun yayılım dinamiği ve uygulanacak tedavilere yanıt oranlarının nasıl olacağı hakkında önemli öngörüler sağlayacağı için önemli bir epidemiyolojik bulgudur.

PubMedID: 29035248 A 39-year-old man who was returning from the Amazon Jungle and had no medical history presented with a furuncular lesion on his right parietal scalp. Despite receiving appropriate antimicrobial treatment, his lesion did not heal. After surgical intervention, a Dermatobia hominis larva was extracted. The human botfly D. hominis is the most common causative agent of furuncular myiasis among travelers returning from Central and South America. Surgery is the main treatment option, and secondary bacterial infection should be kept in mind.

Amazon Ormanlarına yaptığı seyahatten dönen 39 yaşında erkek hasta sağ parietal bölgedeki saçlı derisinde bulunan fronküler lezyon şika- yeti ile başvurdu. Verilen uygun antimikrobiyal tedaviye rağmen lezyon düzelmedi. Cerrahi girişim yapılan lezyondan Dermatobia hominis larvası çıkarıldı. İnsan botfly sineği, D. hominis, Orta ve Güney Amerika seyahatinden dönen gezginlerde fronküler miyazın en sık etkenidir. Cerrahi olarak larvanın çıkarılması ana tedavi seçeneğidir. Sekonder bakteriyel enfeksiyon gelişimi de akılda bulundurulmalıdır. A 39-year-old man who was returning from the Amazon Jungle and had no medical history presented with a furuncular lesion on his right pa- rietal scalp. Despite receiving appropriate antimicrobial treatment, his lesion did not heal. After surgical intervention, a Dermatobia hominis larva was extracted. The human botfly D. hominis is the most common causative agent of furuncular myiasis among travelers returning from Central and South America. Surgery is the main treatment option, and secondary bacterial infection should be kept in mind.

Introduction: Daptomycin is an agent effective on gram-positive pathogens, which has been used since 2009 for skin and soft tissue infections and endocarditis. In this study, our aim was to see how daptomycin was used in our hospital besides clinical studies, and determine the characteristics of the patients and responses to treatment. Materials and Methods: The patients who were started on daptomycin between 2009 and 2013 were retrospectively evaluated. Demographic characteristics, the clinics of the patients, underlying diseases, infection data, isolated microorganism, treatment and clinical response, and adverse events were recorded. SPSS v20.0 was used for analysis. Results: The mean age of 139 patients were 52.9 ± 16.4, and 48.2% of the patients was male, 51.8% was female. Of the patients, 52 (37.4%) were treated for skin and soft tissue infection; whereas, 53 (38.1%) had osteomyelitis,16 (11.5%) had prosthetic infections, seven had primary blood stream infections (three port infections, three catheter associated bacteremia and one laboratory confirmed bacteremia), four had endocarditis, three had septic arthritis, and four had other infections. Treatment was started empirically in 77% of the patients (n= 107). Eighty-six microorganisms were isolated, of which 68.6% was gram positive and 30% was gram negative. Only ten patients (7.2%) had used glycopeptides before. End of treatment response was 85.6% (119/139) for all patients and 87.7% (50/57) for patients whose specimens yielded gram-positive microorganism. Twelve patients had adverse events (8.6%). The adverse events were seven possible eosinophilic pneumonia, two CK elevations, one palpable purpura, one rash, and one renal function impairment. Conclusion: Daptomycin is an alternative choice for complicated patient groups with complicated skin and soft tissue infections and osteomyelitis, randomized controlled studies especially on bone and joint infections are needed in the future.

PubMedID: 24407110 Background: Killer cell immunoglobulin-like receptors (KIRs) are a family of inhibitory and activating receptors expressed by natural killer (NK) cells and regulate NK cell activity in the innate response against viral infections. The aim of this study was to determine the possibility of KIR genes and genotypes as a candidate for susceptibility to or protection against chronic hepatitis B virus (HBV) infection or spontaneous remission of the infection in a Turkish cohort. Material/Methods: The present study was carried out on 37 patients with chronic HBV infection, 36 patients in spontaneous remission of HBV infection, and 85 healthy subjects. Sequence-specific oligonucleotide probes analysis was used to investigate 16 KIR genes. All data were statistically analyzed by the Fisher exact test. Results: The rate of inhibitory KIR2DL3 (p=0.0) and 3DS1 (p=0.0) were higher in the healthy group than the group composed of chronic HBV patients and patients with spontaneous remission. There were no statistically significant differences between the rate of AA and Bx genotypes of chronic HBV patients and patients with spontaneous remission and the control group (p>0.05). Conclusions: Our results suggest that KIR2DL3 and KIR3DS1 genes could be protector genes for HBV infection and they could be important immuno-genetic markers in determining antiviral immunity in the Turkish population. © Med Sci Monit, 2014.

