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AimsThis study aimed to determine HIV incidence and prevalence in Turkey and to estimate the cost-effectiveness of improving testing and diagnosis in the next 20 years.BackgroundHIV incidence in Turkey has been rapidly increasing in the last decade with a particularly high rate of infection for younger populations, which underscores the urgent need for a robust prevention program and improved testing capacity for HIV.MethodsWe developed a dynamic compartmental model of HIV transmission and progression among the Turkish population aged 15-64 and assessed the effect of improving testing and diagnosis. The model generated the number of new HIV cases by transmission risk and CD4 level, HIV diagnoses, HIV prevalence, continuum of care, the number of HIV-related deaths, and the expected number of infections prevented from 2020 to 2040. We also explored the cost impact of HIV and the cost-effectiveness of improving testing and diagnosis.ResultsUnder the base case scenario, the model estimated an HIV incidence of 13,462 cases in 2020, with 63% undiagnosed. The number of infections was estimated to increase by 27% by 2040, with HIV incidence in 2040 reaching 376,889 and HIV prevalence 2,414,965 cases. Improving testing and diagnosis to 50%, 70%, and 90%, would prevent 782,789, 2,059,399, and 2,336,564 infections-32%, 85%, and 97% reduction in 20 years, respectively. Improved testing and diagnosis would reduce spending between $1.8 and $8.8 billion.ConclusionsIn the case of no improvement in the current continuum of care, HIV incidence and prevalence will significantly increase over the next 20 years, placing a significant burden on the Turkish healthcare system. However, improving testing and diagnosis could substantially reduce the number of infections, ameliorating the public health and disease burden aspects.

Introduction: The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods: Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results: Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion: This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

Covid-19 Pneumonia of SARS-CoV-2 pandemic infection, persists to have high disease burden especially in cancer patients. Increased inflammation and thromboembolic processes are blamed to influence cancer patients more than the others but due to lack of knowledge regarding the pathophysiology of the both the virus itself and the response of the host, more basic and translational disease modeling research is needed to understand Cancer-Covid-19 interaction. In this study, serum samples from the patients, who were hospitalized due to Covid-19 pneumonia, applied to different cancer cells and cytotoxicity, motility, proliferation and gene expression analysis were performed. Serum samples derived from healthy volunteers and the fetal bovine serum that is used regularly in cell culture experiments used as controls. Hospitalized Covid-19 patients who had also cancer, were retrospectively screened, and their clinical course were recorded. Overall 12 Patient (PS) and 4 healthy serums (CS) were included in the experiments. PS applied cells showed increased motility in A549 cells as well as lost cell to cell connection in MCF7 and HCT116 cells, and induced expression of VIM, ZEB1 and SNAIL2 mRNA levels. Eight cancer diagnosed patients who were hospitalized due to Covid-19 between April and September 2020 were also reviewed retrospectively, which 5 of them were dead during SARS-CoV-2 infection. Thorax CT images of the 2 patients showed increased metastatic nodules in the lungs as of January 2021. The results of the study indicate that metastasis may be one of the prolonged consequences of COVID-19 pandemic in cancer sufferers.

Daptomycin is the first member of cyclic lipopeptides came into use in the treatment of resistant gram-positive infections. It is shown to be a good option in the treatment of serious infections caused by gram-positive bacteria. Eosinophilic pneumonia may occur rarely during the use of daptomycin. In this paper we described 5 cases of daptomycin-associated eosinophilic pneumonia. Sudden onset of respiratory failure with tachypnea, tachycardia was observed, peripheral eosinophilia was detected in one patient. The symptoms usually resolved with supportive treatment and after discontinuation of the drug, but steroid treatment and mechanical ventilation was required in some patients. Eosinophilic pneumonia in the sudden onset of respiratory failure should be kept in mind during daptomycin treatment. [Cukurova Med J 2016; 41(2.000): 396-399]

