Search

ORIGINAL ARTICLE: Yılmaz N, Çifci A, Balcı M, Cesur S, Sabah Özcan S, Şen SS, et al. Hemodiyaliz hastalarında okült hepatit B ve hepatit C enfeksiyonu sıklığı [Frequency of occult hepatitis B and C infections in hemodialysis patients]. Ortadogu Tıp Derg 2018;10(2):174-8. https://doi.org/10.21601/ortadogutipdergisi.324840 This document states corrections to the original article., ORİJİNAL MAKALE: Yılmaz N, Çifci A, Balcı M, Cesur S, Sabah Özcan S, Şen SS, et al. Frequency of occult hepatitis B and C infections in hemodialysis patients [Frequency of occult hepatitis B and C infections in hemodialysis patients]. Ortadogu Tıp Derg 2018;10(2):174-8. https://doi.org/10.21601/ortadogutipdergisi.324840Bu doküman, orijinal makaledeki hataları bildirmektedir.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of serious infectious diseases in intensive care units. Novel antibiotic combination therapies are needed to treat serious infectious diseases caused by MRSA. Objectives: Our objective was to evaluate the minimum inhibitory concentrations (MICs) of ceftaroline (CPT), telavancin (TLV), daptomycin (DPC), and vancomycin (VA) alone and in vitro synergistic activity of CPT-TLV, CPT-DPC, and CPT-VA combinations against MRSA isolates. Methods: Fifty MRSA strains isolated from blood (90%) and tracheal aspirate (10%) of patients in intensive care units (ICUs) between 2013 and 2016 were included in the study. The Epsilometer test was used for determining the synergistic activities of antibiotic combinations. We evaluated the synergistic, additive, indifferent, and antagonist effects of MRSA strains by the fractional inhibitory concentration (FIC) index. Results: Of the 50 MRSA strains tested, 100% were susceptible to TLV, DPC, and VA. CPT was detected as resistant in 3 (6%) of the isolates. CPT-TLV, CPT-DPC, and CPT-VA combinations were found to have synergistic effects in 14%, 38%, 10% and additive effects in 40%, 32%, and 22% of the isolates, respectively. No antagonism was detected in any of the combinations. Conclusions: The combination of CPT with DPC showed the best synergy profile among all antibiotic combinations tested against MRSA isolates obtained from patients in ICUs.

Aim: The aim of this study is to assess knowledge levels of intensive care unit staff working at four training and research hospitals in Ankara about infection prevention measures before and after receiving training, and to determine the factors which will affect knowledge levels about infection prevention measures. Material and Methods: Doctors and nurses who work at intensive care units in Ankara Numune Training and Research Hospital (TRH), Ankara TRH, Dr. Zekai Tahir Burak Women’s Health TRH and Ankara Turkey High Speciality TRH participated voluntarily in the study between March-April 2015. A questionnaire comprising ten questions about infection prevention measures was administered to healthcare professionals who volunteered to participate in the study (doctors and nurses), and then participants received a training regarding infection prevention measures, after the training, the same questionnaire was administered in order to evaluate the differences statistically. One hundred-sixty four health care workers were included in the study. Answers given to the questionnaire items before and after the training were listed in Excel program and statistical analysis was carried out with SPSS 15.0 (Statistical Package for the Social Sciences) data analysis program. Value of p≤0.05 was considered as statistically significant. Results: While the success rate was 72% before the training, it reached to 83% after the training, the average number of correct answers was eight before the training (1-10), after the training, the average number of correct answers was nine (4-10) and statistically significant difference was observed (p=0.00). Knowledge levels of health care professionals about infection prevention measures significantly increased after the training. Those who have received such training in their earlier professional life had statistically higher knowledge levels compared to those who have not received such training earlier in their career. It was observed that knowledge level increased through training in both genders and in every age group. Conclusion: As a result of the renewal of knowledge with continuous training of health personnel and updating services as well as evaluating the training by using the tests before and after the training is an effective approach to the prevention of infections associated with healthcare associated infections.

Background: We report an outbreak of surgical site infections due to genetically related strains of Streptococcus pyogenes in a cardiovascular surgery department. Methods: The practices that were possibly related to the outbreak were investigated through direct observation and interviews with staff by an infection control team. Surveillance sampling from patients, health-care workers, and environment were done for the investigation of the source. Pulsed-field gel electrophoresis was used to investigate a clonal relationship among the S. pyogenes isolates. Results: Four patients operated on in the cardiovascular surgery department developed surgical site infection due to S. pyogenes. Molecular characterization of S. pyogenes done by pulsed-field gel electrophoresis revealed the same strain. Conclusions: Although a definite source for the outbreak could not be identified, probably lack of adherence to hand hygiene practices during surgical dressings, contamination, and cross contamination led to th...

