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Objectives: Streptococcus pneumoniae infections are an important cause of morbidity and mortality, especially among high-risk groups. Our country has limited data on the clinical findings of pneumococcal infections and invasive pneumococcal disease (IPD). Therefore, we aimed to evaluate patients’ demographic and clinical findings with pneumococcal infection. Methods: The data of the patients who were admitted to our hospital between January 2012 and December 2016 were analyzed retrospectively. Isolation of Streptococcus pneumoniae from sterile body sites was defined as invasive pneumococcal disease. Demographic data, clinical findings, laboratory values, and death rates of patients with the pneumococcal disease were analyzed statistically. Results: One hundred and fifty-four patients were included in the study. Of these patients, 106 (68.8%) were male, and the mean age was 65.3±15.6 (20-94). The diagnosis of the patients were pneumonia (79.2%), sepsis (10.4%), wound infection (3.2%), peritonitis (1.9%), epididymoorchitis (3.2%), pyelonephritis (3.2%), meningitis (1.3%), brain abscess (0.6%), arthritis (0.6%), endocarditis (0.6%) and pericarditis (0.6%). The mean follow-up period was 27.8±22.3 months. The overall mortality rate was 32.5% in all patients. Invasive pneumococcal disease was detected in 31 (20.1%) of all patients. C-reactive protein (CRP) levels (>14.4 mg/dL), penicillin and ciprofloxacin sensitivity rates were significant parameters in invasive pneumococcal disease patients (p=0.039, p=0.028 and p=0.045). Pneumococcal strains obtained from patients with IPD were more susceptible to penicillin and ciprofloxacin than non-invasive pneumococcal strains (96.4% and 78.8%, p=0.028; 100%, and 42.9%, p=0.045). Conclusion: Knowledge of risk factors associated with pneumococcal infections in our country is crucial in supporting national immunization programs. CRP elevation, penicillin sensitivity, and fluoroquinolone sensitivity rates were significantly higher in patients with IPD. According to the results of our study, immunocompromised patients and patients with comorbidities have a higher risk for the development of invasive disease. Keywords: invasive, pneumococcus, risk factors, Streptococcus pneumonia

Calismamizda gecici uriner kateterizasyon uygulanan hastalarda kateter ici ve es zamanli idrar ornegi alinarak kateter lumeninde ve idrarda mikroorganizma kolonizasyonunun arastirilmasi ve olasi risk faktorlerinin degerlendirilmesi amaclandi. Eskisehir Osmangazi Universitesi Tip Fakultesi Egitim, Arastirma ve Uygulama Hastanesi Genel Cerrahi, Uroloji, Ortopedi ve Travmatoloji, Kadin Hastaliklari ve Dogum kliniklerinde 3 aylik calisma periyodu boyunca gecici uriner kateterizasyon uygulanan hastalarda kateter ici ve es zamanli idrar ornegi alinarak kateter lumeninde ve idrarda ureyen mikroorganizmalar ve risk faktorleri degerlendirmeye alindi. Yatis esnasinda uriner sistem enfeksiyonu (USE) klinik ve bulgulari olan hastalar calisma kapsami disinda birakildi. Hastalarin demografik bilgileri kaydedildi. Kateter lumeni veya idrar kulturlerinde ureyen mikroorganizmalar mini API cihazi yardimiyla tanimlandi. Veriler SPSS 15.0 istatistik programi ile degerlendirildi, p 7 gun olmasi (OR= 3.232) gecici uriner kateterizasyon uygulanan hastalarda kateter ici ve idrarda mikroorganizmalarin kolonizasyonu acisindan onemli risk faktorleri olarak saptandi (her biri icin p