Purpose: We aimed to evaluate retrospectively the results of treatment of patients with chronic hepatitis C in our clinic. Material and Methods: We evaluated the treatment results of 109 patients who treated with the diagnosis of chronic hepatitis C between the years of 2003-2015 in our clinic. Results: The 52.3% of the patients were male, the mean age was 52.3, mean ALT value 58.3 IU/ml and average HCV-RNA levels was 3,7x106 IU/ml. Previous treatment history in 47 patients (43%) was available. Eigthy-one patients (74.3%) received treatment of pegylated interferon and ribavirin and 28 patients(25.7%) received combination of pegylated interferon, ribavirin and telaprevir. Early virologic response were obtained in 99(90.8%) of 109 patients. Sustained virologic response was more higher in patients who achieved early virologic response. Sustained viralogic response in group of PegIFN/R was %74.1 and in group of PegIFN/R/T was 76.9%. At least one of complaints as rash, itching, taste disorder and anorectal pain were observed in PegIFN/R/T group. All patients had anemia as the most common hematologic side-effect. Depressive symptoms was observed in 19% of patients. Conclusion: With available treatment options in our country, patients who can not be achieved to SVR rates are available. There is a need for new antiviral drugs that used in the world for the patients infected with genotype 1 who had unsuccessful treatment. [Cukurova Med J 2016; 41(2.000): 342-346]

In 2016, Rickettsia sibirica mongolitimonae was diagnosed for a man in Turkey. He had been bitten by a Hyalomma marginatum tick, from which PCR detected rickettsial DNA. Sequence analysis of the DNA identified R. sibirica mongolitimonae. Immunofluorescence assay of patient serum indicated R. conorii, which cross-reacts. PCR is recommended for rickettsiosis diagnoses.

AIM: To evaluate the antiretroviral treatment (ART) in newly diagnosed people living with HIV (PLWH) and to determine treatment response in pre-pandemic and pandemic periods. BACKGROUND: The COVID-19 pandemic has negatively affected the treatment processes of PLWH. METHODS: This multi-centred, retrospective study included newly diagnosed PLWH aged ≥18 years, between pre-pandemic (01.03.2018-29.02.2020) and pandemic (01.03.2020-28.02.2022) period. Demographic data and ART were recorded. RESULTS: Of 2400 PLWH from 23 centres, 88% were male; mean age was 37,5±12,5. At diagnosis, mean CD4 count was 398/mm3, CD4/CD8 ratio 0,47, HIV-RNA 12288990 copies/ml. Among patients, 52% diagnosed during pre-pandemic, 48% during pandemic period. Thirty patients could not be treated because one died before treatment, 29 did not re-apply after diagnosis. Of remaining 2370 patients, 93,4% were started on ≥3 antiretroviral drugs, 6,6% on dual therapy; 97,8% were integrase inhibitor (INSTI), 1,8% protease inhibitor (PI), 0,4% non-nucleoside reverse transcriptase inhibitor (NNRTI) based. Of patients, 64,5% were receiving single-tablet, 35,5% multiple-tablet regimen. The mean CD4 count at 6th month was 602/mm3, CD4/CD8 ratio 0,72. HIV-RNA negativity rates at 1st, 3rd, 6th months were 49%, 76%, 88%, respectively. Comparison of two periods is shown in Table 1. INSTI based combinations (p=0,002) and dual therapy (p=0,000) were used more frequently during the pandemic period. Mean CD4 count, CD4/CD8 ratio at 6th month, and HIV RNA negativity rates were similar in both periods (p>0,05). CONCLUSIONS: INSTI based combinations and two-tablet regimens were used more frequently during the pandemic period. The treatment response was similar in both periods.

Purpose: We investigated the effects of hypokalemia on clinical outcomes in hospitalized patients with Covid-19 pneumonia. Materials and Methods: In this single-center retrospective study, we recorded characteristics of hospitalized covid-19 pneumonia patients and laboratory test results on the first hospital day. Duration of hospitalization, requiring intensive care including mechanical ventilation and survival, were determined. Results: Our study included 185 patients and of them 111 male (60% male) patients with mean age of 64 ± 14.5 (23-90). Patients were grouped as hypokalemic (16.8%) and normokalemic patients (83.2%). The number of diabetic patients was higher in the normokalemic group. Serum total protein and albumin levels were lower in hypokalemic group, while alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, direct bilirubin, blood pH and bicarbonate level were higher. In multiple logistic regression analyses, alkalosis increased risk of hypokalemia 5.73 times. Duration of hospitalization, requirement of intensive care and hospital mortality were similar in hypokalemia and normokalemia patients. Conclusion: In patients with Covid-19 pneumonia, hypokalemia has been found to be quite common as high as 16.8% at the first presentation. Hypokalemia was related to metabolic alkalosis but unrelated to the duration of hospitalization, requirement of intensive care including mechanical ventilation and hospital mortality.

