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Background: Ceftazidime–avibactam (CAZ-AVI) is recommended as first-line treatment for Oxacillinase-48 (OXA-48) β-Lactamase-producing carbapenem-resistant Enterobacterales (CRE) infections, while polymyxin-based combination therapies (PBCTs) are used as a last resort when CAZ-AVI is unavailable. Research comparing the effectiveness of CAZ-AVI and PBCT in CRE blood stream infections (CRE-BSIs) is limited, mostly focusing on Klebsiella pneumoniae carbapenemase (KPC)-producing isolates. In Turkey, OXA-48 is endemic and OXA-48-Like is common. Therefore, our study aimed to compare the impact of these treatments on 30-day mortality in patients with CRE-BSIs in endemic regions. Methods: Retrospective data from January 2019 to May 2023 were collected from four tertiary healthcare centers in Istanbul. Demographic, clinical, and outcome data of ICU patients treated with CAZ-AVI monotherapy or PBCT for CRE-BSIs were analyzed. The effect on 30-day survival was evaluated using Cox regression analysis post propensity score matching (PSM). Results: Out of 151 patients, 44.4% (n: 67) received CAZ-AVI and 55.6% (n: 84) received PBCT. All-cause mortality rates were 20% (n: 13) with CAZ-AVI and 36.9% (n: 31) with PBCT. Cox regression analysis post PSM indicated CAZ-AVI monotherapy significantly reduced the mortality risk compared to PBCT (HR: 0.16, 95%CI: 0.07–0.37, p < 0.001), while age increased the risk (HR: 1.02 per year, 95% CI 1.0–1.04, p: 0.01). Conclusions: In OXA-48-predominant areas, CAZ-AVI demonstrated significantly lower mortality in patients with CRE-BSIs compared to PBCT. The results were attributed to the pharmacokinetic and pharmacodynamic disadvantages of polymyxins compared to CAZ-AVI, and the impact of age-related physical conditions. Therefore, CAZ-AVI should be the preferred treatment for CRE-BSIs in OXA-48-endemic regions. [ABSTRACT FROM AUTHOR]

OBJECTIVE COVID-19 pandemic has placed an unprecedented burden on health-care system. Patients with cancer are reported to have a higher risk of infection and a more complicated COVID-19 course. Breast cancer (BC) is the most common cancer in women in Turkey. We report clinical outcomes and characteristics of patients with COVID-19 who were on treatment for BC at our center. METHODS We reviewed medical records of BC patients who had COVID-19 between July 2020 and 2021 at our center. We recorded pathological, clinical, treatment characteristics, and the clinical outcome of COVID-19 infection. RESULTS A total 82 BC patients had COVID-19 between July 2020 and 2021. All patients were female, with a median age of 49 (43-64 years). 85% of all patients had early and 14.6% of them had advanced stage BC. COVID-19 had a mild clinical course in 73%, hospitalization was required in 27% of patients. Twenty-five patients who required hospitalization were discharged and three patients died due to COVID-19. All of the patients who died from COVID-19 had metastatic BC (p=0.002). Metastatic disease (p=0.002) and chemotherapy within 7 days of COVID-19 diagnosis (p=0.024) have been associated with increased mortality. CONCLUSION Majority of BC patients with COVID-19 have a mild course, patients with risk factors that increase mortality should be followed more carefully. [ABSTRACT FROM AUTHOR]

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Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: We compared the diagnostic values of individual and composite biomarkers used in the prediction of bacteremia in adult emergency department patients. Methodology: First-hour blood levels of C- reactive protein, procalcitonin, interleukin-6, lactate, lipopolysaccharide-binding protein and white blood cell count were collected from a 30-person control group and 47 adult patients. Patients included in this study were admitted to the emergency department on suspicion of sepsis. We categorized patients according to presence/absence of sepsis and bacteremia. Our control group was categorized as S-B -, septic patients with bacteremia were S+B+, and septic patients without bacteremia were S+B-. Results: All biomarkers showed a statistically significant elevation when S+B- and S+B+ groups were compared with the S-B-. When S+B+ group was compared with the S+B- group only procalcitonin and lactate levels had statistically significant elevation (p < 0.005). Regression analysis demonstrated that lactate and procalcitonin were independently associated with having bacteremia in the state of sepsis and Hosmer- Lemeshow score was 0.772. The areas under the curve (AUC) values of biomarkers procalcitonin, lactate, C-reactive protein, combined 1 (procalcitonin+ lactate), and combined 2 (procalcitonin + lactate + C-reactive protein) were 0.773, 0.744, 0.523, 0.806, and 0.829 respectively. Conclusions: Combination of tests such as combined 1 or combined 2 were highly predictive of bacteremia in adult septic patients. Combined 2 demonstrated the best predictive performance and could be utilized as a tool to assist diagnosis of bacteremia before culture results are available. [ABSTRACT FROM AUTHOR]

Introduction: We compared the diagnostic values of individual and composite biomarkers used in the prediction of bacteremia in adult emergency department patients., Methodology: First-hour blood levels of C- reactive protein, procalcitonin, interleukin-6, lactate, lipopolysaccharide-binding protein and white blood cell count were collected from a 30-person control group and 47 adult patients. Patients included in this study were admitted to the emergency department on suspicion of sepsis. We categorized patients according to presence/absence of sepsis and bacteremia. Our control group was categorized as S-B -, septic patients with bacteremia were S+B+, and septic patients without bacteremia were S+B-., Results: All biomarkers showed a statistically significant elevation when S+B- and S+B+ groups were compared with the S-B-. When S+B+ group was compared with the S+B- group only procalcitonin and lactate levels had statistically significant elevation (p < 0.005). Regression analysis demonstrated that lactate and procalcitonin were independently associated with having bacteremia in the state of sepsis and Hosmer-Lemeshow score was 0.772. The areas under the curve (AUC) values of biomarkers procalcitonin, lactate, C-reactive protein, combined 1 (procalcitonin+ lactate), and combined 2 (procalcitonin + lactate + C-reactive protein) were 0.773, 0.744, 0.523, 0.806, and 0.829 respectively., Conclusions: Combination of tests such as combined 1 or combined 2 were highly predictive of bacteremia in adult septic patients. Combined 2 demonstrated the best predictive performance and could be utilized as a tool to assist diagnosis of bacteremia before culture results are available., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2023 Neval Yurttutan Uyar, Ahmed Kerem Sayar, Ayşe Sesin Kocagöz, Muhittin Abdülkadir Serdar, Rehile Zengin, Zeynep Tuğçe Sarıkaya, Meltem Kilercik, Veysel Balcı, Mustafa Serteser.)