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Sepsis is defined as organ dysfunction due to an irregular host response to infection caused by bacteria, viruses, parasites or fungal microorganisms and may cause morbidity or mortality. The benefit of statins in atherosclerosis and various cardiovascular diseases is explained by their positive effect on the endothelium by lowering high cholesterol levels. Statins have pleiotropic effects such as anti-inflammatory, antithrombotic and antioxidant effects in addition to their lipid lowering effects. It has been shown that pretreatment with statins may affect survival in sepsis. In sepsis and septic shock, cytokine release from endothelial cells, procoagulant molecules and thrombocyte production are encouraged. In addition, with the development of inflammation in sepsis, vascular permeability increases in the infected tissue due to the increase of neutrophils and phagocytes and tissue damage occurs. Thus, homeostasis regulating vascular tone is disturbed and endothelial damage is formed. Statins act on sepsis by providing vascular relaxation in the endothelium and reducing the expression of adhesion molecules and cytokines. In the light of current knowledge, more comprehensive studies are needed to recommend the use of statins to benefit from its pleiotropic effects in the treatment of sepsis.

SARS-CoV-2 genetic variants from alpha (first detected in the UK) to delta (discovered in India this spring) to lambda (currently Argentina, Brazil, Chile, Colombia, Ecuador, and Peru) have been emerging and circulating the world. Also, these variants have raised concerns about the continued effectiveness of COVID-19 vaccines. In this review, influential variants cause countries to review their vaccine strategies, create new vaccine programs, and accelerate existing vaccine studies. The effectiveness of currently available COVID-19 vaccines on variants is discussed. It is also intended to shed light on what should be known about the necessity of third doses.

The number of cases and disease-dependent deaths continue to increase worldwide due to the COVID-19 infection accepted as a global pandemic by the World Health Organization on March 11, 2020. Therefore, the antivirals used in treatment and vaccines that are the most effective weapons for protection remain the most popular topic on the agenda. There are a few conditions that might have an impact on the course of the pandemic, including the mutation of the virus and losing its ability to cause disease, generating herd immunity by reaching a critical rate of immunized people in the community due to the disease, and ensuring herd immunity through effective vaccination. Vaccine trials, which have started owing to the severity and urgency of the situation we are in, continue highly rapidly and effectively. According to the March 2, 2021 data of WHO, there are 258 vaccine trials, 76 of which are at the clinical phase, and 9 of the vaccine trials that are at the clinical phase are RNA-based vaccines. In our study, it was aimed to investigate RNA-based COVID-19 vaccine candidates and review their current data.

The incidence of hypersensitivity reaction with the use of beta-lactam antibiotics ranges from 5-18%. The prescribing tendency of other antibiotic groups in patients with beta-lactam hypersensitivity causes an increase in the incidence of resistant microorganism, health care costs and adverse effects from other prescribed drug groups. Due to the history of unverified hypersensitivity of the patient, the use of penicillin and cephalosporins was avoided, the incidence of resistant infections and antibiotic resistance increased. According to a few studies conducted, the route of administration of beta-lactam antibiotics does not cause a significant difference in terms of the risk of developing hypersensitivity reaction. However, hypersensitivity reactions and anaphylaxis have been reported rarely in oral administration compared to parenteral administration.

There are treatment options with partially shown efficacy against SARS-CoV-2. A drug with proven effect on survival has not yet been developed for the new coronavirus disease (COVID-19) defined in December 2019. Many chemicals that are being used or developed for different indications have been used for COVID-19 treatment, based on their effects observed in in vitro studies. Favipiravir, one of these drugs, was first used in Wuhan, the starting center of the pandemic. Since the spread of the infection to the world, it has been used in our country as well as countries such as Italy, Japan, Russia, Ukraine, Uzbekistan, Moldova and Kazakhstan, Bangladesh, Egypt, India. There are few studies conducted and published to evaluate the effectiveness of favipiravir, but many studies are ongoing. In this review, it was aimed to review and evaluate the studies and case reports reporting the efficacy of favipiravir in the treatment of COVID-19. With the literature search, 223 results were reached, 210 articles were fully accessed, and a total of 34 articles were included in the analysis. In the scope of the review, under the title of pharmacology of favipiravir, adverse effects and drug interactions in addition to pharmacokinetic and pharmacodynamic properties are mentioned. Favipiravir is one of the options for the treatment of COVID-19 patients, but randomized, controlled trials involving much more patients and longer follow-up periods need to be planned and the results of ongoing trials evaluated.

Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality in our country and worldwide, and it imposes a serious economic burden on the health system. It is major cause of deaths due to infections in our country. Therefore, initiating CAP treatment with the most appropriate antibiotic as soon as possible is important in decreasing morbidity and mortality. For this purpose, many evidence-based guidelines have been created to assist physicians in the selection of antibiotics and to reduce the differences between clinical practices. Although these guidelines mainly have common content and recommendations, there are some differences according to the health systems of the countries. In addition, the guidelines contain a number of shortcomings and issues not addressed. This review waswritten to compare five CAP guidelines (British Thoracic Society, National Institute for Health and Care Excellence, European Society of Clinical Microbiology and Infectious Diseases, Spanish Pneumology and Thoracic Surgery Association, Turkish Thoracic Society), to identify and discuss their differences, and to discuss the issues not considered in the guidelines such as drug interactions, dose adjustment in kidney/liver dysfunction, dose adjustment in obesity, serious/common side effects, and pharmacokinetic-pharmacodynamic properties of the drugs.

Research started with the pneumonia cases that emerged in Wuhan, China in December 2019 and whose cause could not be determined clearly, revealed the existence of a new type of coronavirus. The infectious agent was named SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), and the disease setting caused by the virus was entitled COVID-19 (coronavirus disease-2019). The increasing number of cases and mortality rates due to the disease worldwide has caused a large number of vaccine research studies to be initiated simultaneously. According to the World Health Organization (WHO) December 22nd 2020 data, the number of Covid-19 vaccine research studies currently ongoing all over the world is 233 and the number of studies that have passed the clinical trials stage is 61. 15 of these studies are at Phase 3 stage. There are 12 ongoing COVID-19 vaccine studies in our country and all of them are in the preclinical stage. In this review article, 15 vaccine candidate studies whose Phase 3 stage continues, were discussed among the COVID-19 vaccine research studies.

COVID-19 is a newly emerging human infectious disease of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origin described as a pandemic by the World Health Organisation (WHO) on March 11, 2020. There is currently no definitive cure for COVID-19; however, among the many treatment strategies, hydroxychloroquine has been suggested as a potential treatment. The purpose of this article was to review the pharmacological properties and mechanism of COVID-19 treatment with hydroxychloroquine and its potential use on the current COVID-19 pandemic.

In the end of December 2019, a novel coronavirus was identified as the cause of pneumonia cases in Wuhan, China. The disease was later named as COVID-19 (coronavirus disease 2019) and the causative agent was designated as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Even though the disease was suggested to be of zoonotic origin, human to human spread was also described and became the main mode of transmission. The number of cases significantly increased within a short period of time and the disease spread worldwide. On March 11, 2020, the World Health Organization announced COVID-19 outbreak as a pandemic. As of May 6, 2020, it has been reported that there are 3.588.773 people diagnosed with COVID-19 among 215 countries, territories or areas, and 247.503 people have died from the disease. In our country, the first case was identified on March 10, 2020, and the first death from the disease was reported on March 17, 2020. According to the data announced on May 6, 2020, the total number of cases detected in our country was 131.744, and the number of deaths related to the disease was 3584. The knowledge on the characteristics and epidemiology of SARS-CoV-2 and COVID-19 has been increasing day by day. Sequence analysis of the viral genome enabled the development of diagnostic tests and facilitated the initiation of research on both therapeutic options and vaccine development. In this review article, current information on the biology, epidemiology, clinical features, diagnosis, treatment, and prevention of SARS-CoV-2 and COVID-19 was discussed.

The novel coronavirus, which was called 2019-nCoV at the beginning of the outbreak, was named SARS-CoV-2 later. The clinical disease caused by the virus was also called Coronavirus disease 2019 (COVID-19). World Health Organization declared COVID-19 a global pandemic on 11.03.2020. As of 26.03.2020, there have been 462.684 confirmed cases and 20.834 deaths globally, and these numbers are expected to increase in the coming days. The dynamics of virus spread are investigated with various models and outbreak parameters such as incubation time and basic reproduction number (R0) is tried to be illuminated. According to official numbers, as of 03.26.2020, there have also been 3629 cases and 75 deaths in Turkey. COVID-19 Guideline prepared by the Ministry of Health of the Republic of Turkey is constantly updated with additional prevention and treatment strategies. Various predictions are made for the future course of the pandemic, and the contribution of the spread of the virus in Africa and seasonal changes on this issue has been investigated.