Amaç:Bu çalışmada Ankara ilinde dört eğitim ve araştırma hastanesinin yoğun bakımünitesinde çalışan sağlık personelinin enfeksiyon kontrol önlemleri hakkındakibilgi düzeyinin eğitim öncesi ve eğitim sonrasında değerlendirilmesi ve bilgidüzeylerini etkileyebilecek faktörlerinbelirlenmesi amaçlanmıştır. Gereç ve Yöntemler:Çalışmaya Mart-Nisan 2015 tarihleri arasında AnkaraNumune Eğitim ve Araştırma Hastanesi, Ankara Eğitim Araştırma Hastanesi, Dr.Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi yoğunbakımlarında çalışan ve çalışmaya katılmayı kabul eden doktor ve hemşireler dahiledilmiştir. Enfeksiyon kontrol önlemleri ile ilgili on adet soruyu içeren biranket formu çalışmaya katılmak isteyensağlık personeline (doktor ve hemşire) uygulanmış, bir ay sonra enfeksiyon kontrol önlemlerine ilişkin bireğitim verildikten sonra aynı anket formu uygulanarak eğitim sonrasındaki değişiklikler istatistiksel olarak değerlendirilmiştir. Çalışmaya toplamda 164 sağlık çalışanı dahil edilmiştir. Eğitimöncesi ve eğitim sonrasındaki anket formuna verilen yanıtlar Excel programınagirilmiş ve SPSS (Statistical Package for the Social Sciences) 15.0 verianalizi programı ile istatistiksel değerlendirmeler gerçekleştirilmiştir.P≤0.05 değeri istatistiksel olarak anlamlı kabul edilmiştir.Bulgular:Eğitim öncesi başarı oranı %72 iken, eğitim sonrası başarı oranı %83’eyükseldi, doğru cevap sayısı eğitimden önce ortalama sekiz iken (1-10),eğitimden sonra dokuz (4-10) olarak saptandı ve bu fark istatiksel olarakanlamlı idi (p=0.00). Sağlıkpersonelinin enfeksiyondan korunma önlemleri hakkındaki bilgisi eğitimden sonraanlamlı olarak artmıştır. Daha önceki meslek hayatında eğitim alanların bilgisialmayanlara oranla anlamlı olarak yüksek çıkmıştır. Her iki cinste ve tüm yaşgruplarında eğitimle bilgi düzeyinin arttığı saptanmıştır.Sonuç: Sonuçolarak, sağlık personelinin süreklihizmet içi eğitimlerle bilgilerinin yenilenmesi ve güncellenmesi, bunun yanısıra eğitim öncesi ve sonrasında uygulanacak testlerledeğerlendirilmesinin sağlık hizmetleriyle ilişkili enfeksiyonların önlenmesindeyararlı olacağı görüşündeyiz., Aim: The aim of this study is to assess knowledgelevels of intensive care unit staff working at four training and researchhospitals in Ankara about infection prevention measures before and afterreceiving training, and to determine the factors which will affect knowledgelevels about infection prevention measures.Material and Methods:Doctors and nurses who work at intensive care units in Ankara Numune Trainingand Research Hospital (TRH), Ankara TRH, Dr. Zekai Tahir Burak Women’s HealthTRH and Ankara Turkey High Speciality TRH participated voluntarily in the studybetween March-April 2015. Aquestionnaire comprising ten questions about infection prevention measures wasadministered to healthcare professionals who volunteered to participate in thestudy (doctors and nurses), and then participants received a training regardinginfection prevention measures, after the training, the same questionnaire wasadministered in order to evaluate the differences statistically. Onehundred-sixty four health care workers wereincluded in the study.Answersgiven to the questionnaire items before and after the training were listed inExcel program and statistical analysis was carried out with SPSS 15.0(Statistical Package for the Social Sciences) data analysis program. Value ofp≤0.05 was considered as statistically significant.Results:While the success rate was 72% before the training, it reached to 83% after thetraining, the average number of correct answers was eight before the training(1-10), after the training, the average number of correct answers was nine(4-10) and statistically significant difference was observed (p=0.00).Knowledge levels of health care professionals about infection preventionmeasures significantly increased after the training. Those who have receivedsuch training in their earlier professional life had statistically higherknowledge levels compared to those who have not received such training earlierin their career. It was observed that knowledge level increased throughtraining in both genders and in every age group. Conclusion: As a result of the renewal of knowledgewith continuous training of health personnel and updating services as well as evaluating the training by usingthe tests before and after the training is an effective approach to the prevention ofinfections associated with healthcare associated infections.

