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Objective: There are many difficulties in diagnosing and treating Stenotrophomonas maltophilia bacteremia. In this study, we aimed to evaluate “true” and “false-positive bacteremia” and assess mortality risk factors and the impact of different treatment regimens. Materials and Methods: Hospitalized adult patients with S. maltophilia-positive blood cultures were assessed by a two-stage analysis. First, the clinical significance of blood cultures was assessed, and patients were divided into “true” and “false-positive bacteremia” groups. Then, excluding false positives, we analyzed the antimicrobial regimens and the factors associated with 28-day mortality in true bacteremia cases performing univariate and multivariate analyses. Results: The study included 127 out of 138 patients with S. maltophilia bacteremia. True bacteremia was identified in 51.2% and false-positive bacteremia in 48.8% of patients. In the true bacteremia group, hypotension, nosocomial bacteremia, concomitant infections, a source of bacteremia, two positive blood culture sets, and 28-day mortality were more common. The 28-day mortality was 50.7% among true bacteremia cases. In multivariate analysis, age and solid tumor were the independent predictors of 28-day mortality. Early effective antimicrobial therapy and different antimicrobial regimens, including trimethoprim-sulfamethoxazole (SXT), fluoroquinolones (FQs), and tigecycline (TGC), did not have any significant impact on survival. Conclusion: Patients with S. maltophilia bacteremia should first be assessed regarding clinical significance. Clinical findings, the presence of multiple positive blood culture sets and the primary sources of bacteremia are useful parameters while discriminating true from false-positive bacteremia. Patients with advanced age and solid tumors should be followed carefully in terms of mortality. Antimicrobial regimens, including SXT, FQs, or TGC, can be preferred in patients with S. maltophilia bacteremia considering antimicrobial resistance and adverse effects or toxicity. Keywords: Stenotrophomonas maltophilia, true bacteremia, false-positive bacteremia, blood contamination, mortality, treatment

Introduction: Antimicrobial resistance in healthcare-associated gram-negative microorganisms is rising. Monitoring antimicrobial resistance is crucial for determining infection control programs and planning empirical treatment of patients. In this study, it was aimed to determine the distribution of the causative gram-negative bacteria and monitor the antibiotic susceptibility changes of Pseudomonas aeruginosa, Acinetobacter baumanni, Klebsiella spp. and Escherichia coli.

Background/aim: This study aims to evaluate of olfactory and gustatory functions of COVID-19 patients and possible risk factors for olfactory and gustatory dysfunctions. Materials and methods: The cross-sectional study included adult patients who were diagnosed with COVID-19 in Gazi University Hospital between April 2020 and June 2020. Volunteered patients participated in a survey in which olfactory and gustatory functions and various clinical information were questioned. Sinonasal Outcome Test-22 was also administrated to all patients. Results: A hundred and seventy-one patients participated in this study. Olfactory and gustatory dysfunctions rates were 10.5% (n: 18) and 10.5% (n: 18), respectively. Patients without any symptom other than smell and taste dysfunctions were clustered as group 1 and patients who are clinically symptomatic were clustered as group 2. Olfactory dysfunction occurred in 8% of group 1 and 17.4% of group 2 (p = 0.072). Gustatory dysfunction rate of smokers was 19.7% and significantly higher than gustatory dysfunction rate of nonsmokers (5.5%) (p = 0.007). Twenty-seven-point-eight percent of the patients with olfactory dysfunction (n = 5) were male and 72.2% (n: 13) were female. Sex did not show significant effect on rate of olfactory dysfunction. Twenty-five patients participated in psychophysical olfactory function test. No participant reported olfactory dysfunction at the time of test. Of the participants, 64% (n: 16) were normosmic and 36% (n: 9) were hyposmic according to Sniffin' Stick test. Conclusion: Olfactory and gustatory dysfunctions are more common in patients who are clinically symptomatic than those diagnosed during contact tracing. Objective tests may show that frequency of olfactory dysfunction is greater than frequency of self-reported olfactory dysfunction.

Background:This study aimed to evaluate the impact of tocilizumab treatment on clinical improvement in severe COVID-19 cases and the factors affecting clinical response.Methods:This single-center, retrospective, descriptive study was conducted on severeCOVID-19 patients. The ordinal scale of clinical status scores on the 0th, 1st, 3rd, and 7th days of tocilizumab treatment was calculated and compared for each patient. The ordinal scale of clinical status scores calculated on different days for the same patient was compared with Wilcoxon tests. The correlation between the clinical score and some laboratory parameters was evaluated by Pearson correlation analysis. Patients were grouped as responders and non-responders and compared by logistic regression analysis.Results:Forty-two patients were enrolled in the study. The median of the ordinal scale of clinical status scores on the 0th, 1st, 3rd, and 7th days of tocilizumab treatment were 6 (5 to 6), 6 (5 to 6), 6 (5 to 6), and 5 (4 to 7), respectively. When the clinical status scores on the 0 to 7 days of tocilizumab treatment were compared, the difference was statistically significant (p = 0.024, Wilcoxon). There was no statistically significant difference between day 0 and day 1 (p=0.317, Wilcoxon), day 0 and day 3 (p=0.467, Wilcoxon). By multivariate analysis, we determined that age ( OR: 0.91, 95% 0.84-0.98) and respiratory rate (OR:0.78, 95% 0.62-0.98) were factors affecting the response of tocilizumab treatment. No relationship was detected between laboratory parameters before tocilizumab treatment, including IL-6 levels and clinical response (p=0.756, Mann Whitney-U).Conclusion:The use of tocilizumab in younger patients with low oxygen support increases the chance of clinical response after treatment. Since the effect of laboratory parameters in predicting the clinical response of tocilizumab is limited, treatment indications should be determined based on clinical parameters.

