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Additional file 4: Table S3. Pretreatment characteristics of patients receiving STR and non-STR InSTI.

Additional file 1: Table S1. TRIPOD Checklist: Prediction Model Development and Validation.

Additional file 3: Table S2. Pretreatment virological and immunological characteristics of patients receiving InSTI-, PI- and NNRTI-based regimens.

Syphilis has become a serious issue for human immunodeficiency virus (HIV)-infected patients worldwide in recent years; however, the studies related to HIV coinfection and syphilis reinfections in Istanbul, Turkey, are limited. Ourobjective was to determine the seroprevalence of syphilis among HIV-infected men in the city which has one of the highest HIV prevalence rates in Turkey. Two hundred and forty four (244) HIV-positive men were evaluated at Istanbul Medical Faculty, Department of Medical Microbiology from March to June 2018. Serum samples were screened for the presence of antibodies against Treponema pallidum using the chemilumines-cent microparticle immunoassay (CMIA). Samples found to be positive were investigated with the rapid plasma reagin (RPR) test and the T. pallidum hemagglutination assay (TPHA). The patients completed a questionnaire for sociodemographic data. The mean age was found to be 41.8 years; 35.6% were men who havesexwith men (MSM). The overall seroprevalence of syphilis among the patients was 19.3%. MSM had a significantly higher seroprevalence than heterosexual patients (28.7%). In Turkey, there is a high seroprevalence of syphilis in HIV-infected patients, MSM being the most affected group. Therefore, HIV-infected patients should be screened for syphilis at least annually and should be informed about sexually transmitted diseases (STDs). Resumen En los últimos años, la sífilis se ha convertido en un problema grave para los pacientes infectados por el virus de la inmunodeficiencia humana (HIV) en todo el mundo; sin embargo, los estudios relacionados con la coinfección por HIV y las reinfecciones por sífilis en Estambul, Turquía, son limitados. Nuestro objetivo fue determinar la seroprevalencia de la sífilis entre los hombres infectados por el HIV en Estambul, ciudad con las tasas de prevalencia del HIV más altas de Turquía. Se evaluaron 244 hombres con HIV entre marzo y junio de 2018 en la Facultad de Medicina de Estambul, Departamento de Microbiología Médica. Las muestras de suero se analizaron para detectar la presencia de anticuerpos contra Treponema pallidum con un inmunoensayo de micropartículas quimioluminiscentes (CMIA). Las muestras que resultaron positivas en dicha prueba se investigaron con la prueba de reagina plasmática rápida (RPR) y el ensayo de hemoaglutinación T. pallidum (TPHA). Los pacientes completaron un cuestionario de datos sociodemográficos. La media de la edad fue de 41,8 anos; 35,6% eran hombres que tienen sexo con hombres (HSH). La seroprevalencia global de sífilis entre los pacientes fue del 19,3%. Los HSH tuvieron una seroprevalencia significativamente mayor que los pacientes heterosexuales (28,7%). En Turquía, existe una alta seroprevalencia de la sífilis en pacientes infectados por el HIV y los HSH son el grupo más afectado. Por lo tanto, los pacientes infectados por el HIV deben someterse a la detección de sífilis al menos una vez al año y deben ser informados sobre las enfermedades de transmisión sexual (ETS).

