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Amaç: Santral sinir sistemi enfeksiyonları, acil tanı ve tedavi gerektiren morbidite ve mortalitesi yüksek enfeksiyonlardır. Hastanemizde takip edilen toplum kaynaklı santral sinir sistemi (SSS) enfeksiyonları irdelenerek hasta yönetiminde yardımcı olmak amaçlanmıştır.Yöntem: Ümraniye Eğitim ve Araştırma Hastanesi’nde 2013 ve 2020 yılları arasında SSS enfeksiyonu tanısı konan 56 hasta retrospektif olarak değerlendirildi. Bulgular: Yedi yıl içinde SSS enfeksiyonu tanısı konan 56 hastanın klinik sınıflaması incelendi. En sık akut pürülan menenjit (%51.8), ikinci sırada aseptik menenjit-ensefalit (%35.7) ardından tüberküloz menenjiti (%12.5) olduğu görüldü. Akut pürülan menenjit hastalarının %82.9’unda BOS kültürü sterildi. Bos kültüründe üreme olan hastalarda S. pneumonia (%10.3) ve E. coli (%6.8) saptandı. Aseptik menenjit ve ensefalitte %10 oranında HSV1 PCR pozitifliği mevcuttu. Başvuru esnasında klinik ayırım yapılamadığı için ampirik olarak antiviral ve antibiyotik tedavisi beraber başlanan hasta oranı %21.4 idi.Sonuç: Çalışmamızda başvuru esnasında ensefalit ve menenjit ayrımı yapılamayan hastaların oranı dikkati çekicidir. Ayrıca hastaların çoğunluğunda etkenin izole edilemediği görülmüştür. Genel olarak kullanılan ampirik tedavilerin etken izolasyonunu etkileyebileceği kanaatine varılmıştır. Hastaların yönetiminde SSS enfeksiyonlarına neden olan etkenlerin dağılımının bilinmesi ampirik tedavi seçiminde yol gösterici olmaktadır.

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.

Aims: To assess diabetic patients’ knowledge and practices regarding foot care. Methods: This study was conducted as a cross-sectional study in 1030 patients between November 2017 and February 2018.The descriptive survey instrument was developed by the investigators. Survey content and format were based on prior surveys and guidelines. The survey sought socio-demographic characteristics of the patients and the level of knowledge about diabetic foot care practice. Results: 29.5% of patients had bad foot care, 49.6% of patients had moderate foot care and 20.8% of patients had good foot care. There were no significant differences between patient groups in regard to age, gender, foot infection history and having undergone amputation surgery. We found that patients who good at foot care had higher education status (p < 0.001), were more likely live in a city (p < 0.001), had higher income (p < 0.001), had been trained about foot care (p < 0.001) and were more likely to have type I DM (p = 0.015). Disease duration was longer in those who had good foot care compared to the other groups (p = 0.010). Conclusions: The mean knowledge and practice scores of our patients were moderate, indicating that much is to be done for the education of patients on this matter. We also found that knowledge about the importance of this practice, education status and disease duration had significant influence on the practice of foot-care in patients with DM. © 2019 Primary Care Diabetes Europe

WOS: 000471726700008, PubMed ID: 30989418, Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

Introduction: Although diabetic foot infections are polymicrobial, gram-positive microorganisms comprise the majority. Daptomycin is a novel agent in treating infections due to multidrug-resistant gram-positive pathogens. In this multicenter study, the outcomes of the daptomycin treatment were evaluated retrospectively in the treatment of diabetic foot infectious without osteomyelitis. Materials and Methods: Patients with diabetic foot infection without osteomyelitis and who received daptomycin treatment were included into the study. Sociodemographic characteristics of the patients, risk factors for methicillin resistant Staphylococcus aureus (MRSA), antimicrobial treatment, and the data of microbiological and clinical outcomes of the cases were registered in a standard form by eleven centers. Clinical success was defined as a combination of end-of-treatment laboratory parameters, clinical and microbiological responses. Results: A total of 46 patients (30 males, 16 females) were clinically evaluated for the outcome of daptomycin therapy. Mean age was 61.09 ± 11.82 years (31-81) and mean diabetes duration was 13 ± 8.2 years. The number of mild, moderate and severe infections identified according to the infection scoring system of the Infectious Diseases Society of America (IDSA) were 12 (26.1%), 25 (54.3%), and 9 (19.6%) respectively. Duration of daptomycin therapy was 17.5 ± 9.3 days and overall daptomycin success rate was 82.6% (n= 38). Two patients developed side effects. Conclusion: The clinical success rate of this study which assessed the efficacy of daptomycin in diabetic foot infections was 82.6%. Daptomycin can be safely used even in severe cases having had no success with previous antibiotic therapy.

