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© 2021 by Associação Paulista de Medicina.BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nine-teen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.

Human coronaviruses (HCoV) were first described in the mid-1960s. HCoV is an enveloped RNA virus with a single chain and positive polarity. The name “corona” comes from the crown-like spikes on the surface of the virus. Four major subgroups are known as follows: alpha, beta, gamma and delta. Subtypes of coronaviruses circulating in humans (HCoV-229E, HCoV-OC43, HCoV-NL63 and HKU1-CoV) are mostly viruses that cause colds. Coronaviruses are zoonotic viruses that infect many mammals and birds [1]. There are many coronaviruses that have not been transmitted to humans yet but are detected in animals. Before the virus (most likely a bat virus) gained the ability to infect humans, it jumps an intermediate host as occurred in previous outbreaks. It has been revealed that for emerge of SARS-CoV (Severe acute respiratory syndrome), civet cats played an imported role for transmission of disease to humans, whereas one-humped camels played an intermediate host for MERS-CoV (Middle East Respiratory Syndrome) [2]. SARS-CoV was first defined in February 2003 in Asia (Guandong, China) and has spread to more than two dozen countries in North and South America, Europe and Asia. In about eight months, 8098 people are infected, and 774 people died. Since 2004, to our knowledge, there have been no new cases reported in the world. MERS- CoV also causes a severe respiratory disease with symptoms of fever, cough and shortness of breath. The disease was seen for the first time in September 2012 in Saudi Arabia, and all the patients with MERS- CoV had a history of travel or residence in the Arabian Peninsula and nearby countries. Outside the Arabian Peninsula, the disease was seen in the Republic of Korea in 2015. Again, the outbreak was associated with a traveler returning from the Arabian Peninsula. To date, 2494 people have been infected, and there 858 related deaths were reported related to MERS [2, 3].

Aim: To investigate whether C-reactive protein/albumin ratio (CAR) has an association with new onset atrial fibrillation (NOAF) in SARS-CoV-2. Materials & methods: This study included 782 patients with SARS-CoV-2 infection, who were hospitalized in Turkey. The end point of the study was an occurrence of NOAF. Results: NOAF was identified in 41 patients (5.2%). Subjects who developed NOAF had a higher CAR compared with those who did not develop NOAF (p

ÖzetAmaç:Karbapeneme dirençliKlebsiella pneumoniae(KDKp), dünya çapında hastane kaynaklı infeksiyonların önde gelen etkenlerinden biridir. Yüksek mortaliteyle seyreden kan dolaşımı infeksiyonları (KDİ)’na neden olmaktadır. Artan çoklu ilaç direncine bağlı olarak, tedavi seçenekleri çok sınırlıdır ve prognoz kötüdür. Bu çalışmanın amacı KDKp’nin etken olduğu KDİ’lerde mortalite için risk faktörlerini değerlendirmektir.Yöntemler:Eylül 2013 ile Ekim 2017 tarihleri arasında üçüncü basamak bir hastanede KDKp’ye bağlı kan dolaşımı infeksiyonu geçiren erişkin (>16 yaş) hastalar retrospektif olarak değerlendirildi. Hastaların demografik verileri, Charlson komorbidite indeksi (CKİ), yatış tarihinde ve infeksiyon günüde “acute physiology and chronic health evaluation” (APACHE II) skoru üreyenK. pneumoniae suşlarının minimum inhibitör konsantrasyonu (MİK) değerleri, antibiyotik tedavisi ve sonuçları (30 günlük mortalite) elektronik veri tabanlarından kaydedildi.Bulgular:Çalışma süresi boyunca toplam 82 hasta takip edildi. Medyan yaş 54.5’ti ve 48 (%58.5)’i erkekti. İnfeksiyon günü medyan APACHE II skoru 14 (IQR 6-28) ve CKİ 4.0 (IQR 0-12) idi. Kırk altı (%56.1) hastada YBÜ kaynaklı KDİ, 36 (% 43.9)’sında santral kateterle ilişkili KDİ ve 25 (% 30.5)’inde primer KDİ vardı. Elli (%61.0) hastada kombinasyon tedavisi uygulanırken en sık kullanılan antibiyotik kombinasyonu kolistin/tigesiklin (% 28) idi. Hastane ve yoğun bakım mortalite oranları sırasıyla %56.1 (46/82) ve %65.2 (30/46) idi. Tek değişkenli analizde, KDKp-KDİ ilişkili mortalite için risk faktörleri; yüksek CKİ, tedavinin beşinci gününde klinik yanıtsızlık, hastaneye yatış ve infeksiyon tarihinde yüksek APACHE II skoru olarak bulundu (p<0.05). Çok değişkenli analizde; mortalite için en önemli risk faktörü infeksiyon gününde APACHE II skoru idi (OR: 1.190; %95 CI: 1.088-1.301). Kombinasyon tedavisi veya monoterapinin sağkalım üzerine anlamlı bir etkisi yoktu. Ayrıca, KDKp suşlarının MİK değerleri mortaliteyle ilişkili bulunmadı.Sonuçlar:KDKp-KDİ’nın hastane mortalitesi %56.1 idi. İnfeksiyon gününde APACHE II skoru mortalite için en önemli prognostik faktördü. Mortalite oranı, kombinasyon (%54.3) ve monoterapi (%45.7) alan hastalar arasında benzerdi.