Objective: Methicillin-sensitive Staphylococcus aureus (MSSA) is frequent cause of bacteraemias and associated with substantial mortality. We defined risk factors for mortality among patients with either community-acquired (CA) or healthcare-associated (HCA) MSSA bacteraemia with special emphasis on treatment options including cefazolin and other antimicrobials (mainly ampicillin-sulbactam). Material and Method: All adult patients who were hospitalized and whose blood cultures were positive for MSSA between 2009 and 2014 were included. Patients with CA and HCA MSSA bacteraemia were compared. Results: 83% of the 127 patients with MSSA bacteraemia had HCA. The mortality rate of patients was 20.5% and this did not differ between patients with either CA or HCA MSSA bacteraemia. In the multivariate analysis, higher comorbidity index (HR 1.557), presence of metastatic foci (HR 2.883), and requirement for ICU support (HR 16.239) were found as independent risk factors for mortality, and cefazolin use was found to be protective against mortality (HR 0.178). Conclusion: Patients with MSSA bacteraemia should be treated with cefazolin instead of other antimicrobial options, especially in countries where anti-staphylococcal penicillins are not available or in patients who cannot tolerate anti-staphylococcal penicillins, as cefazolin was found to be protective against mortality, Amaç: Metisiline duyarlı Staphylococcus aureus (MSSA), önemli bir bakteriyemi etkeni olup, hastalarda ciddi mortaliteye neden olur. Bu çalışmada, toplum kaynaklı (TK) veya sağlık bakımı (SB)’yla ilişkili MSSA bakteriyemilerinde mortaliteye etki eden risk faktörlerinin belirlenmesi amaçlanmıştır. Ayrıca MSSA bakteriyemilerinin tedavi seçeneklerinden sefazolin ve özellikle ampisilin-sulbaktam olmak üzere diğer antimikrobiklerin tedavideki yeterlikleri karşılaştıırlmıştır. Gereç ve Yöntem: 2009-2014 yılları arasında hastanemizde yatarak tedavi edilen ve MSSA bakteriyemisi tanısı konulan erişkin hastalar çalışmaya dahil edildi. TK veya SB ilişkili MSSA bakteriyemisi olan hastalar karşılaştırıldı. Bulgular: Toplam 127 MSSA bakteriyemili hastanın %83’ü SB ile ilişkiliydi. Mortalite oranı %20,5 olup, TK ve SB MSSA bakteriyemili hastalar arasında fark yoktu. Çok değişkenli analizde yüksek komorbidite indeksi (HR 1,557), metastatik infeksiyon odağı varlığı (HR 2,883) ve yoğun bakım desteğine ihtiyacın olması (HR 16,239) mortalite için bağımsız risk faktörleri, tedavide sefazolin kullanımı ise mortaliteyi azaltan bir faktör olarak saptandı (HR 0,178). Sonuç: Diğer antimikrobiyallerle karşılaştırıldığında sefazolinle tedavi edilen MSSA bakteriyemilerinde klinik sonuçlar daha iyi belirlendiği için, özellikle antistafilokoksik penisilinlerin bulunmadığı yerlerde veya bu ajanları tolere edemeyen hastalarda diğer antimikrobiklerin yerine sefazolin tercih edilmelidir.

Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Diyabetik Ayak İnfeksiyonları Çalışma Grubu, ülkemiz koşullarında diyabetik ayak (DA) yarasının ve DA infeksiyonu (DAİ)’nun tanısı, tedavisi ve önlenmesine yönelik bir ulusal uzlaşı raporu hazırlamak üzere ilgili ulusal uzmanlık derneklerine ve Sağlık Bakanlığı’na işbirliği çağrısında bulunmuştur. Görevlendirilen temsilcilerin periyodik olarak yaptığı toplantılarda ilgili literatür ve uluslararası kılavuzlar gözden geçirilerek, patogenez, mikrobiyoloji, değerlendirme ve derecelendirme, tedavi, korunma ve kontrol konularında yanıt verilmesi gereken sorular saptanmış ve bu sorulara üzerinde uzlaşılan yanıtlar verilmiştir. Rapordaki yanıtlardan birkaçı aşağıda sıralanmıştır: [1] DA yarası gelişmesinin pek çok nedeni olmakla birlikte başlıca neden diyabetle ilişkili vasküler