Toka, Onur/0000-0002-4025-4537; Yoruk, Gulsen/0000-0002-0357-5884; Cinar, Gule/0000-0002-7635-8848; Hakyemez, Ismail Necati/0000-0001-6133-9604; Tulek, Necla/0000-0002-3952-4982 WOS:000511173500009 Objective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment. Methods: The study was designed retrospectively. All patients receiving antiviral therapy due to CHB in the departments of Infectious Diseases and Clinical Microbiology of 29 different hospitals between January 2012 and June 2017 were searched by examining medical records. Results: A total of 1069 patients were included. Six hundred and fifty of the patients had been receiving TDF and 419 of them had been receiving ETV. The rate of virological response obtained at the 48'h week of TDF was higher in patients with steatosis (p=0.029). Virological response at the 24th week and 48th week of ETV were higher in the patients without steatosis (p=0.001). TDF and ETV therapies were compared in the patients with hepatosteatosis and it was found that the virological response at 48th week was higher in the TDF group. Conclusion: Although steatosis has an effect on virological response in the short-term results of nucleos(t)ide therapy, it does not have any effect on virological response in the long-term results.

Aim: The aim of this study is to evaluate the attitudes of healthcare workers against seasonal influenza vaccine and the reasons for vaccine avoidance. Materials and Methods: This national survey was conducted from April 1st to June 30th in 2017. The study was carried out among health care workers working in primary, secondary and tertiary care settings. A total of 12 questions were sent to 5046 health care professionals from 55 different cities who agreed to participate in the survey.Results: 7% of the participants stated that they get vaccinated regularly every year. 65.8% of the participants stated that they don’t get vaccinated at all. The most important reason for those who did not receive influenza vaccination was their disbelief in the necessity of the vaccination (51.9%). The most common reason for the seasonal influenza vaccination was the prevention of influenza infection (56.7%).Conclusion: The results of the study showed that HCWs influenza vaccination rates are very low. Doctors have been found to have slightly better rates than other HCWs. The high level of education and the increase in professional experience had a positive effect on the vaccination rate. It is important to know the HCWs attitudes and behaviors towards the vaccination to increase the rates., Amaç: İnfluenza tüm dünyada önemli ölçüde morbidite, mortalite ve maliyet yükünden sorumludur. Sağlık çalışanları (HCP) mesleksel bulaş açısından risk altındadırlar. Bu çalışmada sağlık çalışanlarının mevsimsel influenza aşısına karşı tutumlarının ve aşıdan kaçınma nedenlerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Bu çok merkezli ulusal anket çalışması 1 Nisan-30 Haziran 2017 tarihleri arasında gerçekleştirildi. Ankete katılmayı kabul eden 55 şehirden toplam 5046 HCP uzaktan katılım yoluyla cevaplamaları için toplam 12 sorudan oluşan bir anket gönderildi.Bulgular: Çalışmaya katılanların %7’si her yıl düzenli olarak aşı yaptırdığını belirtti. Hiç yaptırmıyorum diyenlerin oranı %65,8 idi. İnfluenza aşışını yaptırmayanların en önemli nedeni grip aşısının gerekliliğine inanmama idi (%51,9). Mevsimsel grip aşısı yaptıranların en önemli gerekçesi grip infeksiyonundan korunma (%56,7) idi.Sonuç: Sonuçlarımız, tüm HCP influenza aşılama oranlarının çok düşük olduğunu göstermiştir. Doktorların diğer HCP’lerden biraz daha iyi oranlara sahip olduğunu görülmüştür. Eğitim düzeyinin yüksek olması ve mesleki tecrübenin artması aşılama oranını olumlu yönde etkilemiştir. Sağlık çalışanlarının aşılanma oranlarının artırılabilmesi için öncelikle aşı konusundaki tutum ve davranışlarının bilinmesi gerekir.

