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Objective: Brucellosis is a systemic zoonosis that affects various organs or body systems and can mimic many diseases. Symptoms can range from acute febrile illness to chronic clinical manifestations with severe complications. In our study, we investigated the relationship between bacteremia and clinical and laboratory findings, and complications in patients with brucellosis. Material and Methods: Two hundred and twenty-three patients diagnosed with brucellosis between 2005 and 2020 in the department of infectious diseases and clinical microbiology of a tertiary care university hospital were included in the study. Rose Bengal test, Brucella standard tube agglutination test and culture (blood and/or bone marrow culture) were used for the diagnosis of brucellosis. The patients were divided into two groups according to their bacteremia status. Patients with positive culture were identified as bacteremia, and patients with negative culture were identified as non-bacteriemic. Results: A total of 223 patients were included in the study, of which 142 (63.7%) were male. While weight loss, fever and hematological complications were higher in bacteremia cases (p=0.001, p

Objective: In this study, it was aimed to determine whether risk factors related to candidemia in Anesthesiology and Reanimation Intensive Care Unit and Neurology-Neurosurgery Intensive Care Unit show variability.Material and Methods: One hundred and ten adult patients diagnosed with candidemia at Karadeniz Technical University Health Research and Application Center between January 2014 and November 2019 were included in the study. Demographic, clinical and laboratory features of the patients; patient files, infection control committee data, and infectious diseases and clinical microbiology consultation forms were obtained. The data were evaluated by T-test and Chi-square test. Statistical significance value was accepted as p, Amaç: Bu çalışmada, Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi ve Nöroloji-Nöroşirürji Yoğun Bakım Ünitesinde kandidemi ile ilişkili risk faktörlerinin değişkenlik gösterip göstermediğinin belirlenmesi amaçlandı.Gereç ve Yöntemler: Çalışmaya Ocak 2014-Kasım 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi’nde kandidemi tanısı alan 110 erişkin hasta dâhil edildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi. T-testi ve Ki-kare testiyle veriler değerlendirildi. İstatistiksel anlamlılık değeri p

Amaç: Özellikle yoğun bakım ünitelerinde mortalite ile sonuçlanan enfeksiyonlara neden olan çoklu ilaca dirençli Acinetobacter baumannii ve Pseudomonas aeruginosa’nın sebep olduğu enfeksiyonlarda kolistin sıklıkla kullanılmaktadır. Etkenlerin antimikrobiyal direnç profilleri hastaneden hastaneye hatta hastane içinde farklı üniteler arasında değişiklik gösterebilmektedir. Çalışmamızda izole edilen A. baumannii ve P. aeruginosa suşlarında kolistin direnç oranlarının yıllara göre dağılımını ortaya koymak amaçlanmıştır.Gereç ve Yöntemler: Çalışmada Ocak 2013-Ekim 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi yoğun bakım ünitelerinde yatan hastalardan alınan kan ve kateter kültürlerinden izole edilen A. baumannii ve P. aeruginosa suşlarında kolistin direnç profili değerlendirildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi.Bulgular: Tekrarlayan üremeler çıkarıldıktan sonra izole edilen 1469 örneğin 555’i değerlendirilmeye alındı. Çalışmaya dâhil edilen 555 örnek, 389 hastadan izole edildi, üremelerin %66.7’si A. baumannii ve %33.3’ü P. aeruginosa idi. Beş yüz elli beş üremenin 18’i kolistin dirençli olup, tüm yoğun bakım ünitelerinde kolistin direnç oranı %3.2 idi. Kolistin direnç oranları nöroşirurji, iç hastalıkları, anesteziyoloji ve reanimasyon ve nöroloji yoğun bakım ünitelerinde sırasıyla; %6.3, %5.2, %2.6, %1.9 iken göğüs yoğun bakım ünitesinde hiç direnç saptanmadı. Yıllara göre her iki suşun da direnç oranının giderek arttığı, A. baumannii’de direnç oranının P. aeruginosa’dan daha yüksek olduğu görüldü. Kolistin dirençli üremesi olan hastalar arasında mortalite oranı %77.8, genel mortalite oranıysa %3.6 olarak hesaplandı.Sonuç: Çalışmamızda yıllar içinde kolistin direnç oranlarındaki artış dikkati çekmektedir. Ayrıca dirençli olan üremelerin mortaliteyi de artırdığı görüldüğünden; uygunsuz ve gereksiz kolistin kullanımının engellenmesi, dirence yol açan faktörlerin belirlenmesi, her merkezin kendi epidemiyolojik verilerini ve antimikrobiyal duyarlılık profilini takip ederek tedavi protokolleri oluşturması gerektiği düşünülmektedir.

