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Research of Occult Hepatitis B Infection in HIV-infected Patients, Schindler Study ABSTRACT Objective: Occult hepatitis B infection seems to be more prevalent among subjects at high risk for HBV infection and with concomitant liver disease. The aim of this study was to assess the prevalence of OHBI in group of HIV-1+/HBsAg- Turkish patients. Methods: Ten centers in Turkey have been included in the study. Gender, age, occupation, place of residence, treatment status, clinic, immunodeficiency panel, eliza tests, hemogram, biochemistry and coagulation laboratory results of the patients were evaluated retrospectively. Results: The number of HIV-infected patients followed in these centers is 3172. The mean age of the patients was 37.2 ± 13.1, and they were 235 males (84.5%) and 43 (15.5%) females. 278 (99.6%) of the patients are patients who received antiretroviral treatment. included in the s Of the 279 patients included in the study, it was determined that HBsAg was negative in all of them, 169 were positive for Anti HBs and 125 were positive for Anti HBc IgG. HIV RNA (203/278) was detected in 203 of the patients. 4 (1.4%) of the patients were diagnosed with OHB. In our study, no significant difference was found in hemoglobin and bilirubin levels and complete blood count in patients with HIV-OHB co-infection. However, albumin values were found to be

42nd Interscience Conference on Antimicrobial Agents and Chemotherapy -- SEP 26-30, 2002 -- SAN DIEGO, CA Saltoglu, Nese/0000-0003-4239-9585; Leblebicioglu, Hakan/0000-0002-6033-8543; dokmetas, ilyas/0000-0003-3523-3923; Ersoy, Yasemin/0000-0001-5730-6682 WOS: 000221932100007 PubMed: 15191382 The aim of this study was to investigate the prevalence of hepatitis B virus (HBV) genotypes in Turkey. Epidemiological and clinical data for 158 patients with acute HBV infection from 22 medical centres in the period February 2001 to February 2002 were collected prospectively. HBV genotyping was based on analysis of restriction fragment length polymorphisms and nested PCR. There were 59 female and 99 male patients, with a mean age of 34.2 +/- 15.6 years. The most common probable transmission route was blood contact in 63 (41.1%) cases, but was unknown in 78 (49.4%) cases. The mean alanine aminotransferase level was 1718 +/- 1089 IU/L. Four of the 158 patients (2.5%) died because of fulminant hepatitis. One year after discharge, 11 (10.6%) of 103 cases were positive for hepatitis B surface antigen (HBsAg) and 80 (77.7%) were positive for anti-HBsAg. Genotype determination was unsuccessful in 11 cases because of a negative PCR; genotype D was found in the remaining 147 cases. The results suggested that acute HBV infection constitutes a significant health problem in Turkey and that genotype D is predominant.

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 +/- 2.47 months in P1, 6.52 +/- 4.15 months in P2, and 5.18 +/- 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/ 117) and P3 (6.1%, n = 3/ 49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

The aim of our study was to compare the nephrotoxic effects of liposomal Amphotericin B (Ambisome) and Amphotericin B lipid complex (Abelcet) on rat kidneys at short (14 days) and long term (28 days) treatment applications. Thirty-six male Wistar rats were included and divided into six groups (n=6). Groups 1 and 4 are composed as control groups by administrating intraperitoneal (ip) 0, 9 molar Serum physiologic for a period of 14 and 28 days respectively. Group 2 and 3 are treated with 5 mg/kg Ambisome and 5 mg/kg Abelcet for 14 days respectively, Group 5 and 6 are treated with same agents for 28 days respectively. Then, the rats were transcardially perfused, samples were taken from cortex and medulla regions of kidneys. The micrographs of group 1 and 4 were seen as normal. For short term treatment, some morphological changes were seen in proximal tubule cells in group 3 whereas in group 2 the graphs were observed as normal. However, after long term drug using in group 5 and 6 there were vacuolization, increased lysosomal structures and deep basal folding's into tubular cells lumen. These experiments establish that renal damage were seen in short and long term use of Abelcet and long term use of Ambisome.

Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

Objective: This study is aimed to determine the local profile of blood culture isolates and changes in the susceptibility patterns to guide the antibiotic therapy in oncology and haematology units. Methods: Microbiologically documented hospital-acquired bloodstream infections were reviewed between 2005 - 2007 as a part of infection control surveillance in haematologyoncology department of a university hospital. Results: 194 microorganisms were isolated in 170 bloodstream infections episodes. Among these episodes, 79,1% (n=31), 80,9% (n=51) and 70,5% (n=48) were monomicrobial in years 2005, 2006 and 2007, respectively. Among the isolated 194 microorganisms, the ratio of the gram-negative bacteria were slightly increasing throughout these three years; 68,9%, 70,4% and 77%, whereas the gram-positive bacteria were decreasing 31,1%, 23,9% and 19,2%, respectively and Candida species were the cause of 4 episodes (5,6%) in 2006 and 3 episodes in 2007 (3,8%) (p>0.05). The majority of the cases were primary bloodstream infections. The most prevalent secondary cause of bacteremia was urinary tract infections in year 2005 and 2007 and pneumonia in 2006. Extended spectrum beta lactamases (ESBL) rate among E.coli and Klebsiella spp. isolates were 69,6%, 40% and 79,2% in years 2005, 2006 and 2007 respectively. Vancomycin resistance was high; 15/20 among Enterococcus species in the three years. The most effective agents against gram negative bacteria were aminoglycosides and carbapenems. Conclusion: As a conclusion, gram negative microorganisms especially the Enterobacteriaecea are the major cause of bacteremia in haematology and oncology patients. Due to the high resistance rates, antibiotic therapy should be selected strictly. © Under License of Creat ive Commons Attribution 3.0 License.

PubMedID: 20412409 Aim: To report the incidence of healthcare-associated infections (HAIs), site of infection and bacterial epidemiology in the Neonatal Intensive Care Unit in a university hospital in Adana, Turkey, between 2001 and 2006. Methods: During these years, HAIs were collected by an active surveillance system. Results: Five hundred one of 2832 infants hospitalised more than 72 h had 1124 HAI. The HAI incidence and incidence density ranged between 14.1 and 29.7 infections/100 patients, and 10.9-17.3 infections/1000 patient days within the study period; 61.5% of HAIs were ventilator-associated infections; 26.2% were bloodstream infections; 3.5% were urinary tract infections; 3.5% were necrotising enterocolitis (Stages II and III) and 1.4% was meningitis. The most frequent pathogens were gram-negative pathogens (75.6% of all infections) followed by gram-positive micro-organisms (21.4%) and Candida species (3.0%). Birthweight, gestational age and Apgar scores were lower and overall mortality rate (32.9% vs. 19.7%) and number of inpatient days were higher in patients with HAIs (for all P < 0.001) when compared with those who did not have HAIs. Furthermore, HAI rate was inversely related to birthweight (P < 0.001). Conclusion: In this study, the overall infection rate is high compared with developed countries and predominant micro-organisms are gram-negative enteric rods. These results strongly suggest the need for improving measures for prevention and control of HAIs in this hospital. © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

WOS: 000224790700018 PubMed ID: 15494811 Objective: The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years. Methods: This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria (390 Gram-negative, 180 Gram-positive) against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase (ESBL) production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips. Results: Meropenem was the most effective antibiotic against Gram-negative organisms (89.0%); this was followed by imipenem (87.2%) and piperacillin/tazobactam (66.4%). The most active antibiotic against Gram-positive bacteria was imipenem (87.2%) and this was followed by piperacillin/tazobactam (81.7%) and meropenem (77.8%). The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year (21.7%, 22.1% and 45.5%). All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates. Conclusion: As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance.

PubMedID: 15291364 Here we describe a case of Rosai-Dorfman Disease (RDD) in a 25-year-old female patient from Turkey who was previously misdiagnosed with Toxoplasma Lymphadenitis, and review the manifestations and treatment of this rare entity. To the best of our knowledge this is the third description of RDD [Sinus Histiocytosis with Massive Lymphadenopathy (SHML)], involving bilateral cervical lymphadenopathy and nephromegaly previously misdiagnosed as Toxoplasma Lymphadenitis. Representative clinical, radiographic and histological findings are presented. Its etiology, diagnosis and management are also reviewed. Sinus Histiocytosis with Massive Lymphadenopathy is a rare disorder of unknown etiology, usually associated with lymph node enlargement in various superficial or deep sites. The key histologic feature of SHML is the presence of various numbers of large, pale histiocytic cells that contain within their cellular borders apparently engulfed lymphocytes (emperipolesis); these distinctive large, pale cells are S-100 protein positive CD-68 positive and CD1a negative by immunostaining. According to the literature the most effective treatment found was surgical debulking. © 2004 Taylor & Francis Ltd.