WOS: 000388827200008, PubMed ID: 27138335, Objective Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. Methods Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. Results A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.32.7, p = 0.0001) were associated with diffuse inflammation. Conclusions In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Objective: this study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: the study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: a total of 430 physicians participated in the study. Their mean age was 39.87 +/- 7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p, NA

Study Group for Diabetic Foot Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist societies and the Ministry of Health to issue a national consensus report on the diagnosis, treatment and prevention of diabetic foot (DF) wounds and diabetic foot infections (DFIs) in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions as to pathogenesis, microbiology, assessment and grading, treatment, prevention and control of diabetic foot were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] Although there are many reasons for the development of DF wounds, the main reason is the combined effect of diabetes-related vascular disease and neuropathy. [2] Aerobic Gram- positive cocci are mostly responsible for superficial DFIs in patients with cellulitis and no history of antibiotic use. [3] Pseudomonas aeruginosa is one of the commonly encountered agents when between the toes of the patient are moist. [4] When the other potential reasons are eliminated, DFIs should be considered in presence of at least two of the classical signs of inflammation including redness, warmth, swelling, tenderness, and pain, or purulent discharge in the foot lesion. [5] Infections are classified into mild, moderate, or severe groups according to some criteria such as the depth and width of the wounds, and the presence of systemic findings of infection. [6] PEDIS system should be preferred as a classification system for its high predictive value in diabetes-related foot complications. [7] Culture samples from the DF wound should only be obtained when infection is clinically considered and, where possible, before starting antibiotic treatment. [8] Inflammatory biomarkers such as leukocyte count, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin may be useful in distinguishing between colonization with infection. [9] Magnetic resonance imaging is a sensitive and specific method in patients unresponsive to treatment when osteomyelitis and deep soft tissue abscesses are considered. [10] The gold standard in the diagnosis of osteomyelitis is histopathological examination. [11] To provide wound healing and to save the limb, removal of dead and infected tissue with urgent and aggressive debridement, appropriate antibiotic therapy, metabolic control, and off-loading of pressure, the diagnosis and proper treatment of peripheral arterial disease, and restoration of the foot function are necessary. [12] A lot of different factors playing a role in etiopathogenesis complicate the approach to be developed in this type of lesions, and therefore it requires a team concept. [13] In the empirical treatment, the objective should be treating only the potential agents. Adequate tissue levels, low side effects and patient compliance must be observed; effective drugs should be used in specified doses and duration. [14] Debridement is an essential and integral part of wound treatment and is an important tool allowing the formation of healthy granulation tissue. [15] When the infected tissue cannot be completely cleared with the debridement and in cases when the patient could not cope with the remaining infection load, performing a limb amputation on a safe level of infection would be lifesaving.

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. Ebola virus (EBOV) is transmitted through contact with blood or body fluids of a person who contracted or died from EVD, contaminated objects like needles and infected animals or bush meat. EVD has an incubation period of 2 to 21 days, and the infection has an acute onset without any carrier status. Currently, there is no standard treatment for EVD, so it is important to avoid infection or further spreading of the virus. Although historically the mortality of this infection exceeded 80%, modern medicine and public health measures have been able to lower this figure and reduce the impact of EBOV on individuals and communities. Its treatment involves early, aggressive supportive care with rehydration. Clinicians should consider the possibility of EVD in persons with travel or exposure history with the incubation period presenting constitutional symptoms in order to promptly identify diseased patients, and prevent further spreading of the disease.

PubMedID: 25801665 SummaryBackground The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. Method BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. Results The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. Conclusions When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries. © 2015 Elsevier Ltd. All rights reserved.

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.