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p, TUSEB, We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.

OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age = 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P =.007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P =.235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P =.002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP., Pfizer Pharmaceuticals, Turkey, This work was supported by Pfizer Pharmaceuticals, Turkey.

Amaç Nötropenik hastalarda mukozit orofarenks başta olmak üzere tüm gastrointestinal sistemde oluşabilmektedir. Mukoza bütünlüğünün bozulması lokal invazyona zemin hazırlar ve önemli bir enfeksiyon odağı haline gelmesine neden olur. Bu çalışmada febril nötropenik hastalarda gelişen orofarengeal enfeksiyonların değerlendirilmesi ve oral kavite muayenesinin önemine dikkati çekmek amaçlanmıştır.Yöntem Tersiyer bir hastanede üç yıl boyunca tanı alan hematolojik maligniteli febril nötropenik hastaların demografik verileri, atak sayısı, malignitelerin dağılımı ve gelişen orofarengeal enfeksiyonlar değerlendirildi.Bulgular Toplam 335 atak geçiren 170 hasta çalışmaya dahil edildi. Mikrobiyolojik olarak dökümante edilen enfeksiyonlarda en sık bakteremi (n=92, %27.5) vardı. İkinci en sık enfeksiyon orofarengeal enfeksiyonlardı (n=69, %20.1).Orofarengeal enfeksiyonlardan en sık izole edilen mikroorganizma funguslardı (n=34, %49.3).Sonuç Febril nötropenik hastaların orofarengeal enfeksiyonları lokalize ve sistemik enfeksiyona ilerleyen klinik tablolara neden olabilir. Hastaların oral kavitesinin günlük muayenesi, bakımı özenli bir şekilde yapılmalıdır. Orofarengeal floraları yakın takip edilmeli ve olası bir enfeksiyon tablosunun olduğu durumlarda buradaki floranın da kaynak olabileceği mutlaka göz önünde bulundurulmalıdır., Objective In neutropenic patients, mucositis can occur in the entire gastrointestinal tract, especially in the oropharynx. Disruption of mucosal integrity provides the basis for local invasion and causes it to become an important focus of infection. The aim of this study was to draw attention to the importance of oral cavity examination and evaluation of oropharyngeal infections in patients with febrile neutropenia (FN).Methods Demographic data, number of episodes, distribution of malignancies and developing oropharyngeal infections of febrile neutropenic patients with hematologic malignancies in a tertiary hospital over a three-year period were evaluated.Results A total of 170 patients with 335 FN episodes were included in our study. Bacteremia was the most common microbiologically documented infection (n=92, 27.5%). the second most common infection was oropharyngeal infections (n=69, 20.1%). The most common microorganism isolated from oropharyngeal infections was fungi (n=34, 49.3%).Conclusions Oropharyngeal infections of febrile neutropenic patients may cause localized and systemic infections. Daily examination and care of the oral cavity of the patients should be done with care. The oropharyngeal flora should be closely monitored and it should be considered that the flora may also be a source in case of a possible infection.

Tip, sanattir aslinda. Tibbin mesakkatli tum yollarinda sanatla yurumektir. Sanat, renklerin yesilinde, mavisinde, bir fircanin dokunuslarinda serinlemektedir. Muzigin nagmelerinde, notalarinda dinlenmektir. Ve O gercek sanat sahibinden aldigin ilhamin cuzlerinden, kirintilarindan beslenmektir. Tip ve sanat; sanatla taptaze, dopdolu bir nefes almaktir.