Objectives Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. Patients and methods In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. Results A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). Conclusion Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Background and Aims: Several biomarkers are used in the diagnosis of bacteremia. Procalcitonin (PCT) is more specific than other biomarkers in differentiating bacterial and nonbacterial inflammation. It was aimed to evaluate the diagnostic and prognostic value of PCT in bacteremic patients in Intensive Care Unit (ICU). Materials and Methods: A total of 156 patients diagnosed with noninfectious systemic inflammatory response syndrome, sepsis, and severe sepsis/septic shock in ICU between December 2014 and July 2015 were evaluated in this prospective cohort study. Results: The study group consisted of 64 (41%) bacteremic patients and the control group consisted of 92 (59%) nonbacteremic patients. The overall mortality rate was 60.3%. Although PCT levels in the bacteremic group (11.9 ± 21.5 ng/dL) were higher than nonbacteremic group (5.9 ± 11.5 ng/dL), this difference was not significant (P = 0.168). The mean levels of PCT in bacteremic patients with Gram-negative bacteria were 16.3 ± 27.6 ng/dL, whereas Gram-positive bacteria were 7.3 ± 10.7 ng/dL (P = 0.145). The mean PCT levels were significantly higher in nonsurvivors compared to survivors (10.1 ± 18.0 vs. 5.7 ± 13.7 ng/dL; P < 0.001). Conclusions: PCT may be an effective biomarker for diagnosing sepsis and predicting disease severity and mortality. There is a need for further well-designed studies to confirm the diagnostic and prognostic value of PCT in septic patients in critical care.

Amac: Pseudomonas cinsi bakteriler dogada yaygin olarak bulunan, firsatci enfeksiyonlar ve hastane enfeksiyonlarina yol acan non-fermantatif Gram negatif basillerdir. Hastanelerde ozellikle yogun bakimlarda izole edilen bu etken mekanik ventilatore bagli, kemoterapi ve antibiyotik tedavisi alan bagisiklik sistemi baskilanmis hastalarda onemli morbidite ve mortalite nedenidir. Bu calismanin amaci yogun bakim unitelerinden izole edilen Pseudomonas aeruginosa suslarinda antibiyotik duyarlilik profilinin belirlenmesidir. Yontem: Ocak 2011 – Ekim 2015 tarihleri arasinda hastanemizde yogun bakim unitelerinde izlenmis olan hastalarin cesitli klinik orneklerinden izole edilen toplam 1056 P.aeruginosa susu calismaya dahil edildi. Suslarin tanimlamasi ve antibiyogram profili BD Phoenix™ Automated Microbiology System (Becton-Dickinson, Amerika) cihazi kullanilarak 2011-2014 yillari arasinda CLSI, 2015 yilinda EUCAST onerileri dogrultusunda gerceklestirildi. Bulgular: Izolatlarda en yuksek direnc gorulen antibiyotikler sirasiyla sefaperazon-sulbaktam, aztreonam, seftazidim, piperasilin-tazobaktam ve sefepim olarak bulundu. Kolistin, amikasin, moksifloksasin, netilmisin ise en duyarli bulunun antibiyotikler olarak saptandi. Sonuc: Hastanemizde yogun bakimlardan izole edilen P.aeruginosa suslarinda direnc oranlari ulkemizden bildirilen verilerle uyumlu olarak yuksek bulundu. Her merkezin kendi etken ve antibiyotik duyarliliklarini takip etmesi; ampirik tedavide yogun bakim unitelerinin florasina uygun antibiyotik kombinasyonlari secilmesine, genis spektrumlu antibiyotiklerin yaygin kullaniminin kisitlanmasi suretiyle direncli mikroorganizmalarin azaltilmasina katki saglayacaktir.