Introduction: The number of human immunodeficiency virus (HIV)-infected individuals (HIIs) is increasing day by day and life expectancy is prolonged with the use of highly active antiretroviral therapy (HAART). With the advancing age, chronic diseases that may cause renal dysfunction will also begin to appear. In addition, HIV-associated nephropathy due to inflammation caused by HIV itself and renal dysfunction due to HAART use have been reported in the literature. Considering the social and medical problems caused by HIV, nephropathy as an additional disease makes patient management difficult. Therefore, it is important to detect nephropathy in the early period and take precautions. Creatinine is not always sufficient in the evaluation of nephropathy. New searches are needed in demonstrating nephropathy in HIIs compared to healthy individuals. It was aimed to evaluate cystatin C and NGAL levels in serum, and KIM1 and NGAL levels in urine to determine whether nephropathy developed in HIIs. Materials and Methods: Eighty-eight HIIs in whom renal dysfunction was not detected before and 81 healthy individuals were prospectively evaluated. Cystatin C and NGAL levels were studied in serum samples, while KIM1 and NGAL were studied in urine samples. Serum creatinine, spot urine protein and creatinine levels were recorded in these patients. Results: Of all participants, 114 (67.5%) were male and 55 (32.5%) were female. It was observed that the estimated-glomerular filtration rate (eGFR) was higher, cystatin C level in serum, and NGAL level in serum and urine were higher in the control group than the patient group. Serum creatinine, urinary protein and urinary creatinine levels were higher in the HIV-infected patient group compared to the healthy control group (p

Amaç: Bu çalışmada akut gastroenteritler (AGE) nedeniyle başvuran erişkinlerin dışkı örneklerinde etiyolojik etkenlerin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada, 7 aylık dönemde, günlük dışkı sıklığı 3 üzerinde olan ve belirtileri 14 günden kısa süren ve akut gastroenterit tanısıyla izlenen 110 erişkin hastanın dışkı örneklerinde bakteriyolojik, parazitolojik ve virolojik incelemeler yapılmıştır. Son 10 gün içinde antibiyotik kullanmış hastaların dışkılarında Clostridium difficile’ye ait Toksin A araştırılmıştır. Bulgular: Akut gastroenteritli 110 olgunun 59’u (%53,6) erkek, yaş ortalaması 36 (±14) idi. Hastaların %44,5’inde (n=49) akut gastroenterit etkeni olarak en az bir patojen saptanmış, ancak %55,5’inde herhangi bir etken gösterilememiştir. Dışkı örneklerinde saptanan etkenler sıklığa göre Entamoeba histolytica (%11,8), Shigella türleri (%10,9), rotavirus (%10,9), Giardia intestinalis (%5,4), Salmonella türleri (%2,7), Candida türleri (%2,7), enteropatojenik Escherichia coli (%0,9), Blastocystis hominis (%0,9), Clostridium difficile (%0,9) olarak sıralanmıştır. Hastaların üçünde (%2,7) birden fazla patojen tespit edilmiştir. Shigella türleri (n=12) arasında Shigella sonnei (n=6), Shigella flexneri (n=4) ve Shigella boydii (n=2), Salmonella türleri arasında Salmonella enteritidis (n=2) ve Salmonella arizonae (n=1) belirlenmiştir. Sonuç: Bu çalışmada AGE olgularının dışkı örneklerinin %44,5’inde patojen saptanmıştır. Etiyolojide en sık protozoa (%18,1), başta Shigella türleri olmak üzere bakteriler (%15,5) ve rotavirus (%10,9) belirlenmiştir. Erişkin AGE olgularının %65’inden daha büyük bölümünde tedavide antibiyotik gerekmediği kanaatine varılmıştır.