© 2020 Elsevier Inc.Background: There is limited data concerning the prevalence of arrhythmias, particularly atrial fibrillation (AF), which may develop as a consequence of direct myocardial injury and the inflammatory state existing in COVID-19. Methods: This single-center study included data concerning 658 COVID-19 patients, who were hospitalized in our institute, between April 20th, 2020 and July 30th, 2020. Demographic data, findings of the imaging studies, and laboratory test results were retrieved from the institutional digital database. Results: New onset AF (NOAF) was identified in 33 patients (5%). Patients who developed AF were older (72.42 ± 6.10 vs 53.78 ± 13.80, p < 0.001) and had higher frequencies of hypertension and heart failure compared to patients without NOAF (p < 0.001, for both). The CHA2DS2-VASc score was higher in patients, who developed NOAF, compared to those who did not during hospitalization for COVID-19 (p < 0.001). Subjects, who developed NOAF during hospitalization, had a higher leukocyte count, neutrophil / lymphocyte ratio (NLR), C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels compared to those without NOAF (p < 0.001 for all comparisons). Diffuse lung infiltration was also more frequent in COVID-19 patients, who developed NOAF, during hospitalization (p = 0.015). Multivariate logistic regression analysis demonstrated that age, CHA2DS2-VASc score, CRP, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT were predictive for NOAF. Conclusion: The prevalence of NOAF in hospitalized COVID-19 patients is higher than the general population. Age, CHA2DS2-VASc score, C-reactive protein, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT may be used to identify patients at high risk for development of NOAF. Especially among these parameters, the presence of diffuse lung infiltration on thorax CT it was the most powerful independent predictor of NOAF development.

BK polyomavirus (BKPyV) infections are an important cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Hemorrhagic cystitis (HC) may occur in patients undergoing HSCT due to the BKPyV reactivation. This study aimed to assess risk factors, clinical characteristics and treatment options of BKPyV infections after HSCT. A total of 54 patients with HSCT were retrospectively evaluated and BKPyV disease was found in 24 (44%). HC was seen in 20 (83%) of patients with BKPyV disease. The median age of patients was 42 and 50% of them were male. The most common underlying disease was Acute Myeloid Leukemia (62%). Five patients had autologous and 15 patients had allogeneic HSCT. The median time to engraftment was 15 days. GVHD was seen only in 7 patients. The median time elapsed to BKPyV disease after HSCT was found as 60 days. Nineteen patients with BKPyV disease had grade 3 and one patient had grade 2 HC. While BKPyV viremia was positive in five patients, viruria was detected in all patients. Eighteen (75%) of the patients with BKPyV disease were treated with cidofovir (5mg/kg IV) and 11 with ciprofloxacin (800 mg/day). Four of the patients who received intravesical cidofovir (dose). The complete response was obtained 53% of patients with BKPyV disease. In conclusion, BKPyV disease is an emerging clinical problem after HSCT causing morbidity and mortality. It can develop especially in the early period after allogeneic stem cell transplantation. This situation has been associated with the use of immunosuppressive treatments after transplantation. Close monitoring of BK virus in high-risk patients can be an important method to improve the complication in the early period.

Objective: Bloodstream infection (BSI) is one of the major causes of morbidity and mortality associated with sepsis in the world. The aim of this retrospective study is to investigate positive blood cultures in adult patients with fatal outcome, and to evaluate the results of their blood cultures, the etiology of bacteremia and whether they received appropriate antimicrobial therapy or not.

Background Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients. Materials and Methods This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018. Results During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients. The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P

BackgroundTuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The“Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown.MethodsA multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively.ResultsA total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P P P ConclusionBoth criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

The antibiotic colistin, which had been previously abandoned, is being brought back as a last line of defense against bacterial infection. However, colistin resistance was reported shortly after its reintroduction. This study evaluated the risk factors for colonization/infections due to colistin-resistant Acinetobacter baumannii (ColR-Ab) and Klebsiella pneumoniae (ColR-Kp) strains and characterized the molecular epidemiology of these two strains.Age, previous hospitalization duration, and previous use of carbapenem and colistin were risk factors for ColR-Kp, whereas previous use of carbapenem and colistin was a risk factor for ColR-Ab. According to pulsed-field gel electrophoresis analysis, most ColR-Kp strains could be grouped into two major pulsotypes. This appears to be an indicator of cross contamination of ColR-Kp strain, since different isolates appeared to be belonging to the same clones. The existence of colistin-susceptible (ColS) and colistin-resistant (ColR) strains in the same pulsotypes might also be an indicator of the recent emergence of resistance mechanisms.The results highlight the emergence of ColR pathogens in Turkey, which is considered to be developing country, and that carbapenem use coupled with insufficient infection control measures might increase the risk of ColR outbreaks.

Background: The aim of this study is to assess the clinical and microbiological features of infections in patients with morbidly adherent placenta (MAP) treated by leaving placenta in situ (LPIS). Materials and methods: Retrospective analysis of MAP cases who were treated by LPIS between 2 May 2010 and 15 March 2017. The inclusion criteria were gestational age at or above 24 weeks, prenatal diagnosis, elective operation, and complete data. Results: Nineteen MAP cases were treated by LPIS during the study period. The mean +/- SD duration for total placental resorbtion was 145 +/- 47 days. Three patients were readmitted to the hospital because of fever (3/19). A total of 65 culture samples were taken from the patients during their follow- up periods. In four cases (4/12) cervical cultures showed positive growth [Escherichia coli (2), Klebsiella pneumoniae (1), mixed culture with Enterococcus spp. and E. coli (1)]. Fifteen (15/26) urine samples were sterile, three were polymicrobial. In eight cases, urine culture revealed E. coli growth (one E. coli and Enterococcus spp.). Three out of 16 (3/16) surgical incision samples revealed growth of E. coli. No bacterial growth was detected in blood cultures. Susceptibility results of Gram-negatives indicate that the resistance rates of beta-lactam antibiotics are high (14/20, 70%). No secondary surgical intervention occurred during the study period due to infection. Conclusions: Majority of postpartum cervical discharge, fever, and increased CRP levels do not represent morbid infections and/or sepsis. With early detection, and implementation of antibiotherapy (combination of an aminoglycoside and clindamycin), they can be easily controlled and secondary surgical interventions can be prevented.