Objective: Acinetobacter baumannii is a gram negative, antimicrobial-resistant bacilli difficult to control and treat. This pathogen has became more important in the last decades due to multidrug-resistant nasocomial infections. The aim of this study was to determine the antibiotic resistance rates of A.baumannii isolated from various clinical specimens of intensive care unit (ICU) patients between November 2010 and December 2011. Material and Methods: A total of 172 A.baumannii strains were isolated. Identification and antibiotic susceptibility testing were performed by VITEC 2 (bioMerieux, France) system. Results: A. baumannii strains were isolated 44% from tracheal aspirate, 25% from wounds, 24% from blood, and 7% from urine, consecutively. Although there were no resistant strains detected to colistin and tygecycline, resistance rates of the other antibiotics were found to be 64% for amicacin, 67% for gentamicin, %73 for levosoxacin, 76% for ciprosoxacin, %79 for cefoperazone/sulbactam, 84% for piperacillin/tazobactam, and 92% for imipenem and meropenem, consecutively. Conclusion: In conclusion, no resistant strains were detected to colistin and tygecycline and they were found to be the preferred empirical treatment for A. baumannii infections.

It is important to follow up the epidemiologic and clinical characteristics of the viral especially rotavirus gastroenteritis to develop strategies for prevention and treatment. Therefore we investigated the rotavirus gastroenteritis in acute diarrhea patinets in our clinic. Stool samples of 263 patients admitted to outpatient clinic or emergency room of COMU Faculty of Medicine Hospital with the symptom of acute diarrhea were screened retrospectively from medical records. Stool samples had been studied with the monoclonal antibody based chromatographic immunoassay (Rota-Adeno Virus Combo Test Device, Ecotest, China). 263 medical records were screened. Rotavirus antigen was positive in 62 cases (23.6%). It was 34.5% in children under 2 years. Rota positivity according to the seasons was as follows: 27.8% in spring, 14.6% in summer, 26.3% in autumn and 21.4% in winter. As a result, acute diarrhea case management should be done for age and seasonal distribution. In these cases unnecessary antibiotic usage should be avoided by rapid diagnostic test when required.

Concurrent Hodgkin’s lymphoma and Hepatitis C virus (HCV) infection is a rare clinical condition. Also, HCV related liver dysfunction during lymphoma chemotherapy is uncommon and most data come from patients with non-Hodgkin’s lymphoma. We reported here a case of HCV related liver dysfunction during chemotherapy for Hodgkin’s lymphoma and long term follow-up results of the patient, and we reviewed the literature.

Background/aims The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. Materials and methods Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. Results The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. Conclusion In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.

WOS: 000373481300007, PubMed: 27026760, Objective: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. Materials and Methods: A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. Results: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. Conclusion: Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.

Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics., Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician., Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had 5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05)., Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.

WOS: 000386954300001, PubMed: 27809934, Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.

EASL International Liver Congress -- APR 13-17, 2016 -- -- Barcelona, SPAIN, WOS: 000398711700582, …, EASL

The spine is the most common site of musculoskeletal involvement of brucellosis. However, there is no case report presented in the literature of both cervical vertebrae spondylodiscitis and pulmonary involvement of brucella. We reported a 52-year-old woman complaining for one month of fever with rigors, fatigue, malaise, pain on the neck and arm, and sweating. The Wright agglutination test for brucella was positive at titers of 1/640. MRI of the cervical vertebrae was consistent with spondylodiscitis and paravertebral and epidural abscesses. Ground glass opacity was seen in the left upper lobe on CT scanning of the chest. Percutaneous image-guided biopsy was performed and Brucella melitensis was isolated. The patient was treated with streptomycin for 3 weeks, plus doxycycline and rifampicin for 3 months. We recommend tissue culture for brucella patients with lung lesions. Isolation of the microorganism from a biopsy material provides conclusive evidence. J Microbiol Infect Dis 2015;5(4): 173-175 Key words: Bacterial infection, brucellosis, cervical vertebrae, pulmonary involvement, spondylodiscitis