Objectives: During the healthcare services, healthcare workers are under the risk of sharps and needle stick injuries. In this study, we evaluated occupational injuries seen in our hospital and emphasized the importance of reducing the risk of exposure to these injuries through compliance with infection control precautions.Materials and Methods: In this study, we retrospectively evaluated the data of the Infection Control Committee of Karadeniz Technical University Faculty of Medicine on work-related sharp injuries among healthcare workers between 01.01.2016 and 01.02.2018.Results: This study was carried out with sixty-six healthcare workers. The mean age of the healthcare workers was 29.3(±7.62) years. The injuries were most frequently observed in nurses. Majority of the injuries had occurred in internal medicine clinics and most of them were needle stick injuries. In 99.7% of the injuries, contamination state was known. Forty-nine of 66 employees were immune to the hepatitis B virus. After the injuries, any acute viral infection was not developed. Three out of the 6 employees injured by positive serology of human immunodeficiency virus sources were given prophylaxis for four weeks after contact.Conclusion: All healthcare workers should be informed about the measures against injuries, the proper use of protective equipment and the importance of vaccination and, they should be subjected to periodic training.

WOS: 000466503400007 PubMed: 31073544 Introduction: Anthrax is a zoonosis affecting herbivorous animals. Its agent is Bacillus anthracis and it is gram positive, aerobic or facultative anaerobic, immobile and has a capsule in the polypeptide structure. The incidence is gradually decreasing in the world and in our country. The disease is especially seen in areas where stock breeding is common. In this case series, 3 cases, one of them was mortal, took place after anthrax infected cow was eaten in February 2018 in Trabzon was shared. Case presentations: In the first case, as a result of the animal's meat was eaten, gastrointestinal anthrax and associated sepsis were seen. This patients blood culture was positive and she was died. Second case after contacting the patient who died, and third case after contacting the animal and eating its meat, diagnosed with cutaneous anthrax. Doxycycline treatment was started with cutaneous anthrax patients, these cases were recovered without any complications. Conclusion: We presented this article, to update our information about gastrointestinal anthrax and other anthrax types which are become a current issue again especially due to bioterrorism and also to keep it in mind in the differential diagnosis although it is rarely seen in our stock raising areas.

CONTEXT Crimean-Congo haemorrhagic fever (CCHF) is a life-threatening acute febrile haemorrhagic disease. OBJECTIVE This study was to measure levels of the oxidative stress biomarkers malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) and of CA I-II autoantibodies as biomarkers for autoimmunity and course of disease in patients with CCHF. METHODS Seventy CCHF patients and 39 healthy control volunteers were included in the study. RESULTS Serum MDA and TAS levels were significantly higher (p

Idiopathic CD4 lymphocytopenia (ICL), also known as non-HIV AIDS, is a rare disease characterized by opportunistic infections, malignancies, and autoimmune diseases. Idiopathic CD4 lymphocytopenia is defined as CD4+ T-lymphocyte level below 300/mm3 in at least two measurements or less than 20% of total lymphocytes, which cannot be explained by any other condition, including HIV infection. Nocardia spp. are opportunistic microorganisms that is a frequent cause of infection in immunocompromised individuals. In this paper, we report a 50-year-old patient with ICL and intracranial brain abscess due to Nocardia farcinica and review th literature for related articles published between April 2012 and December 2018. These data suggest that there may be an underlying immunosuppression in adult patients who have infections that are recurrent, refractory, and caused by opportunistic pathogens.

