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Background Due to elderly residents, nursing homes/assisted living facilities were the most affected places in COVID-19 pandemic. Besides symptomatic patients, asymptomatic patients were detected during routine screening. Aim This study aims to determine the factors that affect antibody response and viral shedding in stool samples after natural exposure to the virus in residents and staff who recovered from COVID-19 before the vaccine was available. Methods This prospective cross-sectional study was conducted at the nation's highest-capacity Residential and Nursing Home. Blood samples were collected between December 15, 2020 and January 15, 2021 from participating residents and staff for anti-SARS-CoV-2 antibody testing. Stool samples were obtained for SARS-CoV-2 PCR testing 2 months after COVID-19. The Social Sciences (SPSS) program version 15.0 was used for statistical analysis. The Mann-Whitney U test compared SARS-CoV-2 antibody concentration between two groups. Results Four hundred sixty-four (52.3%) residents and 424 (47.7%) staff participated. Entirely 259 (29.2%) participants were anti-SARS-CoV-2 IgG (+) and 255 (28.7%) were SARS-CoV-2 PCR (+). Both antibody and PCR positivity was detected in 196 (76.9%). In PCR (-) group, 63 (10.0%) participants were SARS-CoV-2 IgG (+). Antibody titers were found highest in SARS-CoV-2 PCR (+) male residents. SARS-CoV-2 IgG titers were significantly high in SARS-CoV-2 PCR (+) and hospitalized participants regardless of age. Stool samples were obtained from 61(23.9%) participants and were found negative. Conclusion A durable SARS-CoV-2 IgG antibody response was monitored at least 9 months after the participants were diagnosed with COVID-19. SARS-CoV-2 antibody positivity was detected 76.9% in PCR (+) and 10.0% in PCR (-) participants. Knowing the duration of detectable antibodies is an important finding for developing disease prevention and public health strategies.

INTRODUCTION Following the announcement of first coronavirus disease 2019 (COVID‐19) case on March 11, 2020, in Turkey we aimed to report the co‐infection rates, and the clinical, laboratory, radiological distinctive features of viral pneumonia caused by viruses other than severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). METHODS A cross‐sectional study was conducted between 18 and 31 March 2020. COVID‐19 suspected cases admitted to pandemic policlinic who had nasopharyngeal swab specimens tested for both SARS‐CoV‐2 and other respiratory viral pathogens were included. RESULTS Within 112 patients SARS‐CoV‐2 was detected in 34 (30%). Among the non‐SARS‐CoV‐2 viruses (n=25, 22%), metapneumovirus (n=10), was the most frequent agent. There were two co‐infections with SARS‐CoV‐2. Sputum was less in the SARS‐CoV‐2 group (p=0.003). The leukocyte, lymphocyte, and thrombocyte count and C‐reactive protein levels were lowest in the SARS‐CoV‐2 group (p

Introduction: Management of carbapenem resistant Acinetobacter baumannii infections in intensive care units is challenging because of few treatment options and poor outcomes. In order to contribute to patients’ survival, the factors related to mortality in these infections were evaluated in this study. Materials and Methods: In the 6-month study period, we included 60 patients with carbapenem resistant A. baumannii infections (45 ventilator associated pneumonia and 15 bacteremia) in two intensive care units of our hospital. We collected data of the patients prospectively. We noted demographic features of patients, Acute Physiology and Chronic Health Evaluation (APACHE II) , Sequential Organ Failure Assessment (SOFA), Clinical Pulmonary Infection Score (CPIS), Acute Kidney Injury (AKIN) scores, antibiotic treatments, clinical and microbiological outputs, and mortality rates during treatment and on the 30th day. Results: We observed that infections appeared at mean 11th day of the patients’ stay in the intensive care unit. Carbapenem resistant A. baumannii isolates were highly resistant to antibiotics except colistin. Only 9% of the patients had proper empirical treatment. Twenty five percent of the patients were dead before having a specific antibiotic treatment. Crude mortality rate was 66.7%, and 30th day mortality was 71.7%. The patients who had colistin and tigecycline combination had higher survival rates, but it was statistically insignificant. In univariate analysis high SOFA score (p= 0.0001), high procalcitonin level (p= 0.01), septic shock (p= 0.005), renal insufficiency (p= 0.005), rheumatological disease (p= 0.03) were related to higher mortality. We detected high SOFA score on the first day of infection as the only mortality related factor in multivariate analysis (p= 0.012). The patients who had higher mortality were those with delayed (> 3 days) proper antimicrobial treatment (p= 0.03). Conclusion: In our study, the high SOFA score on the first day of infection in intensive care units was found as a risk factor for mortality. We suggest that prompt administration of the proper antibiotic treatment to the patients who have risk factors for carbapenem-resistant A. baumannii infection can contribute to survival.

