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PubMedID: 20433052 Influenza pandemics have occurred intermittently throughout the 20th century and killed millions of people worldwide. It is expected that influenza pandemics will continue to occur in the near future. Huge number of deaths and cases is the most troublesome aspect of the influenza pandemics, but the other important trouble is the economic impact of the influenza pandemics to the countries. In this study, we try to detect the cost of a possible influenza pandemic under different scenarios and attack rates. We include the vaccination and antiviral treatment cost for direct cost and we add the work absenteeism cost to the calculations for indirect cost of influenza pandemics. As a case study, we calculate the economic impact of pandemic influenza for Turkey under three different scenarios and three different attack rates. Our optimistic estimation shows that the economic impact of pandemic influenza will be between 1.364 billion dollars and 2.687 billions dollars to Turkish economy depending on the vaccination strategies. © Springer Science + Business Media, LLC 2008.

This study aimed to identify the agents causing community-acquired urinary tract infections (CAUTIs) and their resistance patterns and to investigate risk factors for ESBL production.Patients diagnosed at the Department of Infectious Diseases in the Cukurova University School of Medicine Hospital with CAUTI between January 2006 and April 2007 were included prospectively. Patient data were recorded and the microorganisms and their sensitivity patterns were evaluated by the university's central microbiology laboratory.A total 146 patients with CAUTIs, 109 women and 37 men (mean age: 50.9+/-18.44 years), were included in the study. The most common infectious agents were Escherichia coli (76.9%), Klebsiella pneumoniae (9.2%), Proteus mirabilis (4.1%), and Enterococcus spp. (1.6%). The ciprofloxacin resistance rate for E. coli was 35% and resistance to TMP-SMZ 43%, whereas amikacin resistance was substantially low (3%). Four of 12 K. pneumoniae strains were resistant to ciprofloxacin and 2 to TMP-SMZ. Resistance to amikacin was not found in the K. pneumoniae strains. ESBL production was identified in 25 of the 112 E. coli and K. pneumoniae strains. A history of a UTI within the last 6 months (p=0.029) and a history of frequent UTI (p=0.028) were found to be significant risk factors for ESBL production by univariate analysis. The only independent risk factor was a history of urinary system infection in the past 6 months (p=0.025) according to multivariate regression analysis.These high resistance rates to antimicrobials and particularly the extremely high rate of ESBL production in CAUTI should be carefully considered.

Immunosuppression facilitates varicella zoster virus (VZV) reactivation in immunocompromised patients. Atypical presentation such as disseminated disease of herpes zoster infection has been described in immunosuppressed patients. One of the best choices of therapy in herpes zoster infection is acyclovir, but long-term therapy may cause resistance to it. In this report a disseminated herpes zoster infection is described in a patient with T cell lymphoma after acyclovir/valacyclovir therapy. The infection was irresponsive to acyclovir and valacyclovir and we were unable to control the infection because it was not possible to obtain foscarnet and the patient died due to Staphylococcus epidermis sepsis. © TÜBİTAK.

PubMedID: 18649061 Moxifloxacin is an advanced-generation fluoroquinolone with a broad spectrum of antimicrobial activity that is not metabolized by cytochrome P450 system. Therefore, the drug interaction of moxifloxacin is rarely seen. It has been reported that moxifloxacin is safe and well tolerable. We aimed to report a drug interaction between moxifloxacin and warfarin in a 74-year-old patient with a prosthetic mitral valve. © Springer Japan 2008.

Our aim was to compare the clinical and evaluative features of a series of cases with spondylitis of the 2 most frequent etiologies, brucellosis and tuberculosis, in Turkey.Of the 87 patients with spondylitis, 44 had brucellosis and 43 had tuberculosis. Patients with tuberculosis were more likely to have a history of pulmonary disease, longer time to diagnosis, and higher erythrocyte sedimentation rates and C-reactive protein levels. Fever, night sweating, and arthralgia were more frequent complaints in brucellosis, whereas weakness and neurological involvement were in tuberculous spondylitis. Vertebral destruction and compression, kyphosis, paraspinal masses, and cord compression were more frequent in tuberculosis. Sacroiliitis and discitis were significantly associated with brucellosis. Need for surgical treatment, unfavorable outcome, and death were more common in tuberculosis.In countries with high prevalence of both diseases, documented history, clinical presentation, laboratory and histological examination, and radiographic imaging can be highly suggestive and sufficient for empirical treatment. © 2008 Lippincott Williams & Wilkins, Inc.