To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed (“MICE” score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the “MICE” scoring system. Three cut-off values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/μL): ≤ 7500, 7500–15,000, and > 15,000; total bilirubin (mg/dL): ≤ 3, 3–10, and > 10; CRP (mg/dL): ≤ 5, 5–15, and > 15; creatinine (mg/dL): ≤ 1.5, 1.5–3, and > 3; CK (U/L): ≤ 500, 500–1000, > 1000. AUC was calculated as 0.964 at ROC analysis, while the most noteworthy cut-off point was obtained when MICE score was ≥ 3, exhibiting 93.5% sensitivity, 92.9% specificity, PPV 94.5% and NPV 91.5%. A test score ≥ 3 was regarded as positive. In addition, our patients were evaluated using other current scoring systems in addition to “MICE,” and our scoring system exhibited a greater diagnostic power in our subjects. Leptospirosis and hantavirus infections can be accurately predicted by the MICE scoring system. Early diagnosis and rational treatment will also help to lower the mortality rates in these diseases.

Objectives: Hepatitis C virus (HCV) infection is common among hemodialysis (HD) patients and is associated with increased morbidity and mortality. New generation direct-acting antiviral (DAA) agents are safe and effective in treatment HCV infection in HD patients. The aim of this a multi-center study was to assess the efficacy of DAAs in HD patients with HCV infection. Materials and Methods: HD patients with HCV infection followedup at five centers were included in this retrospective cohort study. Patients demographic and virological characteristics, liver fibrosis status, end of treatment and sustained virologic responses (SVR12) at 12 weeks after treatment were recorded. Treatment of the patients was arranged according to the genotype and drug interactions considering guidelines. Results: Ninety percent of 20 patients were genotype 1b and were treated for 12 weeks with paritaprevir-ritonavir-ombitasvir-dasabuvir; one patient was genotype 4 and received PrOD + ribavirin (RBV) for 12 weeks; and one patient was genotype 3 and was treated with sofosbuvir + RBV for 24 weeks. HCV-RNA negativity was achieved in all patients at the end of treatment and SVR12 rate was 100%. Significant side effects were not observed in any patients, apart from sleeplessness in one patient and itching in another. Conclusion: Our real-life data support that new generation DAAs achieve high SVR and are well tolerated in HD patients with HCV. In these patients, intolerance and side effects were not observed, which would otherwise require cessation of the DAA regimen. Amaç: Hepatit C virüsü (HCV) enfeksiyonu hemodiyaliz (HD) hastalarında sık görülür ve artmış morbidite ve mortalite ile ilişkilidir. Yeni nesil direkt etkili antiviral (DAA) ajanları, HD hastalarında HCV enfeksiyonunun tedavisinde güvenli ve etkilidir. Bu çok merkezli çalışmada, HCV enfeksiyonu olan HD hastalarında DAA’nın etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu retrospektif kohort çalışmaya beş merkezde HCV enfeksiyonu ile takip edilen HD hastaları dahil edildi. Hastaların demografik ve virolojik özellikleri, karaciğer fibroz durumu, tedavinin sona ermesi ve tedaviden 12 hafta sonra kalıcı virolojik yanıtlar (SVR12) kaydedildi. Hastaların tedavisi kılavuz ilkeleri göz önünde bulundurularak genotip ve ilaç etkileşimlerine göre düzenlendi. Bulgular: Yirmi hastanın %90’ı genotip 1b idi ve 12 hafta boyunca paritaprevir-ritonavir-ombitasvir-dasabuvir (PrOD) ile tedavi edildi, bir hasta genotip 4 idi ve 12 hafta boyunca PrOD + ribavirin (RBV) aldı, ve bir hasta genotip 3 idi ve 24 hafta boyunca sofosbuvir + RBV ile tedavi edildi. Tedavi sonunda tüm hastalarda HCV-RNA negatifliği sağlandı ve SVR12 oranı %100 idi. Bir hastada uykusuzluk, diğerinde kaşıntı dışında hiçbir hastada önemli yan etkiler gözlenmedi. Sonuç: Gerçek yaşam verilerimiz, HCV’li HD hastalarında yeni nesil DAA’ların yüksek SVR sağladığını ve iyi tolere edildiğini desteklemektedir. Bu hastalarda, DAA rejiminin kesilmesini gerektiren intolerans ve yan etkiler gözlenmedi.