Objective: The aim of our study was to establish the etiology of and risk factors for infective endocarditis (IE) and determine the prognostic factors for adverse outcome during hospital admission in a Turkish population. Material and Methods: Between January 2002 and January 2004, the clinical and laboratory features of 112 consecutive adult patients (>18 years) with diagnosis of IE who were referred to the infectious diseases clinics/departments of 17 teaching hospitals in Turkey were evaluated. Cases of IE were defined according to the modified Duke Criteria. Mortality was defined as death occurring within 30 days or during hospital stay period. Univariate and multivariate analyses were performed to predict the factors related to fatal outcome. Results: A total of 112 consecutive patients presented with 101 definite and 11 probable IE episodes were defined according to the modified Duke Criteria. The mean age was 45.2±19.9. Fifty percent of the patients were male. Ninety (60.4%) of the 112 patients had risk factors for IE and 48 (42.9%) of them had ≥2 risk factors. On the other hand, 49.1% of patients had cardiac risk factors. Blood cultures were positive in 94 (83.9%) cases. Staphylococci were the most common agents (50.0%), followed by streptococci (28.7%) and enterococi (16.0%). Native cardiac valves were detected in 93 (83%) of the episodes of suspected IE. Valvular involvement was present in 103 (92%) patients; the mitral valve, alone or in combination with other valves, was affected in 70 (62.5%) of the patients. Echocardiography detected vegetations in 105 patients (93.8%). The mortality rate was 28.6%. Three factors were independently associated with mortality: haemodialysis OR: 14.5 (95% CI: 1.5–138.2), mobile vegetation OR: 4.8 (95% CI: 1.5–15.4) and mental alteration OR: 4.1 (95% CI: 1.1–15.6). Conclusion: Mortality is still high in IE. Our data indicate that patients with altered mental status, mobile vegetation, or on haemodialysis had poorer prognosis. [ABSTRACT FROM AUTHOR]

Toksoplazma ensefaliti CD4+ T lenfosit sayısı azalmış olan hastalarda, Toxoplasma gondii’nin latent halde bulunan doku kistlerinin reaktivasyonu ile ortaya çıkan fırsatçı bir enfeksiyondur. Toksoplazma ensefaliti, insan immün yetmezlik virüsü enfeksiyonu ve kazanılmış immün yetmezlik sendromu olan hastalarda, santral sinir sistemi tutulumunun başta gelen nedenlerindendir. Bu yazıda , ateş ve nörolojik bulgularla başvuran, radyolojik incelemeler sonucunda saptanan serebral kitlenin etiyolojisi araştırılırken immün yetmezlik virüsü enfeksiyonu tanısı konan ve antiretroviral ve antiprotozoal tedavi ile tam iyileşme sağlanan bir toksoplazma ensefaliti olgusu sunulmuştur.

Amaç: Kronik hepatit B tanılı hastaların klinik özellikleri ve genotipik dağılımlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Kronik hepatit B tanısı ile Ocak 2011 ve Ocak 2012 tarihleri arasında Enfeksiyon Hastalıkları polikliniğine başvuran hastalar retrospektif olarak değerlendirilmiştir. Hastaların serum örneklerinde bakılan biyokimyasal testler, HBV DNA ve viral genotipleme testleri ve ayrıca karaciğer biyopsisi ile histopatolojik evreleme sonuçları gözden geçirildi. Hbe ag pozitif ve negatif olmak üzere iki gruba ayrılan hastaların özellikleri karşılaştırıldı.Bulgular: Çalışmaya dahil edilen 58 hastanın hepsinde (100%) HBV genotip D tespit edildi. Hastaların yaş ortalaması 40 (18-71) idi. Hastaların 34' ü (58.6%) erkek, 24'ü (41.4%) ise kadındı. Hbe ag pozitif hasta sayısı 13 (22%), Hbe ag negatif hasta sayısı ise 45 (78%) idi.Sonuç: HBV genotipleri, hastalığın bulaş yolunu, seyrini ve verilen tedaviye yanıt oranlarını etkileyebilecek bir parametredir. Dolayısıyla bir bölgedeki veya ülkedeki HBV genotiplerinin bilinmesi, virusun yayılım dinamiği ve uygulanacak tedavilere yanıt oranlarının nasıl olacağı hakkında önemli öngörüler sağlayacağı için önemli bir epidemiyolojik bulgudur.

