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Background: The aim of this national, multicenter, cross-sectional, retrospective chart review study was to determine the rate of patients in Turkey who received hepatitis C virus (HCV) treatment after receiving positive anti-HCV results during HCV screening. Methods: Data related to patients’ demographics, laboratory results, the time interval from obtaining a positive anti-HCV result to treatment initiation, the specialty of the physician requesting anti-HCV screening, and type of hospital were collected and analyzed. Results: Among 1000 patients who received a positive anti-HCV result, 50.3% were male and 78.5% were screened for HCV-RNA. Among HCV-RNA screened patients, 54.8% (n = 430) had a positive result. Among patients testing positive for HCV-RNA, 72.8% received HCV treatment in line with their positive anti-HCV results. The median time from obtaining a positive anti-HCV result to initiation of HCV treatment was 91.0 days (interquartile range 42.0 to 178.5). Non-surgical branches requested HCV-RNA testing more frequently than surgical branches (p < 0.001). The rate of access to HCV treatment was higher in patients screened in university hospitals than in patients screened in training and research hospitals (p < 0.001). Conclusions: Our results indicate a higher rate of treatment initiation in patients with HCV infection than is described in the published literature. Furthermore, the time from screening to treatment initiation was considerably shorter compared with other international studies. However, because HCV-RNA testing was not requested in a significant portion of patients with a positive test result for anti-HCV, there might be a large patient population with HCV who do not receive treatment.

Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin ,and linezolid are frequently used in empirical treatment combinations in critically ill patients Although they are included in the national antibiotic restriction program, thought to be inappropriate, unnecessary and suboptimal use is high due to their widespread use. In our study, in addition to their widespread use, gram-positive spectrum antibiotics were evaluated due to their use in more limited and clear clinical indications. This study aims to determine the frequency of inappropriate uses of gram-positive spectrum antibiotics and risk factors for inappropriate use according to different quality parameters. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital with a total bed capacity of 55. Patients older than 18 years of age onset of gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid ,and daptomycin) were included. Patients under the age of eighteen or immunosuppressed (neutropenic, HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. The demographic and clinical features of the patients were recorded. The treatment was also evaluated and recorded by 2 infectious diseases specialists and 2 clinical pharmacists except for the clinical staff at 24-hour intervals from the first day to the last day of treatment. SPSS software for Windows, version 17 (IBM, Armonk, NY) was used to analyze the data. Categorical variables are presented as number and percentage, and non-categorical variables are presented as mean ± standard deviation. Results In the use of antibiotics, the incidence of non-compliance with at least one of the determined quality parameters was 83%. Multivariate analysis was performed to evaluate risk factors for inappropriate antibiotic use, and creatine values ​​were found to increase the risk of inappropriate antibiotic use. Conclusions In spite of the restricted antibiotic program, inappropriate antibiotic use in ICUs is quite common. In particular, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation and optimal treatment doses Keywords:Antibiotic stewardship, rational antibiotic use, antibiotic resistance, gram positive microorganism, inapropriate use of antibiotics

Fusarium species have gained importance as a cause of keratitis. The pathogenicity and virulence factors of genus Fusarium remain largely unknown. Several putative virulence factors have been reported for fungal pathogens, including biofilm formation, production of proteinases and other hydrolytic enzymes. It has been emphasized that Fusarium species are generally resistant to antifungals but the resistance may vary depending on the species and even according to the isolate. For this reason, pathogenic features and antifungal susceptibility of the clinical isolates gained importance for the management of keratitis cases. The aim of this study was to identify clinical Fusarium isolates, to evaluate their virulence factors and to show antifungal susceptibility patterns. The identification of Fusarium was made on genus level isolated from 25 keratitis cases. Among them, 13 of the isolates were identified by ITS sequencing on species complex level. The production of hemolytic activity, caseinase, esterase, proteinase and phospholipase activity were investigated in 13 of the isolates. Biofilm production was searched among all 25 isolates. Galleria mellonella larvae was used as in vivo infection model. Antifungal susceptibility for amphotericin B, itraconazole, voriconazole and posaconazole was performed according to the Clinical and Laboratory Standards Institute (CLSI) M38-A2 microdilution assay guidelines. As the subcommittee on antifungal susceptibility tests did not determine the clinical resistance breakpoints (CBP) specific to Fusarium species complex, the epidemiological cut off values (ECV) were used for the interpretation of the minimum inhibitory concentration (MIC) values of the antifungal drugs. Isolates were identified as six F.oxysporum, six F.solani species complex and one F.brachygibbosum. One F.solani, one F.oxysporum were positive for hemolytic activity; all isolates were caseinase positive; three F.oxysporum and two F.solani isolate were esterase positive; one F.solani isolate was proteinase positive; five F.oxysporum and two F.solani isolates were phospholipase positive; biofilm activity was positive in 52% of the 25 isolates. The larvae survived for seven days after Fusarium inoculation in the G.mellonella larvae model. MIC range was 0.5-8 µg/ml for amphotericin B, 2-32 µg/ml for itraconazole, 0.5-8 µg/ml for voriconazole, 0.5-16 µg/ml for posaconazole and according to the ECV values F.solani and F.oxysporum isolates were determined as wild type for four antifungal agents. As a result, it was shown that Fusarium isolates have some virulence factors, there was a concordance between in vitro virulence properties and in vivo virulence characteristics and some of the isolates were classified as antifungal susceptible wild type isolates.