Objective: the objective of this study was to investigate some virulence genes and SCCmec types of methicillin-resistant Staphylococcus aureus (MRSA) isolates and to determine their relationship with virulence factors. Methods: A total of 100 MRSA strains, 64 from healthcare-associated and 36 from community-associated infections, were included in the study. the presence of mecA gene was investigated by PCR. SCCmec types and efb, clfB, agrA gene were detected by multiplex PCR and their relationship with virulence factors has been analyzed. Results: All of the isolates contain the mecA gene. At the same time, in 66 strains (66%) agrA gene, in 58 strains (58%) clfB gene, and in 47 strains (47%) efb gene were positive. in terms of SCCmec types, the distribution of these types among the 64 HA-SA strains was 53% similar-to-type-III, 16% type IV, 2% type I and 30% unclassified. the distribution of the types among the 36 CA-SA strains was 19% similar-to-type-III, 25% type IV, 8% type I and 47% unclassified, respectively. When SCCmec types were evaluated according to clinical sample type, similar-to-type-III isolates were found to be dominant in wound samples. Efb (78%), clfB (85%), agrA (88%) were the dominant genes in similar-to-type-III strains, whereas clfB (74%), agrA (100%) were the main genes detected in the type IV strains. Conclusions: It is of clinical and epidemiological importance to know the origin of MRSA strains because this affects the empirical treatment choice.

Background & Objective: Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis.Methods: A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings.Results: A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H2O2, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276).Conclusion: Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.Keywords: Echinococcosis, hydatid cyst, diagnosis, treatment.

To evaluate the vitamin D receptor (VDR) gene polymorphisms and vitamin D levels in inactive hepatitis B virus (HBV) carriers.A cross-sectional analytical study.From March to September 2017 at the Izmir Katip Celebi University (İKCU) Ataturk Training and Research Hospital, Izmir, Turkey.Eighty-six inactive hepatitis B carriers and 86 control individuals were included in the study. Individuals with diseases or under medication that could affect vitamin D levels were excluded from the study. Serum vitamin D concentration of30 ng/mL was considered as sufficient, between 20-30 ng/mL as insufficient,20 ng/mL as deficiency and10 ng/mL as severe deficiency. VDR gene Bsm I, Fok I, Apa I and Taq I polymorphisms were identified by the polymerase chain reaction-fragment length polymorphism (PCR-RFLP) method.When vitamin D levels were examined, 52.3% (n = 45) of the inactive HBV carriers had severe deficiency, 38.4% (n = 33) deficiency, 7% (n = 6) insufficiency; 45.3% (n = 39) of the control group had severe deficiency, 43% (n = 37) deficiency, and 7% (n = 6) insufficiency. There was no statistically significant relationship between VDR gene and Bsm I, Fok I, Apa I, Taq I polymorphisms and vitamin D levels in inactive hepatitis B carriers and control group (p0.05).Vitamin D deficiency is highly prevalent both among control population as well as in chronic hepatitis patients. Key Words: Inactive HBV carrier, Vitamin D, Polymorphism, Vitamin D receptor (VDR).

It is important to identify new biomarkers for early detection of complications and treatment success in patients with brucellosis.A total of 187 brucellosis patients in the Department of Infectious Diseases of Izmir Katip Celebi University Ataturk Training and Research Hospital were evaluated retrospectively from January 2010 to January 2016.Complications of brucellosis were hematologic, osteoarticular, genitourinary, neurologic, cardiovascular, gastrointestinal and ocular involvement. Specific organ involvement was defined as the presence of infection signs in any specific anatomic site except hematologic involvement. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte-ratio (PLR) were evaluated statistically to predict complications and specific organ involvement of brucellosis.Complications occurred in 125 patients. We found that PLR and erythrocyte sedimentation rate (ESR) were higher in complicated patients (P = 0.007, P0.001). The area under curve (AUC) for PLR was 0.622 (95% confidence interval [CI], 0.538- 0.707) with a cutoff value of119.6 in predicting complications in brucellosis. LMR and NLR were not significant in terms of predicting complications in brucellosis. We also evaluated only specific organ involvement as a complication due to frequent occurrence of hematologic abnormalities in brucellosis. ESR, mean platelet volume (MPV), NLR, PLR and LMR were significantly different in patients with specific organ involvement (P = 0.001, P = 0.011, P = 0.001, P = 0.013 and P = 0.040). The AUC values for NLR and LMR were 0.649 (95% CI 0.570-0.728) and 0.589 (95% Cl 0.507-0.671), respectively.These biomarkers are cost-effective, simple and broadly available parameters for predicting complications and specific organ involvement of brucellosis.