Surgical site infections (SSI) are one of the major causes of hospital-acquired infections. Despite not recommended in the guidelines, powdered antibiotics are frequently applied locally. The aim of this application is to obtain more and longer antibiotic concentrations in the surgical site than systemic circulation. Less systemic exposure is expected to result in less undesirable effects. However, there is no high-quality clinical evidence supporting this practice in the literature. The role of the antibiotics applied as local powders and the appropriate timing of these antibiotics are not clear. In addition, the process of both preparation and administration of these antibiotics is not defined, so such practices carry concerns and risks. In this article, it was aimed to summarize the current clinical evidence related to the local use of vancomycin for the prevention of SSI and to present the advantages and disadvantages of this usage.

Inappropriate use of antibiotics increases the risk of resistance development. Development of resistance causes prolongation of hospital stay, increased mortality and health care costs. Antibiotic stewardship seeks to optimize clinical results by limiting the emergence and transmission of resistant bacteria. Antibiotic stewardship program consists of two core strategies and various complementary strategies. Comprehensive antibiotic stewardship programs have demonstrated decreased in antibiotic use and costs. Ideally, antibiotic stewardship program consists of a multidisciplinary team including infectious disease specialist doctor, clinical pharmacist trained in infectious diseases, clinical microbiologist, information systems specialist, infection control professional and hospital epidemiologist. The clinical pharmacist should be knowledgeable about the appropriate use of antibiotics, and appropriate training programs should be made available to achieve and maintain this expertise. There are important roles and responsibilities of the clinical pharmacists in the antibiotic stewardship team as to promote the optimal use of antibiotics, reduce transmission of infections, educate health professionals, patients, and the public. Hence, an active participation of qualified pharmacists should be ensured in the antibiotic stewardship team.

HIV epidemic, itself, was first diagnosed after lung related mortality and morbidity among young men. Pneumocystis pneumonia, tuberculosis, atypical mycobacterial infections, cytomegalovirus (CMV) pneumonia and opportunistic fungal infections must be remembered in the differential diagnosis of human immunodeficiency virus (HIV) positive patients presenting with respiratory distress. A fifty-three year-old male patient with HIV associated nephropathy applied to our clinic due to fever and respiratory distress, which did not respond to broad-spectrum antibacterial treatment. HIV viral replication was suppressed for a year. His vaccination status was up-to-date against seasonal influenza and pneumococci. Massive pulmonary thromboembolism was diagnosed. The patient was put on a fibrinolytic treatment.

Introduction: Pneumococcal and influenza infections are important sources of morbidity and mortality in older adults and high-risk persons. Although the efficacy and cost effectiveness of pneumococcal and influenza vaccines were shown by many studies, vaccination coverage of high-risk adults still remains low. In this study, we aimed to investigate the vaccination coverage rates of the patients, who were hospitalized at an acute care unit and their attitudes towards vaccination. Patients and Methods: A prospective observational study was done between November 2014-July 2015. A questionnaire, including their demographical characteristics, co morbidities, influenza and pneumococcal vaccination statuses and their attitudes towards vaccination was conducted on the patients admitted to the acute care unit. Their risk factors for vaccination indications were assessed. Results: 155 patients were enrolled to the study. The median age of the patients was 70 (18-91), and 41.3% of the patients were male. 93.5% of the patients had indication for both influenza and pneumococcal vaccination. Only 17.2% of the patients who had pneumococcal vaccination indication, and 29.7% of the patients who had influenza vaccination indication, were vaccinated. We found that recommendation to the vaccinated patients was mostly made by doctors from secondary or tertiary care rather than primary care doctors. The most common reason for not getting the vaccines was lack of knowledge of the patients. Conclusion: Influenza and pneumococcal vaccination indication rates were high in patients admitted to the acute care unit. In this study, we found that vaccination coverage rates are still low, there is a lack of knowledge of the patients and the doctors are not recommending vaccination to their patients. Raising awareness of healthcare providers and making them use every visit as an opportunity for vaccination would be effective to improve vaccination coverage rates for adults.

Colistin is a polypeptid antibiotic and it is used to treat infections caused by multidrug-resistant gram-negative bacteria. The intravenous use of colistin has been considered to be associated with considerable nephrotoxicity and neurotoxicity. For this reason, the systemic administration of colistin has been abandoned for about 20 years in most areas of the world. The emergence of multidrug-resistant gram-negative bacteria in parallel with the lack of new antibacterial agents led scientists to understand the importance of colistin. In this manuscript the use of colistin has been discussed in the light of current knowledge.