Son yıllarda literatürde anti-CD20 antikoru (rituksimab) tedavisi sonrası gelişen ciddi viral, mikobakteriyel ve fungal infeksiyonlar bildirilmektedir. Şimdiye kadar rituksimab ilişkili panoftalmit bildirilmemiş olup, CHOP-R tedavisi alan lenfomalı bir olguda ölümle sonlanan panoftalmit tablosu nedeni ile konuya dikkat çekilmesi ve rituksimab tedavileri ile infeksiyon ilişkisinin değerlendirilmesi amaçlanmıştır. In recent years, serious viral, mycobacterial and fungal infection cases which developed after anti-CD20 antibodies (rituximab) have been published. Upto now there was no panophtalmitis case associated with rituximab. In this paper we aimed to evaluate the relationship between rituximab treatments and infections, and attract attention to the issue with a panophtalmitis case with lymphoma who was on CHOP-R treatment and ended up with death.

Hastanemiz Nöroloji Yoğun Bakım Ünitesi'nde (NYBÜ) izlenen hastalarda görülen hastane infeksiyon tiplerini ve izole edilen etkenlerin sıklığı ile antibiyotik duyarlılıklarını belirlemek amaçlanmıştır. Mart 2002 - Nisan 2004 arasında NYBÜ'nde 331 'i (% 56) erkek 593 hasta izlenmiş, 40'ı (% 60) erkek toplam 71 hastada hastane infeksiyonu saptanmıştır. Bu hastalarda 100 infeksiyon atağı tanımlanmıştır. Buna göre hastane kaynaklı infeksiyon insidansı hasta sayısına göre %12ve atak sayısına göre % 17 olarak bulunmuştur. Hastane infeksiyonu belirlenen hastalarda yaş ortalaması 59 yıl (medyan değer 45, alt değer 16 - üst değer 90) idi. Yüz infeksiyon atağının 52 'sinde üriner sistem infeksiyonu, 28'inde primer kan dolaşımı infeksiyonu (7'si kandidemi), 6'sında sekonder kan dolaşımı infeksiyonu, 11 'inde pnömoni, 2 'sinde bası yarası infeksiyonu, 1 'inde menenjit belirlenmiştir. Seksendokuz infeksiyon atağında patojen izole edilmiştir. Atakların beşinde polimikrobiyal üreme saptanmıştır. Üreyen 94 izolatın 57'si Gram negatif, 24'ü Gram pozitif bakteri ve 13'ü Candida türleri olarak belirlenmiştir. Gram negatif bakteriler Escherichia coli (n=23), Pseudomonas aeruginosa (n=16), Acinetobacter baumannii (n=10), Klebsiellapneumoniae (n-6), Stenotrophomonas maltophilia (n=l) ve Burkholderia cepacia (n-1) olarak, Gram pozitif bakteriler Staphylococcus aureus (n=8), koagulaz negatif stafibkok (n=8) ve enterokok (n=8) olarak idantifiye edilmiştir. İzole edilen bakterilerin antibiyotik dirençleri verilmiştir. The purpose of this study was to determine the types of nosocomial infections, frequency and resistance rates of pathogens isolated in our Neurology Intensive Care Unit (NICU). In the NICU, 593 patients (331 males, 56 %) were hospitalized between March 2002 and April 2004, and nosocomial infections were encountered in 71 patients (40 males, 60 %). The total number of infectious episodes was 100. The incidence of hospital infection was 12 %for patients' number and 17 %for episodes number. The average age of these patients was 59 (16-90, median 45). Of the 100 infectious episodes, 52 were urinary tract infections, 28 were primary blood stream infections (7 candidemia), 6 were secondery blood stream infections, 11 were pneumonia, 2 were decubitus infections and 1 was meningitis. Etiological agents were isolated in 89 episodes with polimicrobial growth in 5. Of the 94 isolates, 57 were Gram negative, 24 were Gram positive bacteria, and 13 were Candida spp. Gram negative bacteria were identified as Escherichia coli (n=23), Pseudomonas aeruginosa (n=16), Acinetobacter baumannii (n=10), Klebsiella pneumoniae (n=6), Stenotrophomonas maltophilia (n=l) and Burkholderia cepacia (n=l). The Gram positive bacteria were identified as Staphylococcus aureus, coagulase negative staphylococci and enterococci (8 from each). The antibiotic resistance of bacterial isolates were given.

The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years.This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria (390 Gram-negative, 180 Gram-positive) against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase (ESBL) production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips.Meropenem was the most effective antibiotic against Gram-negative organisms (89.0%); this was followed by imipenem (87.2%) and piperacillin/tazobactam (66.4%). The most active antibiotic against Gram-positive bacteria was imipenem (87.2%) and this was followed by piperacillin/tazobactam (81.7%) and meropenem (77.8%). The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year (21.7%, 22.1% and 45.5%). All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates.As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance.