Objective: Although several biomarkers have been evaluated for the diagnosis and prognosis of sepsis, the gold standard biomarker has not yet been found. We aimed to evaluate the diagnostic value of neutrophil-to-lymphocyte count ratio (NLCR), neopterin, pro-adrenomedullin (pro-ADM) and the other infection markers to predict bacteremia in patients with SIRS, sepsis and severe sepsis/septic shock. Methods: A prospective cohort study was conducted on septic patients in a tertiary referral hospital between December 2014- July 2015. A total of 156 patients diagnosed with SIRS, sepsis and severe sepsis/septic shock in Anesthesia intensive care unit (ICU) were included in the study. Results: A total of 156 patients who had been diagnosed as SIRS(10.9%), sepsis (44.2%) and severe sepsis/septic shock (44.9%) were included. Positive blood cultures were obtained in 64 patients. NLCR, neopterin and pro-ADM levels were insignificant in predicting bacteremia (p>0.05). The mortality rate was significantly higher in bacteremic sepsis (43.9%) compared to non-bacteremic patients (20.8%) (p=0.001). Only procalcitonin levels were significant predictor of mortality (p

Visceral leishmaniasis is an endemic disease in many parts of world, and if untreated, it is a potentially life-threatening infectious disease. It is similar to chronic liver disease because of signs and symptoms such as fever, weight loss, hepatosplenomegaly, and pancytopenia. In this study, we present a case of visceral leishmaniasis, which is known to be a chronic hepatitis B infection, that was coincidentally diagnosed with liver biopsy. Visceral leishmaniasis should be considered as an infectious disease in the differential diagnosis of chronic liver diseases.