Amaç: Hepatit B virüsü (HBV) ve Hepatit C virüsü (HCV) diyaliz ünitelerinde sıklıkla bulaşabilen virüslerdendir. Okült HBV veya HCV enfeksiyonu serumda HBsAg veya anti-HCV saptanamayankişilerdeki HBV veya HCV enfeksiyonunun varlığının kan veya karaciğer dokusundamoleküler yöntemlerle (HBV-DNA, HCV-RNA ile) gösterilmesidir. Bu çalışmada hemodiyalize giren, HBV ve HCVseronegatif hemodiyaliz hastalarına ait plazma örneklerinde HBV-DNA ve HCV-RNA tayini ile okült HBV ya da HCV enfeksiyonu sıklığınınaraştırılması amaçlandı.Gereç ve Yöntem: Çalışmaya hemodiyalizegiren, HBV ve HCV göstergeleri (HBsAg, HBcIgG ve IgM , Anti-HCV) negatif olan121 erişkin hasta dahil edildi. Hastalar hemodiyaliz süresi, kan transfüzyonuöyküsü, ailede hepatit B ve C enfeksiyonu varlığı açısından sorgulandı.Hastalardan alınan plazma örneklerindeHBV-DNA ve HCV-RNA varlığı COBAS® TaqMan® 48 Analyzer (for automated real-time PCR amplificationand detection) kullanılarak COBAS Taqmankitleri ( Cobas Taqman HBV v.2 ve HCV v.2 Roche, US) kiti ile kantitatif olarak araştırıldı. . Bulgular: Toplam 121 hemodiyalizhastasının 1’inde (%0.82) HCV-RNA pozitifliği saptanırken (138.000 IU/ml ), 10(%8.2)’unda HBV-DNA saptanabilir düzeyde idi. HBV-DNA saptanan 10 plasma örneğinin 7 (%70)’sinde HBV-DNA düzeyi < 6IU/ml iken 3(%30)’ünde HBV-DNA düzeyi > 6IU/ml olarak bulundu. HBV-DNA düzeyi > 6IU/ml olan 3 hastaya ait HBV-DNA miktarları 108 IU/ml, 157.000.000 IU/ml ve 72.5 IU/ml olarak saptandı.Sonuç: Çalışmamızda Hepatit B ve C yönünden serolojik göstergeleri negatif olanhemodiyaliz hastalarında okült hepatit B enfeksiyonu sıklığı okült hepatit Cenfeksiyonundan yaklaşık 10 kat daha fazla oranda saptandı. Serumda, veyakaraciğerde HBV DNA veya HCV RNA pozitifliği hemodiyaliz ünitelerindepotansiyel bulaş kaynağıdır. Hemodiyaliz hastalarında HBV veya HCV’yebağlı okült hepatit varlığı diğer hastalara ve sağlık personeline bulaşolasılığı ve böbrek naklinden sonra hastalarda özellikle hepatit reaktivasyonu veya kronik karaciğer hastalığı gelişmesiaçısından önemlidir. Bu nedenle özellikle transplantasyon planlanan hemodiyalizhastalarında okült hepatit varlığı moleküler yöntemlerle araştırılmasınınyararlı olacağı görüşündeyiz., Aim: Hepatitis B (HBV) virus andHepatitis C virus (HCV ) are commonly transmitted viruses in dialysis units.Occult HBV or HCV infections are HBV or HCV infections in patients when HBs Agor anti-HCV is not detected in serum. In this study, it was aimed to detect HBVDNA and HCV RNA in plasma samples belonging to hemodialysis patients who areseronegative for HBV and HCV and to investigate frequency of occult HBV or HCVinfections.Material and Method: 121 adult patientswho are receiving hemodialysis and whose HBV and HCV indicators (HBsAg, HBcIgG andIgM, Anti-HCV) are negative were included in the study. Presence of HBV-DNA andHCV-RNA in plasma samples of patients was investigated by using COBAS® TaqMan®48 Analyzer (for automated real-time PCR amplification and detection) in aquantitative fashion with COBAS Taqman kits (Cobas Taqman HBV v.2 and HCV v.2Roche, USA)Results: In 1 out of 121 hemodialysispatients (0.82%), HCV-RNA level was detected as 138.000 IU/ml, in 10 out of 121hemodialysis patients (8.2%) HBV-DNA was at detectable level. While in 7 of 10plasma samples (70%) in which HBV-DNA was detected, HBV-DNA level was 6IU/ml.HBV-DNA amounts belonging to 3 patients whose HBV-DNA level was >6 IU/mlwere found as 108 IU/ml, 157.000.000 IU/ml and 72.5 IU/ml.Conclusion: It was found out that inhemodialysis patients whose serologic indicators for Hepatitis B and C arenegative, occult Hepatitis B infection is seen 10 times more frequently thanHepatitis C infection. Positive demonstration of HBV-DNA or HCV-RNA in serum orliver is potentially seen in hemodialysis units. Incidence of occult hepatitisdue to HBV or HCV in hemodialysis patients is of significant importance interms of the probability of its transmission to other patients and healthcarestaff and development of especially hepatitis reactivation or chronic liverdisease in patients after kidney transplant.For this reason,we believe it would be particularly useful to investigate the presence ofoccult hepatitis by molecular methods in hemodialysis patients especially scheduled for transplantation.