Objective: In this study, serovar distributions and antimicrobial resistance profiles of Salmonella strains isolated from clinical samples of patients admitted to our hospital between 2013 and 2016 were evaluated.

OBJECTIVE: Patients in surgical intensive care units are thought to be at the highest risk for developing candidemia, especially patients undergoing abdominal surgery. The present study aims to investigate risk factors for candidemia in patients with abdominal surgery. METHODS: A retrospective study was undertaken that involved patients admitted to the surgical ICU between January 2016 and January 2017. All postoperative adult patients (>18 years old) who underwent abdominal surgery were included in this study. RESULTS: During the one-year study period, 49 patients developed candidemia. Thirty-five of candida isolates were non-albicans strains. Of them, 25 (51%) isolates were Candida parapsilosis, eight (16.3%) isolates were C. glabrata, one (2%) isolate was C. tropicalis and one (2%) isolate was C. kefyr. The median age of all patients enrolled in this study was 60.5+-15.6 years. In univariate analysis, the duration of the hospital stays, intensive care unit stay, type of surgery, respiratory failure, total parenteral nutrition, transfusion and use of central venous catheter were significantly higher in patients with candidemia. In multivariate analysis, duration of hospital and intensive care unit stay and use of central venous catheter was associated with an increased risk of candidemia. The mortality rate of case patients was 36.7%. CONCLUSION: Patients undergoing abdominal surgery are at increased risk of candidemia, especially the patients with prolonged intensive care unit/hospital stay and the patients with a central venous catheters. Antifungal prophylaxis may be considered for patients with increased risk.

Brucellosis is a common zoonotic disease with high morbidity. In the majority of human cases, the causative agent is B. melitensis. Infection is transmitted to humans by direct/indirect contact with the contaminated animal products (e.g., consumption of unpasteurized milk), infectious aerosols and aborted fetus. Brucellosis often affects middle-aged adults and young people. Patients with brucellosis tend to have non-specific symptoms, including fever, chills, night sweats, joint pain and myalgia. Brucellosis affects various organs and tissues. The osteoarticular system is one of the most commonly described affected systems in humans. In several clinical studies, the prevalence of Osteoarticular Brucellosis (OB) is reported as 2-77%. Most important osteoarticular clinical forms osteomyelitis, spondylitis, sacroiliitis, arthritis and bursitis. Spondylitis and spondylodiscitis are the most frequent complications. Spondylodiscitis often affects the lumbar (especially at the L4- L5 levels) and low thoracic vertebrae than the cervical spine. Back pain and sciatica radiculopathy are the most common complaints about patients. Sacroiliitis is associated with severe pain, especially back pain in affected individuals. Spinal destructive brucellar lesions are also reported in adults in previous studies. Brucellosis is diagnosed with clinical inflammatory signs (eg. tenderness, pain) of the affected joints together with positive serological tests and positive blood/synovial fluids cultures. Serological test measures the total amount of IgM/IgG antibodies. Standard agglutination test (SAT) titer ≥1: 160 is in favor of brucellosis diagnosis. Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase chain reaction (PCR) are other types of diagnostic tests. Radiological assessments, such as joint sonography, computed tomography, magnetic resonance imaging, are the most helpful radiological methods to diagnose spinal brucellosis. The agents commonly used in the treatment of brucella spondylitis are doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifampicin. The recommended regimens for treatment of brucella involve two or three antibiotics combinations. No standard treatment, physicians prescribe drugs based on conditions of the disease. Patients need a long-term (usually at three months) antibiotic therapy for mainly aiming to prevent relapses. Surgery may be required for patients with spinal abscess. This review focused on physicians' awareness for osteoarticular involvement, clinical presentation, diagnosis and current treatment of OB.

Mucormycosis is a rare, life-threatening opportunistic infection caused by Mucorales. The most common organisms that cause mucormycosis in humans are Rhizopus, Mucor, Rhizomucor, Lichtheimia (Absidia), and Cunninghamella. Risk factors for the disease include diabetes mellitus, metabolic acidosis, hematologic malignancies, prolonged severe neutropenia, use of corticosteroids, and human immunodeficiency virus infection. Diagnosis and treatment of infection are difficult.

Brucellosis is an ancient disease caused by brucellae, which are small, facultative, intracellular, gram-negative coccobacilli. Ten species of Brucella have been identified as the causative agents of brucellosis in mammalian hosts. Natural infections with Brucellae occur globally among humans and animals, resulting in significant economic losses. Research in recent years has focused on appropriate methods for environmental sampling, early detection techniques, decontamination procedures, and the development of new therapeutics and vaccines. Despite this research focus, there is still no human vaccine available. This is of particular concern as Brucellae are highly infectious via the aerosol route; therefore, they have the potential to be misused as agents of biological warfare. The global biological terrorist risk is increasing yearly due to a number of factors including increased migration, escalating numbers of displaced people, the speed and scale of global travel, and technological advances which have enhanced our ability to manipulate pathogens. Presented are a review of the recent developments in brucellosis research and an evaluation of the risks associated with the use of brucellae in deliberate biological attacks.