Objectives: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. Methods: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. Results: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were rehospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, Cl: 1.82-38.15, p = 0.006), isolation of Klebsiella spp. (OR:7.7, Cl: 1.24-47.96, p = 0.028), and chronic heart failure (OR: 3, Cl: 1.01-9.04, p = 0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p < 0.001). Conclusion: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Aim:In this study,we aimed to provide guidance on the empirical antibiotic treatment anddetermine antibiotic resistance rates of extendedspectrum beta-lactamase (ESBL)and inducible beta-lactamase (IBL) producing bacteria isolated fromupper and lower respiratory specimensin the outpatients and hospitalized patients. Materialsand Methods: Respiratory specimenssent in atwo-year period between August2015 and July 2013 were evaluated retrospectively in IzmirKatip Celebi University AtatürkEducation and Research Hospital MicrobiologyLaboratory. Identification and antimicrobial susceptibilitiesof the isolates were determined by conventional methods and BDPhoenix 100 (Becton-Dickinson, ABD) automatedsystems. Antibioticsusceptibilities were established by disk diffusion and were evaluatedaccording to the Clinical Laboratory Standards Institute (CLSI) criteria in2011-2014 and EUCAST criteria in 2015.Results:A total of299 strains isolated from respiratory samples, including 226 ESBL and 73 IBL positive strains were analyzed retrospectively. The most common ESBL-producingstrains were found to be Klebsiellapneumoniae and Escherichia coli. All of IBL-positive strains were found to be Pseudomonas aeruginosa. ESBL and IBLpositive strains were found inthe highest resistance to trimethoprim-sulfamethoxazole. Cefoperazone-sulbactamand piperacillin-tazobactam resistance rates werefound to be quite high in both groups.Conclusion:Empirical antibiotic choices are quite restricted dueto the increase in the rateof beta-lactamase-producing bacterial isolation. The treatment failurewill be reduced with the appropriate use of empirical antibiotic treatment by determining the resistance ratio ofthese strains against other antibiotics., Amaç:Buçalışmada hastanemizde ayaktan ve yatarak takip edilmiş hastaların üst ve altsolunum yolu örneklerinden izole edilen genişlemiş spektrumlubeta-laktamaz (GSBL) ve indüklenebilirbeta-laktamaz (IBL)üreten bakterilerin çeşitli antibiyotiklere direnç oranlarının belirlenmesi veampirik antibiyotik tedavisine yol göstermesi amaçlanmıştır.Yöntem:İzmirKâtip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi TıbbiMikrobiyoloji Laboratuvarı’na Temmuz 2013 ile Ağustos 2015 tarihleri arasındakiiki yıllık dönemde gönderilen solunum yolu örnekleri retrospektif olarakincelenmiş, antibiyotik duyarlılıkları konvansiyonel yöntemler ve BD Phoenix100 otomatize sistemi (Becton-Dickinson, ABD) kullanılarak belirlenmiştir. Antibiyotik duyarlılığınıbelirlemede zon çapları 2010-2014 tarihleri arasında CLSI, 2015 yılında EUCASTkriterleri doğrultusunda değerlendirilmiştir.Bulgular:Solunum yolu örneklerinden izole edilen 226 adet GSBL ve 73 adet IBL pozitif olmaküzere toplam 299 suş retrospektif olarak incelendi. GSBL üreten suşlar arasındaen sık izole edilenler Klebsiellapneumoniae ve Escherichia coliiken IBL üreten suşların tümü Pseudomonasaeruginosa olarak bulundu. Trimetoprim-sulfametoksazol, hem GSBL hem de IBLüreten suşlarda en yüksek direnç oranına sahip antibiyotik olarak bulunurken,sefaperazon-sulbaktam ve piperasilin-tazobaktama karşı direnç oranlarının da heriki grupta oldukça yüksek seyrettiği saptandı.Sonuç:Beta-laktamazüreten dirençli bakterilerin izolasyon oranlarındaki artış, kullanılabilecekampirik antibiyotik seçeneklerini oldukça kısıtlamaktadır. Bu suşların diğerantibiyotiklere karşı direnç oranlarını belirlemek, özellikle ampirik tedavideuygun antibiyotiğin seçilerek tedavi başarısızlığının önüne geçmeyisağlayacaktır.

Coronavirüsler zarflı, tek zincirli pozitif RNA virüsleri olup, genellikle üst solunum yolu enfeksiyonlarına sebep olurlar. 2012 yılıda Arap Yarımadası’nda ciddi akut solunum yetmezliği ile seyreden hastalarda yeni bir coronavirüs türü izole edilmiştir. Middle East Respiratory Syndrome-coronavirus (MERS-CoV) olarak adlandırılmıştır. Asemptomatik hastalıktan, ağır pnömoni, çoklu organ yetmezliği ve ölüme kadar ilerleyebilen çeşitli klinik şekillere sebep olabilir. Patojene özgül bir tedavi bulunmamaktadır. MERS-CoV ile enfekte olan hastalarda enfeksiyon kontrol önlemlerinin uygulanması virüsün yayılımının önlenmesi açısından önemli bir yer tutar.

Medical students are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharps injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, their knowledge and compliance on universal precautions. One hundred and fourteen medical students filled out the questionnaire. 31.6% were in 3rd, 22.8% in 4th, 35.1% in 5th, and 10.5% in 6th class. 61.4% of students had history of occupational injuries at least once. Rate of sharps injuries, needlestick injuries and mucosal exposure were 30%, 82.9%, 35.7% respectively. Rate of OEs was higher and statistically significant in 5th, 6th classes compared to 3rd, 4th.The most common way for exposure was recapping the needle. Rate of underreporting was 74.2%. 53.5% of the participants were vaccinated with complete dose of hepatitis B virus vaccine. 28.9% declared they always wore gloves prior to any percutaneus procedures. Medical students should be educated for the risk and encouraged to report OEs for their own safety.