We presented a sepsis outbreak caused by Serratia marcescens from contaminated propofol to raise awareness. Three patients had sepsis syndrome after chest surgery. Isolation of S marcescens from patients' respiratory and blood samples alerted us to a possible outbreak. Four syringes filled with propofol and 1 saline solution yielded S marcescens. Nine of 10 isolates from samples of patients and environment genotyped by pulsed-field gel electrophoresis were the same. Disobeying aseptic injection rules of propofol is still causing outbreaks. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

WOS: 000407294300013, Introduction: Hemophilia is a genetic disease presenting predominantly with joint hemorrhages in clinical course. Thus, its treatment requires transfusion of numerous blood and blood products. As a consequence, hemophilia patients are under high risk of many transfusion-borne infections, especially viral hepatitis and human immunodeficiency virus infection. Measures should be taken to prevent the transmission of blood-borne diseases in these patients. Vaccination against hepatitis A and B and patient education are especially crucial for prevention. The aim of this study was to evaluate hemophilia patients' knowledge on viral hepatitis and to test whether their knowledge could be improved by a two-hour training program. Materials and Methods: The study was conducted on June 6, 2015 during a full-day educational program on different topics for hemophilia patients being followed by the Department of Internal Medicine, Hematology Division at Ege University Faculty of Medicine. Twenty-four participating patients filled up pre-test questionnaires, followed by a training given by an expert. The same questionnaire was distributed as a post-test after the training session. There were 18 questions in the questionnaire, comprising six questions on socio-demographic characteristics, eight true/false questions on knowledge about hepatitis and four questions on their vaccination status. Pre-and post-tests were compared with the McNemar test. Results: The mean age of the participating 24 patients was 37.0 +/- 13.0 (20-67) years. The mean duration since the diagnosis of hemophilia was 32.7 +/- 12.8 (6-60) years. Among the participants, one had chronic hepatitis B, two had chronic hepatitis C and the rest were unaware of their viral hepatitis status. Before the training, 19 patients had heard of hepatitis B, 17 had heard of hepatitis A and C, four had heard of hepatitis D and two had heard of hepatitis E. Only two patients knew the routes of transmission of hepatitis A correctly. The patients had misconceptions on the transmission routes of hepatitis B and C. After the training, their information on the fact that hepatitis A is spread primarily through contaminated food or water, hepatitis C can be transmitted via sexual intercourse, there are vaccines to prevent hepatitis A and a vaccine against hepatitis C is not available yet, improved significantly. Conclusion: Patient education programs targeting special high-risk groups such as haemophilia patients could both increase their knowledge and render prevention of viral hepatitis possible.

INSERM U914 ‘Emerging Resistance to Antibiotics’, Le KremlinBicetre, France; Department of Infectious Diseases and Clinical Microbiology, Ege University Medical Faculty, Izmir, Turkey; Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland; Department of Medical Microbiology, Ege University Medical Faculty, Izmir, Turkey; Intensive Care and Reanimation Unit, Ege University Medical Faculty, Izmir, Turkey

WOS: 000395632600004, PubMed ID: 28263502, Background/aim: Healthcare-associated meningitis (HCAM) is a relatively rare entity with significant morbidity and mortality. The aim of this study was to systematically review the Turkish medical literature for acute nosocomial meningitis. Materials and methods: One national (ULAKBIM) and two international (www. scopus. com and www. pubmed. com) databases were searched. In addition, abstracts of four national congresses held between 2004 and 2013 were searched for reports for HCAM meningitis. Results: Data for 899 HCAM meningitis episodes were obtained from 24 reports. In terms of clinical findings, 177 of 216 (81.9%) had fever (> 38 degrees C), 55 of 64 (85.9%) had high CRP levels, 105 of 132 had leukocytosis (> 10,000/mm3), and 241 of 759 had shunt infection. Cerebrospinal fluid culture yielded a pathogen in 689 of 872 nosocomial meningitis episodes. The most common pathogen was Acinetobacter spp. (30.7%), followed by coagulase-negative staphylococci (21.2%) and Staphylococcus aureus (19%). Carbapenem resistance was reported in 18 of 48 (37.5%) Acinetobacter spp. Overall mortality was 160/593 (27%). Pathogen-specific mortality was 55.5% (30/54) for A. baumannii whereas it was 18.9% (7/37) for S. aureus and 2/17 (11,7%) for MRSA. Conclusion: Nosocomial meningitis is still a serious and highly fatal disease. More preventive measures should be sought to further decrease HCAM meningitis and the mortality/morbidity related to it.