Excessive inflammatory immune response during SARS-CoV-2 infection contributes to severe disease in COVID-19 patients. Recently, some researchers hypothesized that dysregulation of the bradykinin (BK) system may also play a role in the pathogenesis of severe disease. Des-Arg(9)-bradykinin (DABK), an active metabolite of BK, is responsible for vasodilatation and increased permeability in the lungs and regulated by angiotensin converting enzyme 2 (ACE-2). Viral inhibition of ACE-2 by SARS-CoV-2 increases DABK levels. Serum levels of this metabolite may be linked to disease severity in COVID-19 patients. In this study, it is aimed to investigate the prognostic value of serial measurement of serum DABK levels in severe COVID-19 patients.This prospective cohort study was conducted in hospitalized severe COVID-19 patients. Serum DABK levels of patients were serially measured on day 0, day 3 and day 5. Patients were categorized as cases with poor or good prognosis and critical or non-critical cases. Serum DABK levels of these patient groups were compared with paired sample t-test. Serum DABK levels on different days in the same patients were compared with repeated measures ANOVA tests.There was no statistically significant difference in serum DABK levels measured at day 0, day 3, and day 5 between good and poor prognosis groups. DABK levels in critical and non-critical COVID-19 patients also did not show any significant difference.According to our results serially measured serum DABK levels did not correlate with outcome of severe COVID-19 and do not have prognostic value in severe COVID-19 patients.

Pseudomonas stutzeri (P. stutzeri) is a gram-negative, aerobic and saprophytic microorganism which found in soil, water and hospital environments. Isolation of bacteria from clinical samples usually refers to colonization rather than infection. However, it rarely causes serious infections. This report presents a 33-year-old male immunocompetent patient who developed P. stutzeri meningitis after cerebrospinal fluid (CSF) fistula operation. Although our case was considered mainly a hospital-acquired infection, the fact that the patient was a recycling employee raises suspicion about the source of the infectious agent. In the literature, four cases of meningitis caused by this microorganism have been identified. When these cases were examined, it was seen that three of them had underlying diseases and the other one had no comorbid disease, but he was older than 65 years. Although our patient is young and has no underlying disease or immunosuppression, the development of meningitis with P. stutzeri, a rare infectious agent, is remarkable. In conclusion, it should be kept in mind that rare agents such as P. stutzeri may be the cause of hospital-acquired meningitis.

Background/aim Pneumonia is the most serious clinical presentation of COVID-19. This study aimed to determine the demographic, clinical, and laboratory findings that can properly predict COVID-19 pneumonia. Materials and methods This study was conducted in the Gazi University hospital. All hospitalized patients with confirmed and suspected SARS-CoV-2 infection between 16 March 2020 and 30 April 2020 were analyzed retrospectively. COVID-19 patients were separated into two groups, pneumonia and nonpneumonia, and then compared to determine predicting factors for COVID-19 pneumonia. Variables that had a P-value of less than 0.20 and were not correlated with each other were included in the logistic regression model. Results Of the 247 patients included in the study 58% were female, and the median age was 40. COVID-19 was confirmed in 70.9% of these patients. Among the confirmed COVID-19 cases, 21.4% had pneumonia. In the multivariate analysis male sex (P = 0.028), hypertension (P = 0.022), and shortness of breath on hospital admission (P = 0.025) were significant factors predicting COVID-19 pneumonia. Conclusion Shortness of breath, male sex, and hypertension were significant for predicting COVID-19 pneumonia on admission. Patients with these factors should be evaluated more carefully for diagnostic procedures, such as thorax CT.