This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic factors, he was discharged in a healthy condition after 17 days of hospitalization with close monitoring and supportive care. Tranexamic acid was successfully used together with other supportive treatments.

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products., Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016)., Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p, Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.

WOS: 000446000200057, PubMed ID: 30256855, Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

Background Hepatitis C virus (HCV) infection is widespread in hemodialysis patients worldwide. Studies of the effectiveness of new generation DAAs in the treatment of HCV infection in hemodialysis patients are limited.We investigated the effectiveness of DAAs in hemodialysis patients with HCV infection. Methods Twenty-three HCV-positive treatment naïve or experienced (IFN/pegIFN±RBV) hemodialysis patients were enrolled.Three patients were excluded for not attending follow-ups regularly, and the data for 20 patients were included. Patients’ demographic, virological, and genotypic characteristics, liver fibrosis status, DAAs started, and sustained virological responses at the 12th week (SVR12) were recorded. DAA regimens based on the treatments patients were using and potential drug interactions.Patients completing treatment were followed for 12 weeks for SVR. Results The mean age of the patients was 57.8 (±10.5). Ninety percent were men; 55% were treatment-experienced and 45% were treatment naïve. Ninety percent were noncirrhotic and 10% had compensated cirrhosis. Of the treatment-experienced patients, 45.5% were nonresponder and 54.5% were relapsed (Table 1). Eighteen patients with Genotype 1b were treated with paritepravir-ritonavir-ombitasvir-dasabuvir(ProD) for 12 weeks, one patient with Genotype 4 received ProD+ribavirin for 12 weeks, and one patient with Genotype 2 received sofosbuvir+ribavirin for 24 weeks. HCVRNA was negative on the 4th week in 85% of patients, and was negative in all patients on the 12th week, apart from the patient receiving the sofosbuvir+ribavirinregimen. At the end of treatment, HCVRNA was negative in all patients, and the SVR12 rate was 100%. Patients’ treatment responses were independent of previous treatments, liver fibrosis status, and hemodialysis duration. No marked side effects or complications were observed, apart from sleeplessness in one patient (Table 1). Conclusion Our study data confirm that new generation DAAs in hemodialysis patients provide high SVR and are well tolerated, as in patients other than those with chronic kidney disease. Achieving cure in hemodialysis patients is important in terms of preventing cross-contamination and of global elimination of HCV. Disclosures All authors: No reported disclosures.

Background Crimean-Congo hemorrhagic fever (CCHF) is a widespread, tick-borne disease of humans. CCHF is an endemic in Turkey, and since 2004 many cases have been reported from different regions in the country. CCHF infection in humans can lead to antibody responses that can be protective but there is limited data about the immunity of CCHF. The aim of this study was to investigate the possibility of recurrence of CCHF in people who previously had this disease. Methods The patients who were diagnosed with CCHF between 2005 and 2018 were followed up and contacted via phone in order to answer several survey questions about CCHF. Patients who still live in the same places, who have high risks of disease transmission because of husbandry or farming and high potential of contact with ticks were included in this study. Those who changed their living place and stopped husbandry or farming were excluded from this study. The questions in the survey are the following: Have you had CCHF after your discharge from the hospital?; Has there been any tick contact?; Did you ever get a tick removed from your body? Did you or your family members have CCHF at the same time or at different periods of time? Has anyone had CCHF in the area you live? Do your animals have ticks? Do you live in the same place? Have you changed your job? Results Ninety-nine out of 351 patients who were contacted via phone had data eligible to be included in the criteria. The amount of time elapsed after the discharge of the patients was between 1 and 14 years in average. None of the patients had experienced CCHF disease again. Also, 6 of these patients were bitten by ticks repeatedly (2–5 times). An average of 7–10 years had passed since the transmission of the disease by the patients. Conclusion The results show that the CCHF disease creates an immune response and this response continues for a long time. The findings will be more enlightening with the measurement of the serum antibody levels of patients. Disclosures All authors: No reported disclosures.