Zygomycosis is a rapidly-progressive invasive fungal disease with high mortality rates. Mucor, Rhizopus, Rhizomucor and Absidia species classified in Mucorales order, are the main causative agents of zygomycosis. Uncontrolled diabetes, hematologic malignancies, long term corticosteroid use and immunosuppressive therapies are the main predisposing factors for mucormycosis. In this study, we aimed to evaluate the mucormycosis cases from Turkey published in national and international databases in the last 17 years by means of age, gender, co-morbidities, signs and symptoms, diagnostic methods, therapeutic modalities, and mortality rate by pooling analysis. In our study, two national (http://uvt.ulakbim.gov.tr, http://www.turkmedline.net) and two international (www.ncbi.nlm.nih.gov, http://apps.webofknowledge.com) databases were used. A total of 64 manuscript (34 from national and 30 from international databases) published between 1995 and 2012, which were eligible for the study criteria and accessible as full text were included in the study. A total of 151 mucormycosis patients (71 female, 80 male; mean age: 45.4 +/- 21.4 years) from these studies, with definitive diagnosis of invasive fungal infections according to the criteria of European Organization for Research and Treatment of Cancer (EORTC) have been evaluated. Of 151 patients 91(60%) were diagnosed as rhinocerebral, 42 (%27.8) were sinoorbital, 7 (4.6%) were pulmonary, 6 (3.9%) were disseminated, 3 (1.9%) were skin, and 2 (1.3%) were gastrointestinal mycormycosis. The most common symptoms and signs were; swelling of eye and face (n = 95, 63%), fever (n = 72, 48%), nasal obstruction (n = 60, 40%), headache (n = 58, 38%) and opthtalmoplegia (n = 48, 32%). The most common co-morbidity was diabetes (49%) followed by hematological malignancies (39.7%). Mycological cultures were performed for 82 patients, and fungal growth were detected in the clinical specimens of 51 cases. The distribution of strains isolated in culture were as follows: Mucor spp. (n = 19, 37.2%), Rhizopus spp. (n = 13, 25.5%), Zygomycetes (n = 9, 17.6%), Rhizopus oryzae (n = 4, 7.8%), Rhizopus spp. + yeast (n = 3, 5.9%), Rhizomucor spp. (n = 2, 3.9%) and Rhizosporium spp. (n = 1, 1.9%). In 133 patients, histopathological investigation and in 126 patients radiological examinations were performed for diagnosis. Both surgical debridement and antifungal therapy were employed in 115 patients. Four patients had received only surgical debridement and 30 only antifungal therapies. Classical amphotericin B (AMP-B) therapy for 77 cases, liposomal AMP-B for 60 cases, liposomal AMP-B + posaconazole for six cases and lipid complex AMP-B for two cases have been started as antifungal therapies. Total mortality rate was detected as 54.3% (82/151). In conclusion, despite new diagnostic tools and therapeutic agents, mortality rates in mucormycosis are still very high. For the management, mucormycosis should be considered early in risky patients, and surgical debridement together with effective antifungal therapy should be applied as soon as possible.