hastalığın ve nöropatinin kombine etkisidir. [2] Seluliti olan ve daha önce antibiyotik kullanmamış hastalarda gelişen yüzeysel DAİlerden daha çok aerop Gram-pozitif koklar sorumludur. [3] Pseudomonas aeruginosa, hastanın ayak parmak aralarının ıslak kaldığı durumlarda yaygın olarak karşılaşılan etkenlerden biridir. [4] Diğer nedenler dışlandıktan sonra, ayak lezyonunda kızarıklık, sıcaklık artışı, şişlik, duyarlılık veya ağrı gibi inflamasyonun klasik bulgularından en az ikisinin varlığında ya da purulan akıntı söz konusu olduğunda DAİ düşünülmelidir. [5] DAİ tanısı konulan hastalar öncelikle yaranın derinlik ve genişliği, infeksiyonun sistemik bulgularının olup olmaması gibi ölcütlere dayanılarak infeksiyon şiddeti acısından hafif, orta derece veya şiddetli infeksiyon olarak sınıflandırılır. [6] Diyabetle ilişkili ayak komplikasyonlarını öngörme değeri yüksek bir sınıflandırma sistemi olarak PEDIS sistemi yeğlenmelidir. [7] DA yarasında kültür örneği yalnız klinik olarak infeksiyon düşünüldüğü zaman ve mümkünse antibiyotik tedavisi başlanmadan once alınmalıdır. [8] İnflamasyon göstergeleri olan lokosit sayısı, C-reaktif protein, eritrosit sedimantasyon hızı ve prokalsitonin gibi biyobelirteçler, infeksiyonla kolonizasyonun ayırt edilmesinde yararlı olabilir. [9] Manyetik rezonans goruntulemesi, tedaviye yanıt alınamayan, osteomyelit ya da derin yumuşak doku apsesi duşunulen hastalar icin duyarlı ve özgül bir yöntemdir. [10] Osteomyelit tanısında altın standard histopatolojik incelemedir. [11] Yara iyileşmesini sağlayabilmek ve bacağı kurtarmak için gerekenler, acil ve agresif debridmanlarla olu ve infekte dokuların uzaklaştırılması, uygun antibiyotik tedavisi, metabolik kontrol, ayağın yükten ve basıdan kurtarılması, periferik arter hastalığının tanısı ve uygun şekilde tedavisi ve ayağın işlevinin kazandırılmasıdır. [12] Etyopatogenezinde rol oynayan faktörlerin çok farklı olması, gelişen lezyonları karmaşık hale getirmekte ve bu tip hastalara yapılacak yaklaşımlarda bir ekip anlayışını gerektirmektedir. [13] Ampirik tedavide yalnız etken olabilecek bakterilerin kapsanması hedeflenmeli; yeterli doku düzeyi, düşük yan etki ve hasta uyumu gözetilmeli; etkin ilaçlar belirlenmiş dozlarda ve surede kullanılmalıdır. [14] Debridman, yara tedavisinin temel ve ayrılmaz bir parçasıdır ve sağlıklı granülasyon dokusu oluşmasını sağlayan önemli bir araçtır. [15] Debridmanla infekte dokunun tamamen temizlenmesi mümkün olmadığında ve hastanın kalan infeksiyon yüküyle başa çıkamayacağı durumlarda, infeksiyon bulunmayan güvenli bir düzeyden amputasyon yapılması yaşam kurtarıcı olacaktır. [16] DA yarası olan bir hastada önemli bir arteriyel yetersizlik olduğu düşünülüyorsa, bunun erken tanınması ve girişimsel tedavisi gerekir. [17] Hiperbarik oksijen tedavisi, DAİ’lerde tek başına değil, diğer tedavilerle birlikte bir yardımcı tedavi yöntemi olarak kullanılır. [18] Negatif basınçlı yara kapama yöntemi, seçilmiş olgularda yararlı bir yardımcı tedavi yöntemidir. [19] Büyüme faktörleri, daha ucuz ve güvenli yöntemlerle kapanabilecek yaralar dışında, seçilmiş olgularda kullanılabilir. [20] Kurtcuk tedavisi, DA yarası olgularında bir debridman yöntemi olarak değerlendirilebilir. [21] On yılı aşkın suredir diyabeti olan hastalarda yara gelişmesi ya da amputasyon riski artmaktadır. [22] DA sorunları diyabetin eğitimle önlenebilir tek komplikasyonudur. Study Group for Diabetic Foot Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist societies and the Ministry of Health to issue a national consensus report on the diagnosis, treatment and prevention of diabetic foot (DF) wounds and diabetic foot infections (DFIs) in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions as to pathogenesis, microbiology, assessment and grading, treatment, prevention and control of diabetic foot were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] Although there are many reasons for the development of DF wounds, the main reason is the combined effect of diabetes-related vascular disease and neuropathy. [2] Aerobic Gram-positive cocci are mostly responsible for superficial DFIs in patients with cellulitis and no history of antibiotic use. [3] Pseudomonas aeruginosa is one of the commonly encountered agents when between the toes of the patient are moist. [4] When the other potential reasons are eliminated, DFIs should be considered in presence of at least two of the classical signs of inflammation including redness, warmth, swelling, tenderness, and pain, or purulent discharge in the foot lesion. [5] Infections are classified into mild, moderate, or severe groups according to some criteria such as the depth and width of the wounds, and the presence of systemic findings of infection. [6] PEDIS system should be preferred as a classification system for its high predictive value in diabetes-related foot complications. [7] Culture samples from the DF wound should only be obtained when infection is clinically considered and, where possible, before starting antibiotic treatment. [8] Inflammatory biomarkers such as leukocyte count, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin may be useful in distinguishing between colonization with infection. [9] Magnetic resonance imaging is a sensitive and specific method in patients unresponsive to treatment when osteomyelitis and deep soft tissue abscesses are considered. [10] The gold standard in the diagnosis of osteomyelitis is histopathological examination. [11] To provide wound healing and to save the limb, removal of dead and infected tissue with urgent and aggressive debridement, appropriate antibiotic therapy, metabolic control, and off-loading of pressure, the diagnosis and proper treatment of peripheral arterial disease, and restoration of the foot function are necessary. [12] A lot of different factors playing a role in etiopathogenesis complicate the approach to be developed in this type of lesions, and therefore it requires a team concept. [13] In the empirical treatment, the objective should be treating only the potential agents. Adequate tissue levels, low side effects and patient compliance must be observed; effective drugs should be used in specified doses and duration. [14] Debridement is an essential and integral part of wound treatment and is an important tool allowing the formation of healthy granulation tissue. [15] When the infected tissue cannot be completely cleared with the debridement and in cases when the patient could not cope with the remaining infection load, performing a limb amputation on a safe level of infection would be lifesaving. [16] If an arterial insufficiency is considered in a patient with a DF wound, early diagnosis and interventional treatment is necessary. [17] Hyperbaric oxygen therapy is used as an adjunctive treatment in combination with other treatments in DFI patients. [18] Topical negative pressure therapy is a useful adjunctive measure in selected patients. [19] Growth factors can be used in selected patients other than wounds that can be treated with cheaper and safer methods. [20] Maggot therapy may be considered as a debridement method in DF wound cases. [21] Patients with more than ten years of diabetes history have an increased risk of wound development or amputation. [22] DF problem is the only complication of diabetes that can be prevented through education. © 2015, AVES Ibrahim Kara. All rights reserved.