PubMedID: 15494811 Objective: The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years. Methods: This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria (390 Gram-negative, 180 Gram-positive) against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase (ESBL) production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips. Results: Meropenem was the most effective antibiotic against Gram-negative organisms (89.0%); this was followed by imipenem (87.2%) and piperacillin/tazobactam (66.4%). The most active antibiotic against Gram-positive bacteria was imipenem (87.2%) and this was followed by piperacillin/tazobactam (81.7%) and meropenem (77.8%). The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year (21.7%, 22.1% and 45.5%). All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates. Conclusion: As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance.

PubMedID: 9661955 [No abstract available]

PubMedID: 20424552 Background: This study aimed to identify the agents causing community-acquired urinary tract infections (CAUTIs) and their resistance patterns and to investigate risk factors for ESBL production. Material/Methods: Patients diagnosed at the Department of Infectious Diseases in the Cukurova University School of Medicine Hospital with CAUTI between January 2006 and April 2007 were included prospectively. Patient data were recorded and the microorganisms and their sensitivity patterns were evaluated by the university's central microbiology laboratory. Results: A total 146 patients with CAUTIs, 109 women and 37 men (mean age: 50.9±18.44 years), were included in the study. The most common infectious agents were Escherichia coli (76.9%), Klebsiella pneumoniae (9.2%), Proteus mirabilis (4.1%), and Enterococcus spp. (1.6%). The ciprofloxacin resistance rate for E. coli was 35% and resistance to TMP-SMZ 43%, whereas amikacin resistance was substantially low (3%). Four of 12 K. pneumoniae strains were resistant to ciprofloxacin and 2 to TMP-SMZ. Resistance to amikacin was not found in the K. pneumoniae strains. ESBL production was identified in 25 of the 112 E. coli and K. pneumoniae strains. A history of a UTI within the last 6 months (p=0.029) and a history of frequent UTI (p=0.028) were found to be significant risk factors for ESBL production by univariate analysis. The only independent risk factor was a history of urinary system infection in the past 6 months (p=0.025) according to multivariate regression analysis. Conclusions: These high resistance rates to antimicrobials and particularly the extremely high rate of ESBL production in CAUTI should be carefully considered. © Med Sci Monit, 2010.

PubMedID: 12235463 Objective: The aim of this study was to compare the efficacy, tolerability and side effects of 2 treatment regimens for brucellosis. Methods: Fifty-seven patients with brucellosis were followed up in our clinic. The patients were given rifampicin plus doxycycline or rifampicin plus quinolone. Thirty patients (group one) received rifampicin 600mg/daily plus doxycycline 100mg twice daily and 27 patients (group 2) received quinolones (ofloxacin 200mg twice daily peroral) plus rifampicin 600mg/daily. Both regimens were administered for 45-days. During the course of treatment, patients were followed for the disappearance of physical signs and symptoms. All patients were followed up at least 6-months after cessation of therapy. Diagnosis of brucellosis was established by utilizing the following criteria; Isolation of brucella species in blood, body fluids (Sceptor, Becton-Dickinson, United States of America), compatible clinical picture supported by the detection of specific antibodies at significant titers or demonstration, or both, of an at least 4 fold rise in antibody titer in serum specimens taken after 2-weeks. Significant titer was determined to be >one/160 in the standart tube agglutination test (Brucella abortus Cromatest, Linear Chemicals, Spain). Results: Of patients 14 (24.5%) were male and 43 (75.5%) were female. Mean age was 36.8 ± 11.3 years (range 15-65). Sacroiliitis was the most common involvement in both groups 9 (30%) versus 6 (22%), followed by peripheral arthritis 6 (20%) versus 6 (22%). In this study, relapse rate was found 7.2% and 6.7% for ofloxacin plus rifampicin and doxycycline plus rifampicin for a 6-week therapy (p>0.05). No significant adverse effects were associated with either combination. Conclusion: These results indicated that a 45-day course of doxycycline plus ofloxacin combination was as effective as the doxycycline plus rifampicin combination in patients with brucellosis.

WOS: 000326241700021, PubMed ID: 23663858, Background: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value

PubMed ID: 22155822, No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

PubMed ID: 22177310, Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole. © 2011 Erdem et al; licensee BioMed Central Ltd.