Introduction: Patients who have tetanus-prone wounds, diabetes mellitus, or chronic wounds are more likely to contract tetanus. In this study, we aimed to evaluate the tetanus immunization status of patients with diabetic foot wounds (DFW) and to determine factors that may predict insufficient immunity to tetanus. Materials and Methods: Patients who presented to our outpatient clinics with DFW were included. Tetanus antibody levels below 0.1 IU/ml were defined as “no reliable protection” and levels of 0.1 IU/ml and above were defined as “reliable protection”. Results: Ninety-one patients were enrolled in the study, 66 (72.5%) were male and the mean age was 62±11 years. Sixty-five (71.4%) of the patients had no reliable protection, while 26 (28.6%) had reliable protection. Age, duration of diabetes mellitus, education level, and residency status were significantly different between the immune and nonimmune groups in univariate analysis. In the multivariate logistic regression analysis, age ≥65 years [Odds ratio (OR): 8.33; 95% confidence interval (CI): 2.03-34.16], diabetes mellitus duration ≥11 years (OR: 6.52; 95% CI: 1.97-21.59), and lowest educational level (OR: 10.51; 95% CI: 1.61-68.52) were identified as independent predictors for insufficient tetanus immunity. Conclusion: We found that elderly patients and patients with lower education have a very low rate of immunity against tetanus. Therefore, tetanus vaccination should be conducted in elderly patients with DFW.

Purpose: We aimed to evaluate retrospectively the results of treatment of patients with chronic hepatitis C in our clinic.Material and Methods: We evaluated the treatment results of 109 patients who treated with the diagnosis of chronic hepatitis C between the years of 2003-2015 in our clinic.Results: The 52.3% of the patients were male, the mean age was 52.3, mean ALT value 58.3 IU/ml and average HCV-RNA levels was 3,7x106 IU/ml. Previous treatment history in 47 patients (43%) was available. Eigthy-one patients (74.3%) received treatment of pegylated interferon and ribavirin and 28 patients(25.7%) received combination of pegylated interferon, ribavirin and telaprevir. Early virologic response were obtained in 99(90.8%) of 109 patients. Sustained virologic response was more higher in patients who achieved early virologic response. Sustained viralogic response in group of PegIFN/R was %74.1 and in group of PegIFN/R/T was 76.9%. At least one of complaints as rash, itching, taste disorder and anorectal pain were observed in PegIFN/R/T group. All patients had anemia as the most common hematologic side-effect. Depressive symptoms was observed in 19% of patients.Conclusion: With available treatment options in our country, patients who can not be achieved to SVR rates are available. There is a need for new antiviral drugs that used in the world for the patients infected with genotype 1 who had unsuccessful treatment.

Daptomycin is the first member of cyclic lipopeptides came into use in the treatment of resistant gram-positive infections. It is shown to be a good option in the treatment of serious infections caused by gram-positive bacteria. Eosinophilic pneumonia may occur rarely during the use of daptomycin. In this paper we described 5 cases of daptomycin-associated eosinophilic pneumonia. Sudden onset of respiratory failure with tachypnea, tachycardia was observed, peripheral eosinophilia was detected in one patient. The symptoms usually resolved with supportive treatment and after discontinuation of the drug, but steroid treatment and mechanical ventilation was required in some patients. Eosinophilic pneumonia in the sudden onset of respiratory failure should be kept in mind during daptomycin treatment.