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

Multidrug resistance observed in microorganisms, especially in hospital-based pathogens, poses a serious public health threat. While scientists have not been able to develop a radical solution for the increasing antibiotic resistance problem, the search for treatment alternatives in appropriate clinical settings continues consistently. Although bacteriophage (phage) therapy was quite popular between 1920 and 1950, it has been abandoned in many parts of the world due to various reasons, nowadays it is again at the agenda and is at the forefront of alternative therapies. In this rediscovery process in area of infectious diseases and clinical microbiology, it is important to consider the interesting history of phage therapy, the reasons for abandonment, the advantages/disadvantages over antibiotics, and the concerns about deployment in clinical use.

Microbiology laboratories play an important role in epidemiology and infection control programs. Within microbiology laboratories, molecular microbiology techniques have revolutionized the identification and surveillance of infectious diseases. The combination of excellent sensitivity, specificity, low contamination levels and speed has made molecular techniques appealing methods for the diagnosis of many infectious diseases. In a well-equipped microbiology laboratory, the facility designated for molecular techniques remains indiscrete. However, in most developing countries, poor infrastructure and laboratory mismanagement have precipitated hazardous consequences. The establishment of a molecular microbiology facility within a microbiology laboratory remains fragmented. A high-quality laboratory should include both conventional microbiology methods and molecular microbiology techniques for exceptional performance. Furthermore, it should include appropriate laboratory administration, a well-designed facility, laboratory procedure standardization, a waste management system, a code of practice, equipment installation and laboratory personnel training. This manuscript lays out fundamental issues that need to be addressed when establishing a molecular microbiology facility in developing countries. (C) 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.

Saprochaete capitata is a very rare pathogen that causes invasive disease particularly in patients with haematological malignancies. We recognised a clustering of S. capitata fungaemia in recent years. So, we report our 6-year surveillance study of fungaemia among patients with haematological malignancies and haematopoietic stem cell transplant. We performed a retrospective and observational study. Hospitalised patients aged >18 years with haematological malignancies were included in the study. A total of 51 fungaemia episodes of 47 patients were analysed. The characteristics of fungaemia in patients with S. capitata compared to patients with candidemia. Median duration of neutropenia was 21.5 days in patients with S. capitata fungaemia, whereas this duration was significantly shorter in patients with candidemia (8 days). Interval between first and last positive culture was significantly longer in patients with S. capitata fungaemia (P < 0.05). Previous use of caspofungin was significantly more common in patients with S. capitata fungaemia. Thirty-day mortality was found 40% for patients with candidemia, whereas it was 39% for patients with S. capitata. In conclusion, despite its limitations this study showed that a novel and more resistant yeast-like pathogen become prevalent due to use of caspofungin in patients with long-lasting neutropenia which was the most noteworthy finding of this 6-year surveillance study.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal systemic viral infection which is an important health problem in Turkey. Many systemic symptoms have been reported including fever, hemorrhage, headache, fatigue, muscle ache, abdominal pain, nausea and vomiting. A 45-year-old male farmer with CCHF presented with massive peritoneal effusion and hyperbilirubinemia. To our knowledge, this is the first case of peritoneal effusion and hyperbilirubinemia in an adult patient with CCHF. His clinical symptoms successfully improved with supportive therapy. In patients who live in endemic areas with atypical presentation for the diagnosis of CCHF should be kept in mind.

Background Extensively resistant Acinetobacter baumannii has emerged and spread worldwide as a significant cause of health care-associated infections and outbreaks. It also causes life-threatening infections among neonates, including bacteremia. The aim of this study was to investigate an outbreak of A baumannii bacteremia (ABB) among neonates. Materials and methods A retrospective, case-control study was conducted from July 2014 to July 2015 in a neonatal intensive care unit (NICU). Risk factors associated with ABB in univariate and multivariate analysis with logistic regression was performed. Molecular typing by pulsed field gel electrophoresis was used to confirm relatedness of bacteremic A baumannii strains. Results During the 5-year period (2011-2016), 68 patients in our NICU were diagnosed with BSI due to A baumannii. The case-control study included 41 case patients within the outbreak caused by a major epidemic clone and 108 control patients. Risk factors (by univariate analysis) associated with ABB were intubation, 14-day mortality, and use of peritoneal dialysis and an umbilical catheter. Multivariate analysis identified 14-day mortality (odds ratio, 5.75; 95% confidence interval, 2.58-12.79) and umbilical catheter use (odds ratio, 2.44; 95% confidence interval, 1.1-5.4) as independent risk factors for ABB. Conclusions This outbreak of bacteremia due to resistant A baumannii affected 41 infants and was associated with 58% mortality. Control of the outbreak was achieved by implementing long-term sustained infection control measures within the unit.

Surveillance of candidemia is essential to monitor trends in species distribution and change in the incidence and antifungal resistance. In this study, we aimed to investigate prevalence, resistance rates, antifungal utilization and costs. A 6-year retrospective analysis of the data belonging to patients with candidemia hospitalized between 2010 and 2016 was performed. The annual usage of fluconazole and caspofungin and the usage of these antifungals in different units were described in defined daily doses (DDD) per 1000 patient days. In total, 351 patients of candidemia were included. Median age of the patients was 45 (0-88) and 55.1% of them were male. Overall, 48.1% of the candidemia episodes (169/351) were due to C. albicans, followed by C. parapsilosis (25.1%), C. glabrata (11.7%). Length of hospital stay was longer with a median of 20 days among patients with non-albicans candidemia. Presence of a central venous catheter was found to be an associated risk for candidemia caused by non-albicans strains. Annual incidence of candidemia increased from 0.10 to 0.30 cases/1000 patient days. Antifungal use was increased over years correlated with the cost paid for it. The policy against candidemia should be specified by each institution with respect to candidemia prevalence, resistance rates, antifungal use and costs.