Introduction: This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and clinical course and outcome of Coronavirus disease-2019 (COVID-19). Materials and Methods: In this single-center, prospective study, patients with COVID-19 were divided into three groups with uncomplicated disease, mild pneumonia, and severe pneumonia. Cases were compared in terms of clinical and laboratory findings as well as serum 25(OH)D levels on hospital admission. Patients were also grouped according to their COVID-19-related outcomes and then compared in terms of 25(OH)D levels. Results: The median serum 25(OH)D levels of the COVID-19 and control groups were 16 (11-23) ng/ml and 21.5 (18-25) ng/ml, respectively (p

Angiotensin-converting enzyme (ACE)/Angiotensin (Ang) II pathway has crucial regulatory effects on circulatory hemostasis and immune responses. This pathway has a major role in the development of acute lung injury and acute respiratory distress syndrome (ARDS), which is a devastating complication of SARS-CoV-2 infection. The aim of this study is to investigate the serum ACE activity and its correlation with clinical features and the disease severity in patients with COVID-19. Patients with confirmed COVID-19 by detecting SARS-CoV-2 nucleic acid RT-PCR were included in the study. Demographic data, clinical features, laboratory and radiologic investigations were recorded. Patients were classified by disease severity; asymptomatic, mild, and severe pneumonia. The serum ACE activity was evaluated with an autoanalyzer based on a spectrophotometric method. Fifty-five patients (50.9% female) and 18 healthy subjects (33.3 % female) were enrolled in the study. The median age of patients was 40 years, ranging from 22 to 81 years. Eighteen healthy subjects were served as the control group. The baseline characteristics were comparable between groups. The median serum ACE activity of patients and controls (38.00 [IQR 21] U/L and 32.00 [IQR 24] U/L, respectively) and of between patients grouped by disease severity (38.5 [IQR 19], 36 [IQR 25], and 38 [IQR 22] U/L, asymptomatic, mild and severe pneumonia group, respectively) were similar. There was no correlation between the serum ACE activity and conventional inflammatory markers. In this study, we did not find an association between serum ACE activity and COVID-19 and serum ACE activity on admission did not reflect disease severity.

Objective: The aim of this study was to investigate the distribution of pathogens in urine cultures with significant bacteriuria from inpatients and outpatients, and to detect extended-spectrum beta-lactamase (ESBL) production rates among Enterobacteriaceae and their antimicrobial susceptibilities in our hospital.

Highlights • Coronovirus 2019 (COVID-19) infection induces cytokine storm causing mortality. • Interleukin (IL)-18 is one of the key cytokines in the macrophage activation syndrome. • IL-18 elevated in COVID-19 patients and might be a therapeutic target., Background The effectual immune response is crucial to defeat viral infections. However, exuberant immune response with features of macrophage activation syndrome (MAS) lead detrimental consequences in COVID-19 patients. Interleukin (IL)-18 is one of the leading cytokines in MAS which has not been studied in COVID-19. Objective To investigate the association of IL-18 with the other inflammatory markers and disease severity in COVID-19 for predicting disease prognosis. Methods Patients with COVID-19 who had confirmed diagnosis with SARS-CoV-2 nucleic acid RT-PCR were enrolled into the study. Data on demographic and clinical characteristics, and laboratory values of CRP, ferritin, d-dimer and procalcitonin were measured on admission. Patients were followed up prospectively with a standardized approach until hospital discharge or death. Individuals were classified as asymptomatic, mild and severe pneumonia according to their clinical, laboratory and radiological characteristics. Worse outcome was defined as requirement of intensive care unit (ICU) admission or death. Blood samples were collected at enrollment and serum levels of IL-6 and IL-18 were determined by ELISA. Association between IL-18 and other inflammatory markers and prognosis were analyzed. Results There were 58 COVID-19 patients (50% male) with a median age of 43 (min 22-max 81) years. Twenty age and sex matched healthy subjects were served as control group. The study population was divided into three groups according to disease severity: asymptomatic (n = 20), mild pneumonia group (n = 27) and a severe group (n = 11). During follow up nine (15.5%) patients required ICU admission and three of them were died eventually. Serum IL-18 were correlated with other inflammatory markers and biochemical markers of organ injury; creatinine, liver enzymes and troponin. Serum IL-18 levels were remarkably higher in COVID-19 patients compared to healthy subjects with being highest in severe pneumonia group (p

Background/aim The aim of this study was to investigate the microbiological profile and resistance rates of diabetic foot infections (DFIs) and to determine the effect of peripheral arterial disease (PAD) on the microbiology, clinical condition, and treatment outcomes. Materials and methods Characteristics, laboratory and imaging data, and the treatment modalities of patients admitted to our hospital with a diagnosis of DFI (PEDIS classification 3–4) during 2005–2016 were analyzed according to the presence of PAD. Results Of 112 patients who were included in this study, 86 (76.8%) had PAD. Patients with PAD were older and had higher amputation rates (P < 0.05). A microbiological profile of patients revealed a predominance of gram-positive bacteria (57.1%). Staphylococcus aureus and Streptococcus spp. were the most frequently encountered bacteria. Incidence of Pseudomonas spp. infection was higher in the PAD group (P < 0.05). Of all patients, 24.1% had multidrug-resistant (MDR) microorganisms in their wound cultures. Presence of MDR bacteria in patients with PAD was 4.9-fold higher than that in patients without PAD (P < 0.05). Conclusion This retrospective study indicates that PAD has a significant role, especially in elderly patients with DFIs. Patients should be promptly evaluated and treated for PAD to prevent infections with resistant microorganisms and limb loss.