Trimethoprim-sulfamethoxazole (TMP-SMZ) is recommended as the treatment of choice for Stenotrophomonas maltophilia infections. However, when the administration of TMP-SMZ is not possible, alternative treatment options for S. maltophilia infections has not been clearly established. We compare the efficacy of tigecycline treatment with TMP-SMZ in nosocomial S. maltophilia infections during a 3-year period. For the treatment of S. maltophilia infection, 26 (57.8%) patients received TMP-SMZ and 19 (42.2%) patients received tigecycline. Culture positivity rate was 95.7% in TMP-SMZ group and 70.6% in tigecycline group at the seventh day (P = 0.028), whereas 26.3% versus 18.8% at the fourteenth day (P = 0.700). Clinical improvement was observed 69.2% in TMP-SMZ group and 68.4% in tigecycline group at the fourteenth day (P = 0.954). Mortality rates at the thirtieth day were respectively, 30.8 and 21.1% in TMP-SMZ and tigecycline groups (P = 0.517). There were no significant differences in mortality and clinical response rates between TMP-SMZ and tigecycline treatment. Tigecycline can be considered as an alternative option beyond TMP-SMZ in treatment of S. maltophilia infections.

Splenic abscess is a very rare complication of non-typhoidal Salmonella infections. We report a case of splenic abscess caused by Salmonella enteritidis. The patient is a 63-year-old woman with diabetes mellitus and underwent splenectomy. This case suggests that the patients with comorbities are at increased risk for invasive infections in non-typhoidal Salmonella infections.

Hydatidosis is endemic in many Mediterranean countries, the Middle East, South America, Australia, New Zealand and Africa. It is caused by an infection from the Echinococcus granulosus larvae which can lead to the development of cysts. The most frequently affected organ is the liver. Splenic involvement alone is very rare. In this article, a case of an isolated giant splenic hydatid cyst is reported. The patient underwent splenectomy. The diagnosis of a hydatid cyst was confirmed by histopathology. This case suggests that hydatid disease should be considered as a differential diagnosis in every patient with a cystic mass of the spleen in endemic areas.

tobramycin, 41% also received vancomycin. Kidney function was assessed by estimated glomerular filtration rate (eGFR), recorded prior to treatment, weekly during treatment, and 1 month, 3 months, and 1 year after IE treatment. Therewas ameandecrease of eGFR from88.4 to 78.0mL/min (−11.8%) from start of tobramycin treatment to 1 week post-treatment. The decrease was accentuated 1 month post-treatment (−12.4%). A gradual reversibility was recorded 3 months (−7.4%) and one year (−6.3%) post-treatment, respectively. Age, total dose of tobramycin, cardiac surgery, concomitant treatment with potential renal toxic drugs, concomitant vancomycin treatment, and elevated serum tobramycin concentrations were associated with accentuated in-hospital decrease in eGFR. Major risk factors for permanent decrease in kidney function were established after subgroup analyses of comparable groups. A total dose of >2500mg tobramycin implicated a decreased reversibility of eGFR during 1-year F/U. Concomitant vancomycin + tobramycin therapy caused a 19% loss in eGFR while no reduction followed sequential vancomycin + tobramycin therapy. Patients with an intial eGFR 2500mg tobramycin caused a decreased reversibility during 1-year F/U, while short-term therapy