ileri yaşlar, infeksiyona duyarlılığın arttığı dönem olarak değerlendirilir. Çoğu infeksiyon, bu yaş grubunda mortal seyretmeye eğilimlidir. Bunun yanısıra, yaşam kalitelerini etkileme, uzun süre hastahanede yatma ve ek sağlık harcamalarına yol açma gibi sorunları da beraberinde taşır. Bu çalışmanın amacı, yaşlılarda infeksiyon prevalansını saptama idi. Çukurova Üniversitesi Balcalı Hastanesi Acil Polikliniği'ne bir ay içerisinde, infeksiyöz ve non-infeksiyöz nedenlerle başvuran 60 yaş üstü 124 hastada, infeksiyon varlığı araştırıldı. Hastalarda kadın-erkek sayısı eşitti (%50). Yaş ortalaması 70 olarak (60-90 yaş arası) saptandı. Bu hastaların 33 (%26.6)'ünde diyabet ve 55 (%44.4)'inde hipertansiyon vardı. Hastaların 21 (%16.9)'inde üriner sistem, 12 (%9.6)'sinde akciğer, dördünde (%3.2) akut kolesistit, ikisinde (%1.6) diyabetik ayak infeksiyonu, birinde (%0.8) dekübit infeksiyonu, birinde menenjit saptandı. Bunun dışında iki hastada acil poliklinik koşullarında nedeni ortaya konulamayan ateş vardı. Bunların birisi nötropenikti. Hastaların 43 (%33.8)'ünde infeksiyon belirlendi. İnfeksiyon hastalıkları semptomlarıyla başvuran hasta sayısı 19 idi (%15.3). Yaşlı hasta grubu, asemptomatik olsa da infeksiyon varlığı açısından dikkatlice değerlendirilmelidir. The old age is a period of increased susceptibility to infection. Infections in the elderly tend to have a fatal course. Old-age infections also affect the quality of life, require longer hospitalization and thus extra cost. The aim of this paper was to determine the prevalence of infection in the elderly. For this purpose, 124 patients over 60 years of age attending the emergency unit, Çukurova University Balcalı Hospital, in one month were evaluated. The female to male ratio was 1:1, and the median age 70 (between 60 and 90). Diabetes mellitus was present in 33 (26.6.%) and hypertension in 55 (44.4%). The infections in the elderly were as follows: in 21 (16.9%) urinary tract infection, in 12 (9.6%) pulmonary infection, in 2 (1.6%) diabetic foot infection, in 1 (0.8%) decubitis ulcer infection, and in 1 (0.8%) meningitis. Beside these patients, in 2 patients there was fever of unknown origin and 1 of these 2 patients was neutropenic. Nineteen (15.3%) of the patients presented the symptoms of infection on admittance, but with further infection was diagnosed in 43 (33.8%). The elderly should be carefully evaluated for the possible presence of an infection due to the fact that infections can have symptomless course in this age group.

Eight patients (42.1%) had both sacroiliitis and spondylitis. Pathological involvement was determined in Tc99m bone scintigraphy in only three of 19 patients (15.8%) with sacroiliitis in plain x-rays. One patient with normal bone scintigraphy had bilateral sacroiliitis in MRI. Two patients with normal bone scintigraphy had bilateral spondylitis in MRI. Seven patients had findings of spondylodisciitis in both bone scintigraphy and MRI.

PubMed ID: 22177310, Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole. © 2011 Erdem et al; licensee BioMed Central Ltd.

The purpose of this clinical review was to review clinical presentations, laboratory, and radiologic findings and difficulties on management of tuberculous spondylitis from a series of 40 cases. We carried out a retrospective analysis of 40 adult patients (50% male) with tuberculous spondylitis between January 1997 and December 2003. Infection was diagnosed in patients having a presentation compatible with characteristic histologic and/or microbiologic evidence of tuberculous spondylitis and diagnostic radiographic features, or following adequate response to antituberculous therapy with highly suggestive imaging features. Outcome was assessed according to clinical, radiologic, and laboratory criteria. Mean age was 44.7±19 years. Thirty percent of patients had a history of contact with a patient having active pulmonary tuberculosis. The most frequent symptom and sign were back pain (92.5%) and, spinal tenderness (55%). Magnetic resonance imaging was found to be the most helpful technique for diagnosis. Lumbar spine was the most common affected region (82.5%). Thirty (75%) patients had paraspinal abscess and, 4 (10%) had concomitant sacroiliitis. Spinal biopsy had a yield of 76.5%, 52.9%, and 47% granulomas, positive culture, and acid-fast smear, respectively. Resistance to antituberculous drugs was 44.4%. Although medical treatment alone was given in 15% cases, 85% required additional surgical intervention. The mean duration of therapy was 12±12 months. The improvement without sequela was 77.5% of the patients. In developing countries, diagnostic delay in tuberculous spondylitis is still common and disastrous. Bacteriologic confirmation and susceptibility testing should be achievable in all adult cases. © 2006 Lippincott Williams & Wilkins, Inc.