Infections are the most frequent cause of morbidity and mortality in neutropenic cancer patients. We aimed to evaluate the characteristics of febrile neutropenic cancer patients who were consultated by the infectious disease team in a tertiary care university hospital between January through December, 1999 and to find predictors of treatments success in these patients. Medical charts of the patients were analyzed retrospectively. The febrile attacks were categorized as: “microbiologically” and “clinically documented” infections and “fever of unknown origin (FUO)”. The results of treatment were grouped as “success” or “success only after modification of treatment/failure”. Of the participants, 61% were male and the mean (± st. dev.) age was 48 ± 18 years. About 55% of the underlying diseases were hematological malignancies. The etiology of fever was undetected in 75 (45%) patients, the infection was clinically documented in 52 (31%) patients, and microbiologically documented in 40 (24%). Response to treatment was successful in 43% of the patients with neutropenic fever whereas modification of the treatment regimen was required for success in 14 patients (8.4%) and treatment was failed in another 81 (48.5%). Multivariate logistic regression modeling was used to determine statistically significant predictors of treatment success. The infection category of “FUO” and vancomycin use were found to be significant predictors of treatment success.

After 6 months surveillance of nosocomial infections at Dr. Siyami Ersek Cardiothoracic Surgery Center between December 1st 1995 to May 1st 1996, it was found that 39% (24/61) of nosocomial and 64% (18/28) of surgical site infections were caused by MRSA. The overall percentage of MRSA among all Staphylococcus aureus strains were found to be 62.5% (45/72) during the study period and antimicrobial susceptibility patterns were similar with each other in 89% (40/45) of these MRSA strains. To identify the potential sources of MRSA infections in this institution, nasal swab cultures of health care workers (HCW) were taken and the nasal colonization rate was found to be 2.8% (5/173). The strains that were isolated from patients and HCW’s were evaluated by AP-PCR. It was found that 75% (33/45) of the patient strains were similar with each other. One of the five strains isolated from HCW’s was similar with these strains. Although nasal colonization of that HCW had been treated effectively with mupirocin, MRSA infection rate wasn’t decreased at this hospital. Since MRSA carriage rate was not high in HCW’s and, most of the MRSA strains isolated from HCW’s were found to be different in genetic type from the patients’ strains, for the transmission of MRSA, it was concluded that nasal colonization of HCW’s with MRSA is not a major source of infections in our hospital.

Resistance mechanisms of gram-negative bacteria to aminoglycoside antibiotics differs by region and country. Aminoglycoside resistance mechanisms (Ag RMs) in gram-negative isolates resistant to either one of gentamicin (G), tobramycin (T), netilmicin (N) and amikacin (A) collected in different regions of Turkey were determined by both phenotyping and genotyping methods. Phenotyping was performed on the basis of relative resistance profiles of the isolates to 12 aminoglycoside antibiotics. Genotypically, Ag RMs of the isolates were determined by using hybridization assay including 22 common aminoglycoside resistance gene probes. Among 585 aminoglycoside-resistant gram-negative bacteria, resistance rates were highest for gentamicin (91.5%) followed by tobramycin (93.2%), netilmicin (62.1%), and amikacin (48.2%). Although isepamicin (I) was the most active aminoglycoside in-vitro against gram-negative bacteria, resistance rate (29.2%) for this drug was higher than in most of the other countries surveyed in earlier studies. The most common Ag RMs [AAC(3)-II (GTN), AAC(6’)-I (TNA), ANT(2”)-I (GT)] in earlier studies, were also present in this study. In addition to those mechanisms, two new mechanisms were observed. AAC(6’)-III (TNAI), occurred in both Enterobacteriaceae (11.9%) and Pseudomonas spp.(19.3%). Despite the high incidence of the other new mechanism, AAC(6’)-IV (GTNA) in Enterobacteriaceae (26.9%), it was not determined in Pseudomonas spp. All these mechanisms were mostly found in combination with each other or with less occurring resistance mechanisms except for AAC(6’)-IV which mostly occurred alone. The incidence of combinations of the most common resistance mechanisms were high in both Enterobacteriaceae (48%) and Pseudomonas spp. (58.7%). High incidence of combinations reflects the high resistance rates to clinically useful aminoglycosides (G, T, N, A, I) in gram-negative bacteria. Although enzymatic resistance mechanisms [AAC(3)-I (16.6%), AAC(6’)-II (29.3%), AAC(6’)-III (19.3%), ANT(2”)-I (40%)] were frequent in Pseudomonas spp., permeability resistance seems to be responsible for resistance to a wide range of clinically available aminoglycosides in this organism.