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Summary: Aim: To assess the risk factors for surgical site infection and the effects of selected infection control measures on surgical site infection rates in a general surgery unit. Methods: Surgical site infection rates and adherence to infection control measures were observed in a general surgery unit. Results: In multivariate analysis, male gender, a high American Society of Anesthesiologists (ASA) score, malignancy, transfusion, open surgery, and contaminated and dirty operations were found to be statistically significant risk factors for surgical site infection. Among infection control measures, only the avoidance of preoperative hair removal and a longer AMP duration had protective effects on SSI. Conclusion: The most important risk factor influencing surgical site infection in general surgery was found to be the contamination level of the wound. Keywords: Surgical site infections, General surgery, Risk factors, Infection control measures, Bundle

Tularemia is a bacterial zoonotic disease. The etiologic agent is Francisella tularensis which is a gram negative coccobacillus and has an exceedingly low infectious dose. Natural infections with F. tularensis have been reported in a range of vertebrates including mammals, birds, amphibians and fish. Tularemia occurs in humans only in the northern hemisphere and most frequently in Scandinavian countries, northern America, Japan and Russia. It is also an epidemic disease in some part of Turkey. The infection is transmitted to humans by arthropod bites (ticks, flies, mosquitoes), by direct contact with infected animals, by contact with infected tissues or fluids of infectious animals, by ingestion of contaminated water or food or by inhalation of infective aerosols. Clinical forms are ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory and typhoidal forms. The diagnosis is based on the isolation of F.tularensis and/or positive serology. In the therapy, the first choice is an aminoglycosides (streptomycin or gentamicin) and alternative choice is ciprofloxacin or doxycycline. Duration of therapy is suggested as 10-14 days. A live attenuated vaccine is only in use some parts of the former Soviet Union but no licensed vaccine available.