During the period of 1 st April 1993 and 31st December 1993, we isolated 150 bacteria species from 113 aerobic cultures of 86 patients with nosocomial infections, as CDC defined, in Orthopedics and TraumatoIogy Department of our Faculty. Antibiotic susceptibility, patterns of the isolated bacteria were investigated with disc diffusion test. Among the isolates are 19% Pseudomonas aeruginosa, 13% other nonfermentative Gramnegative rods, 17% Klebsiella pneumoniae, 7% other Gram-negative enteric rods; 33% Staphylococcus aureus, 10% coagulase-negative staphylococci and 1 % Gram-pozitive rods. AII of the isolated Gram-negative rods were found to be sensitive to imipenem; other than imipenem the most active antibiotics are cefoperazone/sulbactam, aztroenam, amikacin, ceftazidime, piperacillin and ciprofloxacin for P. aeruginosa; netilmisin (%68), amikacin (63%) and cefoperazone/sulbactam (63%) for other nonfermentative Gram-negative rods; amikacin (69%) and ciprofloxacin (65%) . 69% of the isolated S. aureus species and 60% of coagulase-negative staphylococci were found to be methicillin-resistant. These data reveals once more that antibiotic susceptibility patterns are required for choosing antibiotics in the treatment of nosocomial infections in Orthopedics and Traumatology Department of our Faculty., 1 Nisan - 31 Aralık 1993 tarihleri arasında Fakültemiz Ortopedi ve Travmatoloji Kliniği'nde yatmakta olan ve CDC tanımına göre nozokomiyal infeksiyonu olduğuna karar verilen 86 hastanın toplam 113 aerop kültür örneğinden 150 bakteri suşu izole edildi. izole edilen bakterilerin antibiyotik duyarlık testleri disk difüzyon yöntemiyle yapıldı. Suşların % 19'u Pseudomonas aeruginosa, % 13'ü diğer nonfermentatif Gram-negatif çomakIar, % 17'si Klebsiella pneumoniae, %7'si diğer Gram-negatif enterik çomaklar; %33'ü Staphylococcus aureus, % 1 O'u koagülaz-negatif stafilokoklar ve % 1'i Gram-pozitif çomaklar idi. İzole edilen Gram-negatif çomakların tümünün duyarlı olduğu imipenem'den sonra en etkili antibiyotikler P.aeruginosa için sefoperazon/sulbaktam, aztreonam, amikasin, seftazidim, piperasilin ve siprofloksasin; diğer nonfermentatif Gram-negatif çomaklar için netilmisin (%68), amikasin (%63) ve sefoperazon/sulbaktam (%63); K.pneumoniae için ise amikasin (%69) ve siprofloksasin (%65) idi. S.aureus suşlarının %69'u; koagülaz-negatif stafilokoklann ise %60'ı metisiIine dirençli bulundu. Bu veriler, Fakültemiz Ortopedi ve Travmatoloji Kliniği'ndeki nozokomiyal infeksiyonlanmn tedavisinde kullanılacak antibiyotiklerin seçiminde antibiyotik duyarlık testlerinin kılavuzluğuna gereksinim olduğunu bir kez daha göstermektedir.

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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 (R) strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC(50) 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 MIC(90) of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gram-negative pathogens, mostly Acinetobacter spp., MIC(50) 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.

Bu çalışmada, doripenem, imipenem ve meropenemin gram-negatif klinik izolatlara karşı in vitro aktivitesinin değerlendirilmesi amaçlanmıştır. Türkiye genelinde toplam 10 merkezden Eylül-Aralık 2008 tarihleri arasında, yoğun bakım ünitesi (YBÜ) ve YBÜ dışı hastalardan, toplam 596 adet klinik izolat toplanmıştır. Bunlardan %42.4’ü nozokomiyal pnömoni, %40.4’ü kan dolaşımı enfeksiyonu ve %17.1’i komplike intraabdominal enfeksiyon kaynaklı olup; %51.8’i YBÜ hastalarından alınmıştır. İzolatların %49.8’i Pseudomonas spp., %40.3’ü Enterobacteriaceae ve %9.9’u diğer gram-negatif etkenlerden oluşmaktadır. Her merkezde Etest® (AB Biodisk, Solna, İsveç) kullanılarak tüm izolatlar için doripenem, imipenem ve meropenemin minimum inhibitör konsantrasyonu (MİK) belirlenmiştir. İzolatlardan 188 (%31.5)’i en az bir karbapeneme dirençli bulunmuştur. Pseudomonas türlerine karşı doripenem için MİK50 değerleri meropeneme benzer olarak 1 mg/L bulunurken, imipenemden iki kat daha düşük olduğu izlenmiştir. Pseudomonas aeruginosa izolatlarının duyarlılıkları, doripenem için MİK 2 mg/L düzeyinde %64, imipenem ve meropenem için MİK 4 mg/L düzeyinde sırasıyla %53.9 ve %63 olarak tespit edilmiştir. Doripenem ve meropenem, Enterobacteriaceae türlerine karşı benzer aktivite gösterirken (MİK90 0.12 mg/L), imipenem dört kat daha az aktif (0.5 mg/L) bulunmuştur. Büyük çoğunluğunu Acinetobacter türlerinin oluşturduğu diğer gram-negatif basiller için doripenem MİK50 