Introduction: Opportunistic infections are frequent in human immunodeficiency virus (HIV)-positive patients in developed and developing countries. Tuberculosis is one of the most important opportunistic infections. It accelerates the progression of HIV infection and takes place in acquired immunodeficiency syndrome (AIDS)-defining illnesses. In this study, we aimed to investigate the clinical course of tuberculosis developing in HIV-positive patients, and to present our experience with the co-occurrence of these conditions. Materials and Methods: HIV/AIDS patients, who were diagnosed with tuberculosis between 1998 and 2015 in our clinic, were included in the study. Demographic and clinical data were obtained retrospectively. Results: Between 1998 and 2015, 262 HIV-infected patients (75.2% male) were followed up in our clinic and of these patients, 15 (5.73%) were diagnosed as tuberculosis. Thirteen of the patients with tuberculosis (87%) were male and two (13%) were female. The mean age of the patients was 43±10 years. Twelve patients (80%) had pulmonary tuberculosis, whereas two (13%) had miliary tuberculosis, and one (7%) had tuberculous meningitis. While one of the isolates had intermediate susceptibility to rifampicin, the other isolates had no drug resistance. Three patients died while receiving tuberculosis treatment and overall 40% of patients were cured. Conclusion: There are numerous opportunistic infections that can develop during HIV infection. The first and foremost of these opportunistic infections is tuberculosis, which is also an important problem in Turkey. The coexistence of the two diseases brings up some issues, such as poor compliance with treatment and prognosis of HIV infection, increase in drug interactions, adverse events, and prevalence of drug-resistant tuberculosis. Therefore, early diagnosis of tuberculosis as well as importance of precautions for the prevention of reactivation should be kept in mind in HIV-positive patients.

Herpes simplex virus (HSV) is the most common viral cause of sporadic encephalitis. Fever, altered consciousness and focal neurologic signs are typical clinical features of HSV encephalitis. Untreated cases have high mortality. Even with appropriate and timely treatment, permanent neurologic sequelae can still be seen. The diagnostic gold standard is the detection of HSV-DNA in the cerebrospinal fluid, and this method has a high specificity and sensitivity. In HSV diagnosis, cerebral magnetic resonance (MR) is the best radiological examination. In this paper a case with fever and mental confusion for five days who was diagnosed as HSV encephalitis is presented. HSV-polymerase chain reaction (PCR) was positive in the cerebrospinal fluid and cerebral MR revealed hemorrhage in the temporal lobe. Despite acyclovir treatment, sequelae like cognitive disorders and polyphagia were seen. In conclusion, mortality and morbidity of HSV encephalitis can be reduced with early treatment. Acyclovir should be started in patients with suspected HSV encephalitis until proven otherwise.

Introduction: Daptomycin is an agent effective on gram-positive pathogens, which has been used since 2009 for skin and soft tissue infections and endocarditis. In this study, our aim was to see how daptomycin was used in our hospital besides clinical studies, and determine the characteristics of the patients and responses to treatment. Materials and Methods: The patients who were started on daptomycin between 2009 and 2013 were retrospectively evaluated. Demographic characteristics, the clinics of the patients, underlying diseases, infection data, isolated microorganism, treatment and clinical response, and adverse events were recorded. SPSS v20.0 was used for analysis. Results: The mean age of 139 patients were 52.9 ± 16.4, and 48.2% of the patients was male, 51.8% was female. Of the patients, 52 (37.4%) were treated for skin and soft tissue infection; whereas, 53 (38.1%) had osteomyelitis,16 (11.5%) had prosthetic infections, seven had primary blood stream infections (three port infections, three catheter associated bacteremia and one laboratory confirmed bacteremia), four had endocarditis, three had septic arthritis, and four had other infections. Treatment was started empirically in 77% of the patients (n= 107). Eighty-six microorganisms were isolated, of which 68.6% was gram positive and 30% was gram negative. Only ten patients (7.2%) had used glycopeptides before. End of treatment response was 85.6% (119/139) for all patients and 87.7% (50/57) for patients whose specimens yielded gram-positive microorganism. Twelve patients had adverse events (8.6%). The adverse events were seven possible eosinophilic pneumonia, two CK elevations, one palpable purpura, one rash, and one renal function impairment. Conclusion: Daptomycin is an alternative choice for complicated patient groups with complicated skin and soft tissue infections and osteomyelitis, randomized controlled studies especially on bone and joint infections are needed in the future.