Hantaviruses as a member of the family Bunyaviridae are RNA viruses with enveloped, negative-sense, singlestranded segmental genome. Today, more than 20 different hantavirus species are recognized. Eleven of them cause clinical symptoms in humans. While Hantaan (HTNV), Puumala (PUUV), Dobrava (DOBV), Seoul viruses causes different forms of hemorrhagic fever with renal syndrome (HFRS), Sin Nombre virus and Sin Nombre-like viruses found especially in the United States causes hantaviruses pulmonary syndrome (HPS) with high mortality. In our country, infections have been reported with subtypes of the hantaviruses firstly PUUV in the Western Black Sea region, then DOBV from Giresun and Kastamonu. A case of hantavirus infection similarly in the form of RSHF from the rural area of Kazan district in Ankara has been reported in this article. Sixty seven year old male patient was admitted to the emergency room with complaints of dizziness, fever and fatigue in June of 2011. Leukopenia, thrombocytopenia elevated liver enzymes and creatinine was detected in laboratory investigations at the emergency room. The patient was hospitalized and followed with initial diagnosis of Crimean-Congo hemorrhagic fever (CCHF). Further investigation of the serum samples at the Refik Saydam Hygiene Center and Research Laboratory of Virology with indirect immunofluorescent antibody (IFA) (Hantaviruses Mosaic-1, Euroimmun, Germany) resulted OZET Bunyaviridae ailesinin bir uyesi olan hantavirusler zarfli, negatif polariteli tek iplikli segmenter RNA genomuna sahiptirler. Gunumuzde 20’den fazla hantavirus turu tanimlanmistir. Bunlardan 11 tanesi insanda klinik bulgulara yol acmaktadir. Hantaan (HTNV), Puumala (PUUV), Dobrava (DOBV), Seoul virusleri farkli formlarda renal sendromlu kanamali atesi (RSKA) neden olurken, Sin Nombre virus ve Sin Nombre benzeri virusler ozellikle Amerika’da yuksek mortalite ile giden hantavirus pulmoner sendromundan (HPS) sorumludurlar. Ulkemizde, ilk olarak Bati Karadeniz bolgesinde PUUV alt tipine ait hantavirus olgulari, daha sonra Giresun ve Kastamonu’dan DOBV alt tipinde RSKA olgulari bildirilmistir. Bu makalede benzer sekilde RSKA formunda Ankara’nin Kazan ilcesinde gorulen hantavirus enfeksiyonu olgusu sunulmustur. 67 yasinda erkek hasta; bas donmesi, yuksek ates ve halsizlik sikâyetleri ile 2011 yili haziran ayinda acil servise basvurmustur. Acilde yapilan tetkiklerinde; lokopeni, trombositopeni, karaciger enzimleri ve kreatininde yukseklik saptanmistir. Hasta Kirim Kongo kanamali atesi (KKKA) on tanisiyla yatirilmis ve takip edilmistir. Ileri laboratuvar incelemeler icin Refik Saydam Hifzisihha Merkezi Baskanligi, Viroloji Referans ve Arastirma Laboratuvari’na gonderilen serumda indirekt immunflorasan testi (IFA) (Hantavirus Mosaic–1, Euroimmun, Germany) ile hantavirus IgM zayif pozitif, IgG zayif pozitif olarak sonuclanmistir. Immunoblot testi (Euroimmun, Turk Hijyen ve Deneysel Biyoloji Dergisi 1 Erciyes Univeristesi, Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji, KAYSERI 2 Refik Saydam Hifzissihha Merkezi Baskanligi, Viroloji Referans ve Arastirma Laboratuvari, ANKARA 3 Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji, ANKARA Gelis Tarihi / Received : Kabul Tarihi / Accepted : Iletisim / Corresponding Author : Aysegul ULU-KILIC Erciyes Univeristesi, Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji, KAYSERI Tel : +90 505 445 11 32 E-posta / E-mail : draysegululu@yahoo.com 06.02.2012 03.05.2013 DOI ID : 10.5505/TurkHijyen.2013.50103 Ulu-Kilic A, Caglayik-Yagci D, Dede G, Tutuncu E, Uyar Y, Sencan I. Ankara Ili Kazan Ilcesi kirsal bolgesinden hantavirus enfeksiyonu olgusu. Turk Hij Den Biyol Derg, 2013; 70(1): 27-32. Cilt 70  Sayi 1  2013 Turk Hij Den Biyol Derg 28 Hantavirusler dogada kendine ozgu farkli rodent veya bocek yiyicilerle tasinan zarfli RNA virusleridir. Avrupa’da PUUV, DOBV ve Saarema (SAAV) olarak uc hantavirusun RSKA’ye neden oldugu bilinmektedir. PUUV, hafif seyirli RSKA ile iliskilidir. SAAV; Danimarka, Estonya, Finlanda Almanya, Rusya’da tespit edilmis fakat SAAV’nun neden oldugu RSKA olgusu rapor edilmemistir. DOBV, Apodemus flavicollis turu rodent ile tasinir ve Arnavutluk, Bosna Hersek, Cek Cumhuriyeti, Yunanistan’da bulunmustur. DOBV siddetli formda RSKA ile iliskilidir. RSKA’nin kulucka suresi ortalama 1–4 gun olup, tipik olarak atesli, hipotansif, oligurik, diuretik ve konvelasan donemlerden olusur. Bu donemlerin ayirimi her zaman klinik olarak belirgin degildir. Enfeksiyonun seyri subklinikten, olumle seyreden forma kadar cesitlilik gosterebilir, cesitli organlari etkileyerek yaygin hale gelebilir (1–3). Ulkemizde ise ilk olarak Zonguldak ve Bartin’da PUUV alt tipine ait hantavirus olgulari, daha sonra Giresun ve Kastamonu’dan DOBV alt tipinde olgular bildirilmistir (4–6). Bu makalede benzer sekilde RSKA formunda Ankara’nin Kazan ilcesinde gorulen hantavirus enfeksiyonu olgusu sunulmustur. Olgumuz, Ankara’dan bildirilen ilk RSKA olgusu olmasi nedeniyle onem tasimaktadir. OLGU Altmis yedi yasinda erkek hasta, hastaneye yatisindan 4–5 gun once baslayan bas donmesi ve yeni eklenen yuksek ates ve halsizlik sikâyetleri ile 2011 yili Haziran ayinda acil servise basvurmustur. Acilde yapilan tetkiklerinde; lokopeni, trombositopeni, karaciger enzimleri ve kreatininde yukseklik saptanmistir. Hasta KKKA on tanisiyla yatirilmis ve takip edilmistir. Ankara’nin Kazan ilcesi Dutozu Koyunde yasayan hasta ciftcilik ve hayvancilikla ugrasmaktadir. Hastanin klinigimize yatisinda yapilan ilk fiziksel muayenesinde genel durumu orta-iyi olup, vucut isisi; 38°C, KB 110/80 mmHg, nabiz 90/dak ve solunum sayisi 20/dak olarak izlenmistir. Hastanin laboratuvar bulgularinda beyaz kure sayisi 3.360/ mm3, hemoglobin 14,1g/dl, trombosit sayisi 118.000/ mm3 olup, periferik yaymasinda %87 polimorfonukleer lokosit (PNL), %4 lenfosit, %3 monosit, %3,5 eozinofil belirlenmistir. Hastanin basvurusunda ve takibinde izlenen laboratuvar bulgulari Tablo 1’de gosterilmistir. 24 saatlik idrarda proteinuri 1650 mg (normal 50–80 mg/gun) ve kreatinin 2.280 (800–2.000 mg/gun) tespit edilmistir. Abdominal ultrasonografi degerlendirmesinde ise karaciger ve dalak normal boyut ve eko yapisinda saptanmis, bilateral bobrek parankim ekolari grade 1 artmis, parankim kalinliklari GIRIS HANTAVIRUS OLGUSU Germany) ile ise negatif saptanmistir. Fakat hastanin 11 gun sonra gonderilen ikinci serumunda IFA testinin yani sira DOBV pozitifligi immunblot testi ile de serolojik olarak gosterilmistir. Hastanin ilk serum orneginden yapilan realtime (RT) polimeraz zincir reaksiyonu (PZR) testi negatif olarak bulunmustur. Olgumuz, Ankara’dan bildirilen ilk RSKA enfeksiyonu olmasi nedeniyle onem tasimaktadir. Anahtar Kelimeler: Hantavirus, renal sendromlu kanamali ates in weakly positivity of anti-hantavirus IgM and IgG. The first serum samples revealed negative by immunoblot test (Euroimmun, Germany). After 11 days the second sample of the patient revealed DOBV positivite with both IFA and immunoblot serologically. In-house RT Polymerase chain reaction (PCR) test was found to be negative in the first serum sample of the patient. This case is important of being the first HFRS infection reported from Ankara.