Acquired immunodeficiency syndrome (AIDS) is a significant disease which affects the individual physically, emotionally, and socially. The aim of this study was to determine the relationship between the quality of life and social support of patients with HIV/AIDS. 49 patients with HIV/AIDS who applied to the Infectious Diseases Polyclinics of the university hospital between November 2010 and December 2011 were enrolled in study. All the data were collected using a personal information form, SF 36 quality of life scale (QOL) and perceived social support from the family scale (PSS-Fa). Average age of patients was 41.23 ± 10.62, 65.3 % of them were male. It was found that the diagnosis period for 55.1 % of patients was 24 months or longer, and 55.1 % of them were diagnosed at a university hospital, 81.6 % received a treatment. When the average scores of QOL was analyzed, it was found that the average score of functional status subscale was 39.35 ± 8.90, well-being subscale was 42.59 ± 14.70, general health perception subscale was 19.18 ± 6.25 and global quality of life score was 33.70 ± 9.31. The mean PSS-Fa score of patients was 28.65 ± 9.56. Comparing socio-demographic and clinical characteristics of patients and average scores of QOL and PSS-Fa, there was not a statistically significant relation (p > 0.05). No statistically significant correlation was found between the average scores of QOL and PSS-Fa. These results showed that quality of life was poor and perceived social support was moderate in patients with HIV/AIDS. According to these results, it is recommended that patients with HIV/AIDS should be supported in this regard. © 2013 Springer Science+Business Media New York.

Material and methods: Parameters that evaluated from patients treated in our department between 1st of January, 2006 and 31st of December, 2009 were age, conditions causing immune deficiency, habits of cigarette or alcohol, the way of perineal hair removal, glucose and HbA1c levels at admission, number of debridement under general anesthesia, results of microbiological studies and antibiotics used. Diagnosis was made with physical examination and the finger test proposed by Andresen. All patients underwent to surgical debridement immediately. Wide spectrum antibiotics and attempt to eliminate the underlying causes were started simultaneously with surgical debridement under general anesthesia. Results: Six patients were available regarding the study criteria. The mean age was 46,5 ± 10,4. All patients except one had uncontrolled diabetes. The remaining had hematological malignancy and immune suppression caused by the chemotherapeutics. The hygienic condition of perinea was poor in all. Numbers of debridement under general anesthesia were three, two and one in one, two and three of the patients consecutively. The mean hospital staying was 35 ± 14,9 days. Death due to necrotizing fasciitis was not observed in any cases. Two patients died long after their discharge because of the underlying disease. Necrotizing fasciitis did not relapse in anyone. Conclusion: Results derived from the small number of patients show that synchronous and intensive surgical and medical treatments are promising. However, they need to be reevaluated in studies having larger number of cases.a

Amac: Cerrahi profilaksi saglik-bakimi iliskili en sik enfeksiyon olan cerrahi alan enfeksiyonlarini onlemede onemli bir uygulamadir. Bu calismada tum hastane genelinde, cerrahi klinik ve yogun bakim unitelerinde cerrahi profilaksinin uygunlugunun saptanmasi amaclanmistir. Gerec ve Yontem: Cukurova Universitesi Tip Fakultesi Hastanesinde enfeksiyon kontrol hemsireleri tarafindan 11.11.2014 tarihinde 1 gunluk nokta prevalans calismasi yapildi. Cerrahi yapilan tum hastalar calismaya dahil edildi. Hastalarin demografik verileri, cerrahi ozellikleri, cerrahi profilaksi uygunlugu kaydedildi. Bulgular: Cerrahi islem yapilan 57 hastanin yas ortalamasi 37.6±23.1 olup, %73.7’si yetiskin ve %57.9’u erkektir. Cerrahi islemlerin %38.6’si temiz kontamine, %5.3’u kontamine iken %56.1’i temiz cerrahidir. Cerrahi islemlerin %91.2’si elektif ve %45.5’i acik cerrahidir Ameliyattan once yatis suresi ortalama 4.3±9.4 gun idi. Ameliyat oncesi tiras olan %22.8 (n=13) hastanin sadece dordu ameliyattan hemen once ameliyathanede tiraslanmisti. Banyo yapan hastalarin tamamina yakini (%95.7) antiseptik kullanmamisti. Hastalarin %49.1’inde cerrahi profilaksi uygunsuz bulundu. Sefazolin cerrahi profilaksi icin en sik kullanilan ajandi. Uygunsuz antibiyotik profilaksi nedenlerinin %53.6’sini antibiyotigin baslama zamani, %39.3’unu antibiyotik secimi, %28.6’sini temiz cerrahide profilaksi verilmesi, %10.7’sini profilaksi verilmemesi, %25’ini uzun sureli profilaksi ve %7.7’sini ise yanlis dozda profilaksi verilmesi olusturmaktadir. Sonuc: Calisma sonuclari goz onune alindiginda profilaksi uygulamalarinda ciddi uyumsuzluk tespit edildi. Bu baglamda guvenli hasta cerrahisi icin uygun profilaksinin onemi hakkinda farkindaligin attirilmasi gerekmektedir. Anahtar kelimeler: Hastane, cerrahi profilaksi, prevalans.