We aimed to establish that a bronchoscopic view can be as reliable as microbiology, and support an empirical tracheobronchial fungal infection (TBFI) treatment decision. We retrospectively studied 95 respiratory failure patients with suspected TBFI admitted to the intensive-care unit (ICU) in 2008 with sticky secretions, hyperaemic mucosa, and whitish plaques on bronchoscopic view. Patients not suspected of having TBFI were chosen as a control group ( n = 151). Broncheoalveolar lavage (BAL) fluid was cultured, and biopsy samples were taken from the lesions. Biopsy samples positive for fungi were defined as ‘proven', only BAL-positive (+ fungi) cases were ‘probable TBFI', and BAL-negative (– fungi) cases were ‘possible TBFI'. BAL (+ fungi) and BAL (– fungi) in the control group were defined as ‘colonization' and ‘no TBFI', respectively. The sensitivity, specificity and positive and negative predictive values of BAL (+ fungi) were 85.1% (63/74), 81.4% (140/172), 66.3% (63/95), and 92.7% (140/151), respectively. Biopsies were performed in 78 of 95 patients, and 28 were proven TBFI with fungal elements, and 100% were BAL (+ fungi). Probable TBFI was seen in 30 of 95 patients with BAL (+ fungi), and possible TBFI (BAL(– fungi)) in 25 of 95. Among the 95 patients, microbiology revealed fungi (90.5% Candida species; 9.5% Aspergillus ) in 63 (66.3%). In the controls, the colonization and no TBFI rates were 11 of 151 and 140 of 151, respectively. Observing sticky secretions, hyperaemic mucosa and whitish plaques by bronchoscopy is faster than and may be as reliable as microbiology for diagnosing TBFI. These findings are relevant for empirical antifungal therapy in suspected TBFI patients in the ICU.

Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital’s Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival. © 2017, Springer-Verlag Berlin Heidelberg.

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study., Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH., Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was, Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing.

The optimal duration of the treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1 week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10 to 14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital’s intensive care units between 1 January and 31 December 2015. Duration of antibiotic therapy was determined with 5 day clinical evaluation according to previously established criteria. Patients were divided into two groups depending on length of treatment, short (7–10 days) and long treatment (>10 days). Nineteen patients received 7 to 10 day antibiotic therapy, and 30 received >10 day antibiotic therapy. Demographic and clinical characteristics, Glasgow Coma Scale score, CPIS and the PaO2/FiO2 ratio at the time of diagnosis of VAP were statistically similar between the two groups (P>0.05). A second VAP attack occurred post-treatment in three patients receiving short-term treatment and in four receiving long-term treatment (P=0.561). The numbers of antibiotic-free days were 15.6±6.2 in the short-term treatment group and 8.3±7.5 in the long-term group (P

Rhizobium spp., generally present in soil, is a gram-negative, catalase-, oxidase- and urease-positive, motile, non-fermentative, nonspore-forming rod, often known as a plant pathogen but rarely detected as the agent of infection in humans. In this article, we present an 83-year-old female patient with bile duct malignant neoplasm who underwent biliary drainage catheterization after detection of obstruction at the Klatskin level and developed catheter-related bacteremia caused by Rhizobium radiobacter. Identification and antibiotic susceptibility testing of the bacteria were performed using BD Phoenix automated microbiological system (Becton Dickinson, Sparks, MD). In conclusion, it should be kept in mind that R. radiobacter may rarely cause opportunistic infection, especially in immunocompromised patients. In the presence of catheter, it should be considered among the pathogens causing bacteremia.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that can lead to epidemics and because of its multiple antibiotic resistance, it continues to pose a serious health problem all over the world. In many cases, MRSA becomes resistant to antibiotics in use today, which results in the need for the development of new anti-staphylococcal antibiotics. The first representative of cyclic lipopeptids, daptomycin, in this context, is a new antibiotic among effective anti-staphylococcal drugs. In this study, vancomycin and daptomycin susceptibilities of MRSA strains were investigated with the E-test method. Materials and Methods: In the study, the vancomycin and daptomycin susceptibilities of 51 MRSA strains isolated as cause of infection from various clinical specimens in our hospital were investigated in vitro between the years 2000 and 2006. Susceptibility tests were performed with E-test method by using vancomycin and daptomycin strips in Mueller-Hinton agar (MHA) medium. Results: All strains of MRSA were sensitive to vancomycin and daptomycin with E-test method. Vancomycin minimal inhibitory concentration (MIC) range was 0.5-1 µg/mL and daptomycin MIC range was 0.094-0.75 µg/mL. Daptomycin MIC50 was 0.25 µg/mL and MIC90 was 0.38 µg/mL; whereas, vancomycin MIC50 was 0.75 µg/mL and MIC90 was 1 µg mL. Conclusion: MIC values determined for vancomycin were at the highest level among the results. That may be taken as a sign of alarm for the resistance and clinical treatment failure of vancomycin. With the low MIC values, daptomycin seems to be a better option in the treatment of MRSA infections.