We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121(27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum beta-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% Cl 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% Cl 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% Cl 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% Cl 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% Cl 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% Cl 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% Cl 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Background Scintigraphy using leucocytes labelled with 99m Tc hexamethylpropyleneamine oxime ( 99m Tc-HMPAO) is widely used for the localization of inflammatory foci and abscesses in cases of acute pelvic inflammatory disease, which is one of the serious health problems of women of child-bearing age. Early diagnosis and effective management of this condition can preserve fertility and prevent serious complications, such as peritonitis and sepsis. Aim To evaluate the importance of scintigraphy using 99m Tc-HMPAO labelled leucocytes in the early diagnosis of patients with pelvic inflammatory disease. Methods Fifteen women (mean age 29.2 ± 8 years, range 25-46 years) with suspicion of pyogenic pelvic inflammatory disease based on gynaecological examinations, clinical findings and blood tests were included in this study. The patients received 555 MBq 99m Tc-HMPAO labelled leucocytes, by injection, and were scanned by scintigraphy 0.5-1, 3 and 24 h later in the anterior abdominal projection. Ten of the patients were then evaluated by abdominal or transvaginal ultrasonography, four by computed tomography and two by both ultrasound and computed tomography. The final diagnosis was made by surgical intervention. Results Scintigraphy detected pelvic inflammatory disease in five of the patients. In three of them the disease was apparent on the scans taken at 0.5-1 h, and in the other two it was apparent at 3 h. There were no false negative results, and one false positive result. The scan accurately reflected the absence of pelvic inflammatory disease in nine patients showing non-pathological tracer uptake in the lower abdominal region. Conclusion We showed that scintigraphy with 99m Tc-HMPAO labelled leucocytes had a sensitivity of 100%, specificity of 90%, overall accuracy of 93%, positive predictive value of 83%, and negative predictive value of 100%. Therefore, we conclude that 99m Tc-HMPAO labelled leucocyte scans provide a rapid and highly accurate method for diagnosing pelvic inflammatory disease in women of child-bearing age. This adds an important contribution to the diagnosis of infection and helps determine further operative or conservative treatment.

Our object is to determine the prevalence of group B streptococcus (GBS) carriage among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility to formulate a policy for treatment and prevention regarding perinatal GBS diseases in eastern Turkey. A total of 150 pregnant women were screened for GBS colonisation. Samples were collected from the vagina and the rectum of pregnant women, and the ear canal, throat and umbilicus of the neonates of colonised mothers. Antimicrobial susceptibility of the isolates was also investigated. GBS was isolated in at least one specimen from the 150 women in 48 cases; it was estimated that, overall, about 32% of the pregnant women and 17.3% of overall newborns were colonised with GBS. The overall rate of GBS vertical transmission was 54.2% in this study. Maternal colonisation rate was significantly higher in younger ages (p < 0.01) when maternal age of 20 years was taken as a cut-off point. All isolates were found to be sensitive to penicillin, ampicillin, cefazolin and vancomycin. Resistance to erythromycin and clindamycin were found to be 13.5 and 2.7%, respectively.

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."

Here, we report 1 case of Brucella orchitis detected by 99mTc human immunoglobulin scintigraphy and confirmed by testicular ultrasound. A 29-year-old farmer was admitted to our hospital with fever, fatigue, arthralgia, and painful scrotal swelling that had appeared 12 days before admission. Clinically, right sacroiliitis was recorded through the Fabere test Unilateral sacroiliitis and orchitis were detected by 99mTc human immunoglobulin scintigraphy. Hypoechoic left testicular lesions and swelling of the concurrent epididymis were seen on a testicular ultrasound examination. Wright agglutination test and blood specimen culture for Brucella species were positive.

WOS: 000329585200001, PubMed ID: 24118178, We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200mg/day, rifampicin 600mg/day and streptomycin 1g/day; doxycycline 200mg/day, rifampicin 600mg/day and gentamicin 5mg/kg; doxycycline 200mg/day and rifampicin 600mg/day; doxycycline 200mg/day and streptomycin 1g/day; and doxycycline 200mg/day, rifampicin 600mg/day and ciprofloxacin 1g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Summary Polysaccharide slime seems to be the most important factor by which coagulase negative staphylococci (CNS) strains adheres and colonises catheters. The aim of this study was to determine the prevalence of slime-producing CNS strains isolated from nasal samples of patients on haemodialysis and of healthy persons as a control. Nasal cultures were performed for 131 haemodialysis patients and 56 healthy persons. CNS strains were isolated from 86 of 131 patients (72.9%), and 46 of 56 healthy persons (82.1%). Twenty-four (27.9%) of the 86 CNS strains tested in the patient group and four (8.7%) of the 46 CNS strains in the control group were slime factor positive. There was a significant difference (p

The aim of this case report is to draw attention to the frequent occurrence of metoclopramide-induced movement disorders. We report a case of an acute dystonic reaction to metoclopramide in a patient treated for hepatitis A. Metoclopramide can cause severe adverse events, such as an acute dystonic reaction, and should be used with caution in patients with infectious diseases.