Health care workers (HCWs) are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharp injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, condition of hepatitis B virus immunization, their knowledge and compliance on universal precautions. One hundred and thirty HCWs filled out the questionnaire. One hundred and three (79.2%) of participants determined at least one or more occupational exposure during last one year. Eighteen (17.5%) of participants exposed to accidental exposure during last one year reported these exposures. One hundred and nine (83.8%) of participants had history of hepatitis B virus vaccination. Results showed that only 30 (23.1%) followed universal precautions completely.

Infective endocarditis is a life threatening disease of endocardium of the heart. Viridans streptococci are the most common reported isolates among patients with infective endocarditis. Abiotrophia and Granulicatella species form part of the normal flora of the oral cavity. They are infrequently isolated in patients with infective endocarditis. We report a case of native valve endocarditis attributed to Granulicatella elegans. We isolated G. elegans in two blood samples of the patient. Patient was successfully treated with ceftriaxone and gentamycin.

WOS: 000379252100027, PubMed ID: 27085724, There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection. (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

WOS: 000358623200015, PubMed ID: 25779579, Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.

Alpay, Yeşim (Balikesir Author), "Background: Manynoninvasive methods, including aspartateaminotransaminase (AST)/alanineaminotransaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, thesemethodsare developed for patients with chronic hepatitisC(CHC) andproduce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 +/- 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was >= 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvave models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future."

Chryseobacterium indologenesis nonmotile, oxidase, and indole positive Gram-negative aerobic bacilli which is widely found in plants, soil, foodstuffs, and water. It can colonize hospital environment due to ability to survive in chlorine-treated water supplies. Chryseobacteria can also colonize patients via contaminated medical devices such as respirators, intubation tubes, humidifiers, intravascular catheters, and prosthetic valves. Immune suppression, comorbidities, use of broad-spectrum antibiotics, and extreme age are other important risk factors forChryseobacteriuminfections. We report a case of an 82-year-old male admitted to our hospital with the complaint of altered mental status with history of trauma, and recent orthopedic and neurosurgery operations. He was transferred to neurosurgery intensive care unit due to respiratory failure. Urine culture yielded extended spectrum beta lactamase (ESBL) (+).E. coliandC. indologeneswere isolated from transtracheal aspirate. He was treated with ertapenem, and levofloxacin and discharged with full recovery.

Background In the present study, our objective was to evaluate and compare the clinical and microbiological results in patients receiving systemic and systemic plus inhaled colistin therapy due to nosocomial pneumonia (NP) or ventilator associated pneumonia (VAP) caused by Acinetobacter baumannii. Methods A retrospective matched case–control study was performed at the ICUs at Izmir Katip Celebi University Ataturk Training and Research Hospital from January 2013 to December 2014. Eighty patients who received only systemic colistin were matched 43 patients who received systemic colistin combined with inhaled therapy. Results In 97.6 % of the patients colistin was co-administered with at least one additional antibiotic. The most frequently co-administered antibiotics were carbapenems (79.7 %). The patient groups did not differ significantly in terms of the non-colistin antibiotics used for treatment (p > 0.05). Acute renal injury was observed in 53.8 % and 48.8 % of the patients who received parenteral colistin or parenteral plus inhaler colistin, respectively (p = 0.603). There were no significant differences between the groups in terms of clinical success (p = 0.974), clinical failure (p = 0.291), or recurrence (p = 0.094). Only, a significantly higher partial clinical improvement rate was observed in the systemic colistin group (p = 0.009). No significant differences between the two groups in terms of eradication (p = 0.712), persistence (p = 0.470), or recurrence (p = 0.356) rates was observed. One-month mortality rate was similar in systemic (47.5 %) and systemic plus inhaled (53.5 %) treatment groups (p = 0.526). Conclusions Our results suggest that combination of inhaled colistin with intravenous colistin had no additional therapeutic benefit in terms of clinical or microbiological outcomes.