Background Platelet count is an important tool for the diagnosis and prognosis of Crimean-Congo Hemorrhagic Fever (CCHF). The platelet indices plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) are parameters obtained as part of the automated complete blood count. These parameters are of prognostic importance in several diseases. The aim of this study was to evaluate the platelet count and its relations with platelet indices in CCHF patients. Methods One hundred and forty-nine patients with confirmed CCHF were included in the study. Patients were divided into two groups (severe cases, patients who exhibited hemorrhage during their hospital stay, and mild/moderate cases with no hemorrhage during hospital stay). The demographic characteristics and laboratory test results of all patients were compared. P < 0.05 was regarded as statistically significant. Results Hemorrhaging was observed in 38.3% of patients during hospitalization. Platelet count, PCT and PDW values (respectively) on the first day of hospitalization were 43.3 ± 29.3, 0.06 ± 0.07%, and 17.4 ± 1.5% in the severe cases and 64.5 ± 35.4, 0.08 ± 0.03%, and 16.8 ± 1.5% in the mild/moderate cases, respectively (P < 0.05). The difference between MPV values was not statistically significant. At cutoff values at ROC analysis, platelet count (≤53000) and PCT(≤0.06) exhibited 73.7% and 71.9% sensitivity, respectively, and predicted a hemorrhagic disease course with a 80.9% negative predictive value. Seven of the severe patients died (P = 0.001). At cutoff values, platelet count (>31000) and PCT (>0.03) predicted patient survival with 100% specificity and 100% positive predictive value. Conclusion Our study shows that platelet count, PCT and PDW are parameters that may be used to determine disease severity. The platelet index, and particularly PCT, may be at least as useful as platelet count in helping clinicians identify severe cases. Disclosures All authors: No reported disclosures.

Background The course of hepatitis B virus (HBV) infection is more severe in patients using immunomodulatory drugs (ID) than in the normal population. This study evaluates the results of double-dose administration of HBV vaccine of 40 μg at months 0, 1, 2, and 6. Methods Anti-HBs negative patients presenting to our polyclinic between January 1 and July 1, 2017 and using ID were administered a double dose of HBV vaccine at months 0, 1, 2, and 6. Patients’ primary diseases and comorbid factors were recorded. Anti-HBs titers above 10 mIU/mL 1 month after completion of vaccination schedules were regarded as response to vaccine. Results Eighty patients presented during the study. Seventeen patients failing to attend follow-ups were excluded. Twenty-eight (44.4%) of the 63 patients enrolled were men and 35(55.6%) were women. Patients’ ages ranged between 18 and 66, with a mean age of 44.2 (±12.2) and a median value of 46. Comorbid factors were essential hypertension in 5 patients, diabetes mellitus in 4, and hypothyroid in 3. Vaccination was started within 2 weeks before commencement of ID or simultaneously with a biological agent in 29(46%) patients, and anti-HBs titers above 10 mIU/mL were achieved in 24 (82.8%). Thirty-four (54%) patients were started on vaccination while using medication [mean 21.1(±27.7) months], and anti-HBs titers above 10 mIU/mL were achieved in 29. Response was achieved in 53(84.1%) of all the patients in the study, while no response was obtained in 10 (15.9%). No gender difference was observed between the responding and non-responding patients. Response to vaccine was independent of sex, comorbid diseases, immunosuppressive agents, and time of commencement of vaccination (Table 1). Conclusion In our study, anti-HBs positivity was achieved in 84.1% of patients receiving doses of 40 μg. Although the ideal situation is for patients to start receiving vaccination at least 2 weeks before starting ID, vaccination in the shortest time possible after commencement of treatment is recommended for previously unvaccinated patients. In conclusion, physicians need not be concerned that response to vaccination cannot be achieved in patients started on ID, and seronegative patients must be enrolled in the HBV vaccination program as quickly as possible. Disclosures All authors: No reported disclosures.