Sporotrichosis is a cutaneous or systemic fungal infection caused by Sporothrix schenckii. The infection is characterized by nodular, pustular, or ulcerative lesions. Infection usually occurs after traumatic implantation of the fungus into the skin. We report a case presenting first cellulitis and later on as a non-healing ulcer which was diagnosed by punch biopsy as sporotrichosis and managed successfully with itraconazole. A 56-year-old woman admitted to our department with complaint acute onset of swelling of the right lower-extremity with erythema and warmth. The patient was diagnosed initially as celulitis and started on ampicillin-sulbactam. Diagnosis of sporotrichosis was made with histological examination skin biopsy and the patient was started on itraconazole. One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months the lesions had healed. This case shows that if a wound do not respond to antibiotics in cases with ulcer, some rare etiological agents should be considered. [Dis Mol Med 2016; 4(3.000): 34-36]

To examine the bacterial isolates from the burn patients and to compare the antibiograms of the predominant bacteria isolated from 51 patients who were hospitalized at least 3 weeks or more over a period of 7 months, a prospective study was undertaken. Periodic swabs were taken from burn wound, nasal, axillary, inguinal, and umbilical region of the patients on admission and on 7th, 14th, and 21st days of hospitalization. Mean hospital stay was 36.5 days. A total of 1098 microbial isolates were detected during the study period. Coagulase-negative staphylococci (CNS, 63.0%) and Staphylococcus aureus (19.7%) were the most prevalent isolates in admission cultures. During the next weeks, these bacteria were superceded by mainly Pseudomonas aeruginosa. Between admission and 21st day, the rates of methicillin resistance of staphylococci strains increased steadily. There was no vancomycin resistance in any staphylococci strains, although nine of the S. aureus isolates (2.7%) were resistant to teicoplanin. There were no strains producing inducible beta lactamase (IBL) among P. aeruginosa strains. One extended-spectrum beta-lactamase (ESBL)-producing strain was recovered on admission, although strains producing IBL and ESBL were detected at rates of 79.6 and 57.1%, respectively, on the 21st day. The nature of microbial wound colonization, flora changes, and antimicrobial sensitivity profiles should be taken into consideration in using empirical antimicrobial therapy of burned patients.

We review, in detail, 2 cases of anthrax during pregnancy, its maternal and perinatal complications, and its management. Patient 1 was a 33-year-old woman at 32 weeks of gestation. She had a submandibular eschar; extensive edema on her face, neck, and upper thorax that inhibited respiratory function; and fever. The patient was treated with penicillin G and prednisolone after the diagnosis of anthrax. She recovered within 10 days but delivered a preterm baby. Patient 2 was a 29-year-old woman at 33 weeks of gestation. Her anthrax lesion was on her right elbow, and therapy consisted of procaine penicillin. She also delivered a preterm baby. These 2 cases show that anthrax during pregnancy can be successfully managed, but preterm delivery could be a complication.

Women colonized with group B Streptococcus (GBS) during pregnancy are at an increased risk of premature delivery and GBS amniotic infection can result in intrauterine death. GBS also infects the newborn. The vaginal flora of a healthy woman is composed of Doderlein bacilli. Bacterial vaginosis (BV) is a clinical condition caused by the replacement of these bacilli with high concentrations of aerobic and anaerobic bacteria. GBS inhibits Lactobacillus species in vitro. The main goal of this study was to assess differences in the vaginal flora of pregnant women and provide a detailed evaluation of vaginal swab for the presence of GBS and other organisms. From January 2002 to February 2003 150 healthy pregnant women were included in the study. Their mean ± S.D. age was 26.1 ± 6.7 years (range 17—45 years) and pregnancy duration was 31.4 ± 5.3 weeks (range 22—40 weeks). Vaginal fluid samples were collected with cotton swabs. The swabs were Gram-stained and placed on appropriate media. Slides were then assessed according to the criteria of Nugent et al. (excerpt)