değeri 8 mg/L, diğer iki ilaç için ise 32 mg/L’dir. P.aeruginosa izolatları 8 mg/L MİK düzeyinde doripenem ile %84.2, meropenem ile %72.1 oranında inhibe olmuştur. Sonuç olarak doripenem, bu çalışmada toplanan patojenlere karşı genel olarak meropenem ile benzer ya da daha iyi; imipenemden ise belirgin olarak daha iyi in vitro aktiviteye sahiptir. Üç karbapenem arasında Pseudomonas türlerine karşı en aktif olan ilacın doripenem olduğu görülmüştür. Doripenem ve meropenem Enterobacteriaceae türlerine karşı benzer aktiviteye sahip olup, imipenemden en az dört kat daha aktiftir. Bu bulgular ışığında, hastanede YBÜ’de ya da YBÜ dışında tedavi gören nozokomiyal pnömoni, kan dolaşımı enfeksiyonu ve intraabdominal enfeksiyonu olan hastalar ile antibiyotik direnci gelişim riski olan hastaların antimikrobiyal tedavisinde doripenemin öne çıkan yeni bir antibiyotik olduğu kanısına varılmıştır. 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 (R) strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC(50) 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 MIC(90) of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gram-negative pathogens, mostly Acinetobacter spp., MIC(50) 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.

Background: There is limited evidence on the modification or stopping of antiretroviral therapy (ART) regimens, including novel antiretroviral drugs. The aim of this study was to evaluate the discontinuation of first ART before and after the availability of better tolerated and less complex regimens by comparing the frequency, reasons and associations with patient characteristics. Methods: A total of 3019 ART-naive patients registered in the HIV-TR cohort who started ART between Jan 2011 and Feb 2017 were studied. Only the first modification within the first year of treatment for each patient was included in the analyses. Reasons were classified as listed in the coded form in the web-based database. Cumulative incidences were analysed using competing risk function and factors associated with discontinuation of the ART regimen were examined using Cox proportional hazards models and Fine-Gray competing risk regression models. Results: The initial ART regimen was discontinued in 351 out of 3019 eligible patients (11.6%) within the first year. The main reason for discontinuation was intolerance/toxicity (45.0%), followed by treatment simplification (9.7%), patient willingness (7.4%), poor compliance (7.1%), prevention of future toxicities (6.0%), virologic failure (5.4%), and provider preference (5.4%). Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (aHR = 4.4, [95% CI 3.0-6.4]; p < 0.0001) or protease inhibitor (PI)-based regimens (aHR = 4.3, [95% CI 3.1-6.0]; p < 0.0001) relative to integrase strand transfer inhibitor (InSTI)-based regimens were significantly associated with ART discontinuation. ART initiated at a later period (2015-Feb 2017) (aHR = 0.6, [95% CI 0.4-0.9]; p < 0.0001) was less likely to be discontinued. A lower rate of treatment discontinuation for intolerance/toxicity was observed with InSTI-based regimens (2.0%) than with NNRTI- (6.6%) and PI-based regimens (7.5%) (p < 0.001). The percentage of patients who achieved HIV RNA < 200 copies/mL within 12 months of ART initiation was 91% in the ART discontinued group vs. 94% in the continued group (p > 0.05). Conclusion: ART discontinuation due to intolerance/toxicity and virologic failure decreased over time. InSTI-based regimens were less likely to be discontinued than PI- and NNRTI-based ART., Gilead SciencesGilead Sciences, This study was funded by Gilead Sciences.

Objectives: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. Methods: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. Results: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were rehospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, Cl: 1.82-38.15, p = 0.006), isolation of Klebsiella spp. (OR:7.7, Cl: 1.24-47.96, p = 0.028), and chronic heart failure (OR: 3, Cl: 1.01-9.04, p = 0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p < 0.001). Conclusion: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Background: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods: This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1) pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results: In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1) pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions: Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.