Background The efficiency of ribavirin for treatment of Crimean-Congo hemorrhagic fever (CCHF) is unknown. In the literature, prospective randomized studies investigating the efficacy of ribavirin are not found. Objectives To investigate the efficacy of ribavirin in treatment of patients with CCHF. Study design In this prospective randomized cohort study 136 cases were included between June 2004 and August 2007. The diagnosis was confirmed in the CCHF reference laboratory of Refik Saydam National Hygiene Central Institute of the Turkish Ministry of Health. Patients either received ribavirin plus supportive treatment (Group A) ( n = 64) or only supportive treatment (Group B) ( n = 72). For the evaluation of efficacy of ribavirin, various parameters were compared between Group A and Group B. Results As well as the similarity of demographic features between the two groups, there were no statistical differences in incubation time; hospitalization time; patients requiring platelet replacement therapy; the time taken for platelet levels to return to normal levels and mortality. In Group B, the rate of tick contact was higher ( p = 0.03). In Group A, leukocyte levels took longer to return to the normal levels ( p = 0.02). Conclusion In our study, there was no positive effect determined on clinical or laboratory parameters in CCHF patients treated with ribavirin, also it was observed that leukocyte levels took longer to return to normal ( p = 0.02) and, while not statistically significant, the longer period of hospitalization ( p = 0.09) needed was observed as a negative effect. Because of these reasons, it is thought that the use of ribavirin makes no significant contribution to the prognosis of the CCHF disease.

Azole class of antifungal agents has been used in treatment of invasive fungal infections since 1944. The azoles classified as imidazoles or triazoles according to the number of nitrogen in the azole ring. Fluconazole, itraconazole, voriconazole, posaconazole, ravuconazole, albaconazole and isavuconazole were reviewed in this manuscript.

WOS: 000373481300007, PubMed: 27026760, Objective: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. Materials and Methods: A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. Results: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. Conclusion: Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.

Background/aim: The purpose of this study was to evaluate nosocomial infections occurring in our hospital intensive care units (ICUs) and the risk factors for these, and to determine the effect of these infections on mortality and cost. Materials and methods: This retrospective study was performed via infection control committee surveillance data, ICU records, and information processing data between 1 January and 31 December 2013 at the Kanuni Education and Research Hospital. Results: A total of 309 nosocomial infections were observed in 205 out of 566 patients. The density of nosocomial infections was 25.4 in 1000 patient days. Hospitalization was prolonged, and APACHE II and Charlson comorbidity scores were high in patients developing nosocomial infections (P < 0.001). Of the patients diagnosed with a nosocomial infection, 170 died. Infections were determined as the cause of death in 62 (36.5%) of the nonsurviving patients with a nosocomial infection. Acinetobacter baumannii was identified in 46 (74.2%) of the patients that died from nosocomial infections. The mean cost in patients developing a nosocomial infection was 15,229.30 Turkish lira (TL), compared to 9648.00 TL in patients without a nosocomial infection (P = 0.002). Conclusion: Regular infection control education sessions need to be held and the number of nurses needs to be increased in order to be able to reduce this high mortality, morbidity, and cost.