Background The screening of critically ill patients at high risk of vancomycin resistant enterococci (VRE) colonization, to detect and isolate colonized patients, is recommended to prevent and control the transmission of VRE. Screening asymptomatic carriers brings financial burden for institutions. In this study, we performed risk analysis for VRE colonization and determined the financial burden of screening in a middle-income country, Turkey. Methods We retrospectively analyzed the VRE surveillance data from a pediatric hospital between 2010 and 2014. A case-control study was conducted to identify the risk factors of colonization. Total cost of VRE screening and additional costs for a VRE colonized patient (including active surveillance cultures and contact isolation) were calculated. Results During the 4-year period, 6,372 patients were screened for perirectal VRE colonization. The rate of culture-positive specimens among all patients screened was 239 (3.75%). The rate of VRE infection was 0.04% (n = 3) among all patients screened. Length of hospital stay, malignancy, and being transferred from another institution were independently associated risk factors for colonization. Annual estimated costs for the laboratory were projected as $19,074 (76,295/4) for all patients screened. Cost of contact isolation for each patient colonized in a ward and an intensive care unit was $270 and $718, respectively. Conclusions In developing countries, institutions should identify their own high-risk patients; screening priorities should be based on prevalence of infection and hospital financial resources.

Objective: We aimed to describe the risk factors for fatality among the patients with Acinetobacter baumannii bacteremia. Methods: Patients with a positive blood culture for A. baumannii by BacT/Alert (bioMerieux, Durham, NC) system were selected. Surviving and nonsurviving patients were compared in terms of demographic characteristics, underlying diseases, invasive procedures, and antibiotic resistance of the microorganisms. Therapies were evaluated according to the results of antibiotic susceptibility tests, and impact of inappropriate therapies for A. baumannii bacteremia was evaluated statistically. Results: Of the 40 patients enrolled, 21 (52.5%) died due to A. baumannii bacteremia. Univariate analysis of risk factors for fatality revealed the following parameters to be significant: >50 years of age, an APACHE II score >16, and transfer from one unit to another more than once (p 16. Overall imipenem resistance in A. baumannii was 67.5%, and carbapenem resistance among fatal cases was 76%. When the antibiotic sensitivity results were assessed, it was noted that 70% of the patients had been receiving inappropriate therapy. However, the antibiotic therapy received or initiated empirically was not shown to be a significant risk factor for mortality (p>0.05). Conclusions: Knowing the risk factors that indicate mortality in such patients and ensuring early diagnosis are of critical importance with respect to prognosis. Starting appropriate therapy by making the right decisions regarding the severity of acute and un

Skin infections caused by Paecilomyces species have been rarely described in patients with solid organ transplantation. Cutaneous manifestations are highly variable and include erythematous macules, nodules, pustules, and vesicular and necrotic lesions. The diagnosis of these infections is generally made by examination of a skin biopsy. Management of these fungal infections is difficult due to the immunocompromised state of the patients. Moreover, antifungal therapy and immunosuppressive drug interactions should be considered during treatment management. Herein, we reported a case of cellulitis caused by Paecilomyces variotii in a 56-year-old man who had undergone a kidney transplantation. Erythematous macular and nodular lesions on the left hand and left foot appeared first; within 2 months the skin lesions became ulcerated, hemorrhagic, and progressively painful and the patient was admitted to our hospital. The diagnosis was made by skin biopsy and tissue culture. The skin lesions resolved by the sixth week of the treatment with voriconazole.

WOS: 000384527500014, PubMed ID: 27625226, Aims: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. Materials and Methods: This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. Results: In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27u86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for 9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68u19.57]). According to linear regression analysis, fever was significantly persisting (7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. Conclusions: In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.

WOS: 000364000400001, PubMed ID: 26538030, Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any firstline drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0: 34-13: 42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.

Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. Design: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Results: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6–93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79–0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73–0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54–0.60, p 0.0001). Conclusions: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.

The pegylated interferon alpha and ribavirin treatment is well established therapy for hepatitis C virus (HCV) infection.During the treatment alanine aminotransferase (ALT) flare may be observed rarely.A 51-year-old female receiving pegylated interferon and ribavirin therapy for HCV infection, complained nausea, vomitingin seventh week of the therapy, and her ALT level was detected over 20 times above the normal level. Hepatitis B surfaceantigen, anti-nuclear antibody, anti-mitochondrial antibody, anti-double stranded DNA antibody and anti-hepatitisA virus IgM antibody were negative, and thyroid stimulating hormone was normal. HCV RNA level was 424 IU/ml. PEGIFN and ribavirin therapy was interrupted for three weeks, after liver enzyme level was detected less than 100U/L, thetreatment was resumed. The patient was followed up for 2 months, ALT flare was not observed.In conclusion, we present a rare case with ALT flare, while receiving pegylated interferon and ribavirin therapy forchronic HCV infection. J Microbiol Infect Dis 2012; 2(3): 121-123Key words: Pegylated interferon, ribavirin, ALT flare, hepatitis C virus

Introduction: The widespread use of tigecycline raises the question of increasing infection rates of Pseudomonas aeruginosa (PA) in ICUs which are not affected by this antibiotic. Objective: The aim of this study was to determine if treatment with tigecycline is a risk factor for PA infection in ICU patients. Methodology: A retrospective and observational study was conducted at Erciyes University Hospital, Turkey, between 2008 and 2010. The Erciyes University Hospital is a 1300-bed tertiary care facility. The patients included in this study were hospitalized in four adult ICUs. Patients with PA infections (case group) were compared with patients with nosocomial infection other than PA (control group). Results: A total of 1,167 patients with any nosocomial infections were included in the study. Two hundred and seventy eight (23.8%) of the patients had PA infection during their ICU stay. Fifty nine patients (21.2%) in the case group received tigecycline before developing PA infections, which were found to be significantly more frequent than in the controls (p < 0.01). Multivariate analysis showed that risk factors for PA infection were previous tigecycline use (4 times), external ventricular shunt (4.2 times), thoracic drainage catheter (2.5 times) and tracheostomy (1.6 times). Conclusion: Our results contribute to the need for new studies to determine the safety of tigecycline use, especially for the treatment of critically ill patients. Since tigecycline seems to be an alternative for the treatment of multidrug resistant (MDR) microorganisms, rational use of this antibiotic in ICU patients is essential.