Glycopeptide resistant Enterococcus faecium strain was isolated from the blood cultures of a patient of the Haemotology Department of Gülhane Military Medical Academy, who was diagnosed acute myelocytic leukaemia. The strain was identified by the conventional and commercial automatic systems as E. faecium. Susceptibility pattern showed multiply resistance to all antibiotics except ciprofloxacin and levofloxacin. Using the E-test method, the MIC levels for vancomycin, teicoplanin, ciprofloxacin and levofloxacin were determined as 256 µg/mL, 64 µg/mL, 0.75 µg/mL and 1.5 µg/mL, respectively. VanA-1 and VanA-2 type resistance genes were detected by PCR. This strain is the first glycopeptide resistant E. faecium isolated from our hospital and Ankara and the second from Turkey. In the epidemiologic point of view, taking preventive measures against the wide spread of this dangereous bacteria is crucial.

Detection of P. carinii is increased by the use of polymerase chain reaction (PCR), particularly on sputum samples. In this study, sputum samples obtained from 30 immunosuppressed patients with respiratory symptoms (12 HIV infected) were tested by standard cytochemical staining (Giemsa and methenamine silver), immunofluorescense (IF) staining and PCR for detection of P. carinii and the results were compared. P. carinii were detected in 4, 8, and 13 sputum samples by cytological staining, IF test and PCR, respectively. Specific amplification bands were obtained in all sputum samples which were positive by both other tests. All tests gave negative results in sputum samples obtained from 5 HIV infected asymptomatic patients. Our observations suggest that PCR results were found to be well correlated with P. carinii pneumonia (PCP) especially in non-HIV infected patients. However, PCR positivity obtained on HIV infected patients could be misleading in the diagnosis of PCP without careful clinical evaluation. Positive results obtained by Giemsa staining or IF test confirm diagnosis of PCP with high degree correlation. As a result, we suggest testing sputum samples by both PCR and IF techniques for detection of P. carinii.

Nosocomial isolates of staphylococci and enterococci were studied for their antimicrobial susceptibilities against frequently used antimicrobials. Two hundred and fifty one staphylococci were evaluated against teicoplanin, vancomycin, cephalothin, oxacillin, penicillin, trimethoprime-sulfomethoxazole, ciprofloxacin, gentamicin, rifampicin, chloramphenicol, sulbactam/ampicillin and erythromycin and 126 enterococci were evaluated against ampicillin, teicoplanin, vancomycin, gentamicin and streptomycin. The resistance results were evaluated according to NCCLS criteria. The MIC50 and MIC90 values of vancomycin and teicoplanin of all our clinical staphylococcal and enterococcal isolates were found within susceptible limits. In conclusion, teicoplanin can be considered as an alternative therapeutic agent for patients infected with staphylococci and enterococci infections.

With respect to HIV pathogenesis, it is known that the asymptomatic, so called clinical latency phase is far from the quiescent period it was once thought to be. More potent antiretroviral drugs and their use in clinical trials made viral load measurements quite important. Rapid and reliable quantitative assays for viral load are possible by the use of nucleic acid amplification techniques. New and accurate means of monitoring viral load by these techniques are now available to predict disease progression and monitor the effects of the therapy. It is now recommended that both viral load measurement and CD4+ T-cell count should be used concurrently to manage HIV disease and to evaluate new drugs.

As a result of the extensive use of new generation cephalosporins, an increase in the frequency of gram negative bacteria in nosocomial infections is observed in recent years. Awareness of the rate of resistance to these agents is a requirement in order to install apropriate control measured. A study was undertaken with the participation of nine hospitals in Turkey to determine the frequency of gram negative bacteria isolated in the ICU’s and compare the resistance rates to selected antibiotics. 981 bacteria were collected and antibiotic susceptibilities were determined by E-test. Pseudomonas spp. was the most prevalent organism (30%) followed by Klebsiella spp. (25%) and E. coli (18%). Imipenem, amikacin and ciprofloxacin were the most active agents in vitro with slight variations according to each center. The high rate of resistance to the new generation cephalosporins suggested the Class I and extended-broad-spectrum ß-lactamases.

The most common mechanizm of methicillin resistance in staphylococci is the synthesis of a new penicillin binding protein (PBP2a). The genetic material responsible for PBP 2a syhthesis is carried in mec A gene. Only methicillin resistant staphylococci have this gene. It can be trasported to sensitive strains by transduction. There are also other genes (factor X, fem A, fem B, mec R mec I) which control the expression of mec A gene. As a result of interaction of these genes 2 types of PBP 2a related methicillin resistance occurs: Homogenous resistance, heterogeneous resistance. Besides chromosomal (intrinsic) resistance, methicillin resistnace in staphylococci can develop through secretion of beta lactamase enzymes or decrease in the affinity of PBS’s to beta lactam antibiotics.

Vancomycine resistant enterococcus (VRE) strains, especially important in United States of America are not seen frequently in our country. However VRE rate seens to be increased in our country according to recent studies. In this article two cases of VRE infection in our hospital are presented.