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Introduction: The Standardized Infection Ratio (SIR) is a statistic used to track healthcare associated infections over time, at a national or facility level. SIR gives clearer data due to patient and institutional characteristics. It makes it possible to fairly compare hospital performance because the data are risk-adjusted. The aim of our study is to evaluate SIR and cumulative attributable difference (CAD) and to compare for national data. Materials and Methods: The study was conducted in Atatürk Training and Research Hospital reanimation 1 and 2, coronary, cardiovascular surgery, internal medicine-neurology and general surgery intensive care units (ICU). Based on total data reported at national level, stratified calculations based on type of institution and intensive care unit (ICU) type ventilator-associated pneumonia, central line-associated bloodstream infection and catheter-associated urinary tract infection rates calculated, and SIR and CAD were calculated by SIR-matic, which was organized by the Department of Infectious Diseases, General Directorate of Public Health of the Turkish Ministry of Health. Results: According to the infection rate and SIR value for ventilator-associated pneumonia, our ventilator-associated pneumonia rate in all ICUs, the ventilator utilization rate of coronary, internal medicine-neurology and general surgery ICUs is above the Turkey’ average, and in all ICUs except coronary and general surgery ICU, SIR values for ventilator-associated pneumonia were found to be statistically significant > 1.00. According to the infection rate and SIR values for catheter-associated urinary tract infection, our rates were high in ICUs, while SIR value was calculated equal to 1.00. There was no more infection than predicted on an institution basis. When the CAD values were examined, it was found that the unit-based cardiovascular surgery and general surgery ICUs had less infection than expected within one year. According to the infection rate and SIR values for central line-associated bloodstream infection, the rates in our ICUs are higher than the national average. Conclusion: As a result of the study, infection rates and SIR values were higher in most intensive care units than national values. SIR values were found to be more reliable in infection monitoring.

Tularemia is a zoonotic disease caused by Francisella tularensis. Humans can acquire the infection through bites from arthropods, contact with animal tissues, consumption of the infected water and inhalation of aerosolized bacteria. The oropharyngeal form is the most common presentation in Turkey, reflecting the consumption of contaminated water. While the most common complication of the disease is the suppuration of the lymph nodes, abscess formation can be a very rare complication. In this study, we report a glandular tularemia case with bilateral inguinal lymphadenopathy and intra-abdominal abscess. A 51-year-old woman came to the infectious diseases clinic with fever and swelling in the groin ongoing for two months. She had been started on a treatment of amoxicillinclavulanic acid at another hospital for two weeks and had a history of watering her garden bare feet with natural pool water. She had fever and bilateral inguinal lymph nodes in her physical examination. One of her lymph nodes was extracted for diagnosis. The pathological examination result was granulomatous lymphadenitis. The sample’s culture and PCR results were negative for tuberculosis and tularemia but the F. tularensis microagglutination test (MAT) was positive. She had received treatment for Tularemia but her clinical and laboratory findings had not improved. Pelvic lymphadenopathies and an intra-abdominal abscess were observed in an MRI. Percutaneous drainage was done and the patient’s condition improved. This tularemia case was presented to emphasize that in regions, like our country, where tularemia is epidemic, if specific treatment is late, rare complications can be seen.

Infections are one of the major cause of death in the patients with hemato-oncological cancer. The prevention and appropriate treatment of infections is lifesaving. Infectious Diseases Society of America (IDSA)-licensed guideline “Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA” and “European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growingresistance: summary of the 2011 4th European Conference on Infections in Leukemia (ECIL)” written by the 4th ECIL expert group are two main guidelines that help clinicians for the diagnosis and treatment of infections in febril neutropenic patients and contribute to evidence-based medicine. The IDSA guideline is more comprehensive than the ECIL. The recommendations of two guidelines are mostly similar. However, there are differences in some issues between the two guidelines. The risk stratification and empiric antibiotics recommendation are different. However, the main differences between the two guidelines result from their recommendations about the empiric antifungal indication and the discontinuation time of therapy. Empirical antifungal treatment is recommended in both febril patients who are clinically stabil or unstabil in the IDSA quideline, although ECIL guideline recommends empirical antifungal treatment in only febril patients who are clinically unstabil. IDSA guideline recommends clinicians to continue antibiotic treatment for at least the duration of neutropenia. However, ECIL guideline recommends to discontinue of antibiotics after 72 hours in neutropenic patients who are hemodynamically stable and afebrile for at least 48 hours, irrespective of neutrophil count.

Hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection is occurred generally in highly endemic areas and among persons with a high risk of parenteral infections, because of both virus have common routes of transmission. The worldwide prevalence of coinfection is unknown, but it is estimated to be about 15 million HBV/HCV co-infected patients. HBV/HCV co-infection presents with a heterogeneous clinical appearance depending on the individual differences and diversity of the viral replication. HCV superinfection in patients with chronic HBV infection was the most common clinical features of coinfection in Asia-Pacific countries, while HBV superinfection was more common in Europe and United States. HBV/HCV interact with each other. HBV viral replication is generally suppressed by HCV. However, the longitudinal studies suggest that the viral interference is a fl uctuating dynamic process. Co-infection is characterized by a more severe liver injury and a higher incidence of cirrhosis and hepatocellular carcinoma (HCC). The dominant virus should be determined by pretreatment serological and virological evaluations. A good treatment response was obtained with pegile-interferon(Peg-IFN)/ribavirin in co-infected patients. Treatment outcomes was similar to HCV monoinfection. The effective treatment of HCV infection in the HBV/HCV co-infected patients may lead to HBV reactivation. For this reasons, long-term follow-up and monitoring for HBV infection are recommended in this patients. Although adding to a nucleos(t)ide analogues to the combination of Peg-IFN/ribavirin is a treatment alternative in HBV-active or dually-active co-infection, the optimal treatment strategies remains still unknown. The role of IFN-free direct acting antivirals treatment in co-infection is another issue to be resolved. However, the treatment of HCV with new potent drugs without any anti-HBV effect may increase the risk of HBV reactivation. The introduction of new antiviral for the treatment of hepatitis C may alter the optimal treatment of HBV/HCV coinfection. Further studies are needed in this regard.

Introduction: Human immunodeficiency virus (HIV) infection is an important cause of morbidity and mortality. Patients and Methods: We describe the epidemiologic and clinical characteristics of 70 HIV infected patients, followed between 2001 and 2008 in this study, retrospectively. Results: Eighty seven percent of the patients were male, and mean age at the diagnosis was 40 years (range, 21-75). Forty-seven percent of the patients had a history of working abroad. Heterosexual intercourse was the most common (80%) route of transmission. The mean CD4 count was 236 ± 257/mm3 (range, 1-936) and mean viral load was 6.6 x 107 ± 3.7 x 107/mm3 (range, 323-2.3 x 108) at diagnosis. The most common opportunistic infections were tuberculosis, Pneumocystis Jiroveci pneumonia and oral candidiazis. Fifteen (21.4%) patients died at the first admission and 5 (7.1%) patients died during follow up. CD4 counts at the admission were lower in fatal cases compared to survived cases. Conclusion: Most of the patients was male and the most common route of transmission was unsafe heterosexual intercourse.

Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia, strains isolated from the patients with invasive infections are mainly A, B, C, Y and W135. In our country, meningitis by W135 strain is rarely seen. In this article, a case with meningococcal meningitis due to W135 strain is presented.