Francisella tularensis is the etiological agent of tularemia which is a zoonosis of the northern hemisphere. For decades, streptomycin was considered the drug of choice, despite possible side effects, and vestibular toxicity in particular. Alternatives are tetracylines and chloramphenicol which are bacteriostatic agents that are associated with a considerable risk of relapse. The aim of the present study was to assess the in vitro susceptibility of F.tularensis subsp. holarctica biovar II strains to tigecycline, a member of a new class of glycylcyclines. Fourteen F.tularensis strains isolated from patients in Central Anatolia region of Turkey were examined. Minimum inhibitory concentration (MIC) values of tigecycline, doxycycline, streptomycin, gentamicin, and ciprofloxacin were determined using the E-test method on glucosecysteine blood agar plates. Interpretation of results was made according to CLSI clinical breakpoints. All strains were susceptible to the antibiotics traditionally used to treat tularemia. Tigecycline showed good in vitro activity to all the isolates (MIC range: 0.094-0.38 mg/L). In this study, tigecycline was more active than doxycycline against F.tularensis subsp. holarctica strains, according to MIC50 (0.19 mg/L) and MIC90 (0.25 mg/L) values. Doxycycline (MIC90: 0.38 mg/L) showed good in vitro activity against all the isolates and MIC values interpreted according to the CLSI criteria for potential bioterrorism agents, have shown ranges below the breakpoint for sensitivity determination (S

WOS: 000353295400011, PubMed ID: 25634680, Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.

WOS: 000349144300018, PubMed ID: 25821319, Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A) . Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Introduction Mercury intoxication may present in a wide range of clinical forms from a simple disease to fatal poisoning. This article presents a case of acute mercury poisoning, a rare condition that presents challenges for diagnosis with fever of unknown origin. Case presentation A 52-year-old Caucasian woman was admitted to the hospital with high fever, sore throat, a rash over her entire body, itching, nausea, and extensive muscle pain. She had cervical, bilateral axillary and mediastinal lymphadenopathies. We learned that her son and husband had similar symptoms. After excluding infectious pathologies, autoimmune diseases and malignancy were investigated. Multiple organs of our patient were involved and her fever persisted at the fourth week of admission. A repeat medical history elicited that her son had brought mercury home from school and put it on the hot stove, and the family had been exposed to the fumes for a long period of time. Our patient’s serum and urine mercury levels were high. She was diagnosed with mercury poisoning and treated accordingly. Conclusions Mercury vapor is a colourless and odorless substance. Therefore, patients with various unexplained symptoms and clinical conditions should be questioned about possible exposure to mercury.

Preoperative antibiotic prophylaxis is one of the preventive measures for surgical site infections (SSIs). Very little data about the cost effectiveness of the appropriate duration of antibiotic prophylaxis in low- and middle-income countries are available. We aim to assess the cost effectiveness of the use of antibiotic prophylaxis for24 hours to prevent neurosurgical infections in a middle-income country, Turkey.A 1-year prospective study was performed between June 2012 and June 2013. During this study period patients were followed-up on for the development of SSI by means of hospital and postdischarge surveillance. Patients included in the study group received appropriate duration of antibiotic prophylaxis (24 hours), and the duration of prophylaxis was longer in the control group. The antibiotic costs per patient, including prophylaxis and treatment, were calculated.A total of 822 operations consisting of craniotomy (n = 558), spinal fusion (n = 220), and ventricular shunt (n = 44) were included in the study. The study group included 488 (59.4%) patients who underwent operations with appropriate duration (24 hours) of antibiotic prophylaxis. Prophylactic antibiotic cost per patient was significantly lower in the study group ($3.35 and $20.41, respectively). The SSI rates did not differ between the 2 groups: 3.5% (17/488) in the study group and 3.6 (12/822) in the control group (P .05).This cost-analysis study demonstrates that prolonged antibiotic prophylaxis correlates with increased burden of cost, but it is not preventive for SSI.

Tularemia is a bacterial zoonotic infection. The disease is endemic in most parts of the world, has been reported through the northern hemisphere between 30 and 71 degrees N latitude. Francisella tularensis causes infection in a wide range of vertebrates (rodents, lagomorphs) and invertebrates (ticks, mosquitoes and other arthropods). Humans can acquire this infection through several routes including; a bite from an infected tick, deerfly or mosquito, contact with an infected animal or its dead body. It can also be spread to human by drinking contaminated water or breathing contaminated dirt or aerosol. Clinical manifestation of this disease varies depending on the biotype, inoculum and port of entry. Infection is potentially life threatening, but can effectively be treated with antibiotics. Travelers visiting rural and agricultural areas in endemic countries may be at greater risk. Appropriate clothing and use of insect repellants is essential to prevent tick borne illness. Travelers also should be aware of food and waterborne disease; avoid consuming potentially contaminated water and uncooked meat. Physicians should be aware of any clinical presentation of tularemia in the patients returning from endemic areas. (C) 2014 Elsevier Ltd. All rights reserved.