Pulmonary aspergillosis which is an important opportunistic infection in neutropenic patients, is usually caused by Aspergillus fumigatus. Since the pathogenesis of disease is not well understood, the main proposed mechanism is thought to be cell-mediated immunity and cytokine response. The aim of this study was to investigate the local production of cytokines in the lung tissues of rats with experimentally developed aspergillosis, by reverse transcriptase-polymerase chain reaction (RT-PCR). A total of 33 Wistar albino type rats were included in the study with the consent of Experimental Animal Ethics Committee. Twenty-five of the rats were infected with A.fumigatus by intratracheal way, while 8 animals were used as controls. The presence of A.fumigatus in the lung tissues of infected rats was confirmed with the use of quantitative culture and histologic staining methods. RNA isolation from the lung tissue samples of both groups were performed by a commercial kit (Qiagen, Germany). After obtaining complementary DNAs from the genomic RNAs, in-house qualitative and quantitative (real-time) PCR methods were used to amplify the target regions for interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-?) and interferon-gamma (IFN-?) by using specific primers (Tıb Molbiol, Germany). Mean mRNA levels achieved by real-time PCR for IL-10, TNF-? and IFN-? in aspergillosis group were 6.5 x 106 copies/ml, 7.9 x 105 copies/ml and 2.2 x 103 copies/ml, respectively, while those values in control group were 4.3 x 102 copies/ml, 5.6 x 103 copies/ml and 1.3 x 102 copies/ml, respectively. Our data indicated that rat model of aspergillosis was associated with significantly increased expression of mRNA encoding IL-10 and TNF-? than controls (p0.05), however there was no statistically significant difference between the groups with respect to IFN-? expression (p= 0.53). In conclusion, the production of proinflammatory cytokines which mediate the influx of phagocytic cells might account for the localization of Aspergillus infection to the upper respiratory tract. The up-regulation of the expression of the immunomodulatory cytokine TNF-? and IL-10 in lung tissue from infected rats might be important to limit the extent of local tissue destruction, but might also account for the fact that infected rats are generally unable to clear the infection spontaneously.

West Nile virus (WNV) which is a flavivirus transmitted by mosquitos, may lead to asymptomatic infection, mild febrile illness or encephalitis. Many sporadic cases and major outbreaks of West Nile fever have been reported worldwide, however, WNV infections have not been well documented in Turkey. The aim of the present study was to determine the prevalence of past WNV infections in a population of blood donors. Blood samples were collected from donors with their informed consent. Samples were processed and tested for WNV IgG by enzyme-linked immunosorbent assay (ELISA) (Euroimmun, Germany) according to the manufacturer's guidelines. Demographic data of the donors were recorded. A total of 2821 serum samples were tested. Among them, 28 samples were found to be WNV IgG positive (0.9%) and 41 of them were indeterminate (1.4%). Thus a total of 69 objects were considered to have encountered WNV (2.4%). All of the IgG positive samples (n= 69) and randomly-selected negative samples (n= 60) were re-analysed for the presence of viral RNA by a commercial real-time reverse transcriptase PCR (LightMix® Kit West Nile Virus, TIBMolbiol, Germany). West Nile virus RNA was not found in any of the samples. In conclusion, our data have supported the results of other studies indicating the presence of WNV infection in Turkey. Further larger scale studies are necessary to evaluate the possible risks of WNV infections in our country in terms of blood banking.