Metformin is a biguanide used in the treatment of type 2 diabetic patients with normal renal function. Lactic acidosis is the most serious side effect of metformin. Renal failure is the most common cause of reduced lactate excretion. It is aimed to present a case of metformin-induced lactic acidosis exacerbated by acute renal failure. A 68-year-old female patient used metformin was admitted to the infectious disease department due to diarrhea, nausea and vomiting. Type B lactic acidosis due to metformin was diagnosed after the detection of high anion gap metabolic acidosis and high lactate level on blood gas analysis. Hemodialysis was performed because of acute renal failure. The patient was discharged on the 11th day of the hospitalization with normal serum parameters. Metformin may cause lactic acidosis among patients with acute renal failure; early hemodialysis provides rapid clinical improvement. KEy woRDS: Acute renal failure, Hemodialysis, Lactic asidosis, Metformin doi: 10.5262/tndt.2013.1001.24 Yazisma Adresi: Mustafa YAPRAK Ege Universitesi Tip Fakultesi, Ic Hastaliklari Anabilim Dali, Nefroloji Bilim Dali, Izmir, Turkiye Gsm : 0 505 572 56 67 E-posta : mustafayaprakdr@yahoo.com Gelis Tarihi : 20.05.2012 Kabul Tarihi : 11.06.2012 duyarliligini artirir. Ayrica glikozun gastrointestinal sistemden absorbsiyonunu azaltir (4). Metforminin en sik yan etkisi diyare, bulanti ve kusma semptomlarini iceren gastrointestinal sistem yan etkileridir (5). Laktik asidoz, metformin kullaniminin seyrek gorulen ama ciddi bir yan etkisidir. Karaciger ve bobrek fonksiyon bozuklugu gibi komorbid durumlarin varliginda daha sik gorulmektedir (6). Insidansi her 100.000 hasta yilinda 9’dur (7). Laktat, hepatik glukoneogenez icin bir substrat oldugundan, metGIRIS Metformin biguanid sinifindan oral antidiyabetik bir ilactir. Tip 2 diyabetes mellitusta (DM), bobrek fonksiyonlari normal olanlarda ilk basamak ilac secenegidir (1). Metformin primer olarak hepatik glikoz uretimini baskilayarak hiperglisemiyi iyilestirir (2). Tip 2 DM’li kisiler normale gore 3 kat fazla glukoneogenez oranina sahiptir; metformin tedavisi bunu ucte bir oranina kadar azaltir (3). Buna ek olarak metformin periferik glikoz alimini artirarak insulin Yaprak M ve ark : Akut Bobrek Yetmezliginde Metformine Bagli Laktik Asidoz Turk Neph Dial Transpl 2013; 22 (1): 133-135 134 Turk Nefroloji Diyaliz ve Transplantasyon Dergisi Turkish Nephrology, Dialysis and Transplantation Journal Δ bikarbonata orani 1,42 saptandi. Bakilan laktat duzeyi 9,88 mmol/L saptanmasi uzerine metformin kullanimina bagli Tip B laktik asidoz olarak degerlendirildi. Metformin ve laktat klirensini saglamak ve metabolik asidozu duzeltmek amaciyla hasta bikarbonatli hemodiyalize (HD) alindi. Takibinde hastanin idrar cikisi basladi. Ikinci gun asidozu devam eden hasta tekrar HD’ye alindi. Ucuncu gun kan gazinda asidozu duzelen, laktati normale gelen hasta bikarbonat duzeyi dusuk oldugu icin tekrar HD’ye alindi. Kan gazi takipleri ve diyaliz tedavisi Tablo I’de verildi. Dorduncu gun kan gazi normal sinirlarda saptandi. Daha sonraki gunlerde HD ihtiyaci olmadi. Hastaya sonrasinda metformin kullanmamasi, DM tedavisi icin insulin kullanmasi onerildi. Yatisinin 11. gununde tum kan parametreleri duzelmis olarak sifa ile taburcu edildi.

WOS: 000298113400020, PubMed ID: 21956978, Mycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. The rapid diagnosis of tuberculosis and detection of rifampin (RIF) resistance are essential for early disease management. The GeneXpert MTB/RIF assay is a novel integrated diagnostic device for the diagnosis of tuberculosis and rapid detection of RIF resistance in clinical specimens. We determined the performance of the MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in smear-positive and smear-negative pulmonary and extrapulmonary specimens obtained from possible tuberculosis patients. Two hundred fifty-three pulmonary and 176 extrapulmonary specimens obtained from 429 patients were included in the study. One hundred ten (89 culture positive and 21 culture negative for M. tuberculosis) of the 429 patients were considered to have tuberculosis. In pulmonary specimens, sensitivities were 100% (27/27) and 68.6% (24/35) for smear-positive and smear-negative specimens, respectively. It had a lower sensitivity with extrapulmonary specimens: 100% for smear-positive specimens (4/4) and 47.7% for smear-negative specimens (21/44). The test accurately detected the absence of tuberculosis in all 319 patients without tuberculosis studied. The MTB/RIF assay also detected 1 RIF-resistant specimen and 88 RIF-susceptible specimens, and the results were confirmed by drug susceptibility testing. We concluded that the MTB/RIF test is a simple method, and routine staff with minimal training can use the system. The test appeared to be as sensitive as culture with smear-positive specimens but less sensitive with smear-negative pulmonary and extrapulmonary specimens that include low numbers of bacilli., Ege UniversityEge University [2010/TIP/01], This work was supported by grant 2010/TIP/01 from the Ege University Medical Science Program.