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Aim: The literature seems to miss the clinical course of COVID-19 infection among the pregnant and its effects on the fetus. The present study aimed to evaluate a total of 21 pregnant inpatients in Ankara Training and Research Hospital with the diagnosis of COVID-19 in terms of symptoms, physical examination findings, laboratory findings, treatment results, and complications. Material and Method: A total of 21 pregnant patients diagnosed with COVID-19 by reverse transcriptase polymerase chain reaction (RT-PCR) in Ankara Training and Research Hospital between 22.04.2020 and 27.09.2021 were included in the study. The clinical symptoms, physical examination findings, laboratory findings, and treatment outcomes of the patients, and the health status of the pregnant and newborn were retrospectively evaluated. Results: Of the 21 pregnant patients, 10 were Turkish citizens, and 11 were foreign nationals. The patients were aged 20-41 years with a mean age of 28.76 years. All patients were unvaccinated. Considering underlying diseases among the patients, it was found that one patient had hypertension, and one patient had thyroid disease. In order of frequency, the symptoms in the patients were cough (n =10), fatigue (n=8), sore throat (n=6), dyspnea (n=5), fever (n=3), myalgia (n=3), joint pain (n=1), and diarrhea (n=1). Physical examinations of the patients yielded a fever of 37.4 °C above in 3 patients and rales in one patient. Although one patient with COVID-19 pneumonia was followed up in the intensive care unit, all were discharged upon recovery. Chloroquine tablets were started in 6 patients, a combination of ritonavir (50 mg) and lopinavir (200 mg) in 4 patients, and favipiravir in one patient. Cesarean section was performed in 9 patients, while 12 patients gave normal delivery. Conclusion: Overall, the clinical course of COVID-19 infection in the pregnant followed up in this study was mild, and all newborns were healthy except for one. It is thought that close follow-ups for the pregnant are needed to minimize complications that may develop in them and their fetuses due to COVID-19 infection. Finally, the COVID-19 vaccine seems to be a must for the pregnant to prevent all possible COVID-related complications.

Objective: We evaluated PCR negativity in oropharyngeal and nasopharyngeal secretions of COVID-19 patients at the end of hydroxychloroquine and/or favipiravir treatments. Methods: Study inclusion criteria were being hospitalized, being older than 18 years, PCR positivity in oropharyngeal and nasopharyngeal secretions and being tested for SARS CoV-2-RNA PCR after treatment. Initially hydroxychloroquine treatment (group 1) was administered to the patients according to COVID-19 guide of Health Ministry. Favipiravir (group 2) alone or in combination with hydroxychloroquine (group 3) was administered to patients who were unresponsive to hydroxychloroquine or had severe pneumonia or were admitted to intensive care unit. Control respiratory specimens were taken no earlier than 24 hours, after the end of therapy. Repeated tests with 24–48-hour intervals were performed in patients with still positive PCR test results. The detection of SARS CoV-2-RNA was made by real-time PCR. Results: The study group included 492 patients who received treatment. Mean duration of symptoms was similar among three groups. PCR negativity rate was 52.8% in the specimens taken 24 hours after the end of treatment. PCR negativity rates was 27.9% (200/492) in 48 hours after the end of treatment, %13.8 (123/492) in 72nd hour and %3.8 (80/492) in 96th hour. The ratios of PCR negativity for all specimen days were similar in three groups. There was no statistically significant difference between the groups for time to PCR negativity from the date of positivity and after the end of treatment. We determined that early or late treatment did not make a difference in terms PCR negativity time. Conclusion: No difference was found in terms of the ratios of PCR negativity or time for negativity in oropharyngeal and/or nasopharyngeal specimens taken after the end of treatment in COVID-19 patients receiving hydroxychloroquine and/or favipiravir treatment.

Bu yazıda literatürde nadiren bildirilen bir durum olan varicella zoster ensefaliti ile tüberküloz menenjiti birlikteliği olan 58 yaşında erkek hasta sunuldu. Orbitofrontal bölgede zona tanısıyla valasiklovir tedavisi alırken hastada varicella zoster virüse bağlı olarak ensefalit kliniği gelişti. Tedavi sonrası ateşinin düşmemesi üzerine yapılan incelemelerde beyin omurilik sıvısında polimeraz zincir reaksiyonu testinde Mycobacterium tuberculosis kompleks’in pozitif saptandı. Hastaya tüberküloz menenjit tanısı konuldu. Tedavi sonrasında hastanın ateşi ve klinik yakınmaları tamamen düzeldi.

Aim: COVID-19 is an important public health problem in world and Turkey. The present study aimed to compare the clinical and laboratory findings and mortality rates among vaccinated and unvaccinated COVID-19 inpatients.Material and Method: We included patients receiving inpatient treatment in COVID-19 wards of our hospital between April 25 and October 22, 2021. The patients were divided into two groups: those with and without the COVID-19 vaccine. We extracted patient information from anamnesis files and the hospital information system. Then, we recorded the patients’ epidemiological and laboratory findings and vaccination status. Patients with at least two doses of the COVID-19 vaccine were considered “vaccinated.” We performed Fisher’s exact test and Chi-square test to analyze the data. All statistical analyses were performed in SPSS, and a p-value

Rino-orbito-serebral mukormikozis, Zygomycetes türü küf mantarlarının neden olduğu, mortalitesi ve morbidite oranı yüksek fırsatçı bir mantar enfeksiyonudur. Mukormikozis için en önemli risk faktörü kontrolsüz diyabet ve diyabetik ketoasidozdur. Bunun dışında; desferoksamin tedavisi, demir yüksekliği, immünosüpresif ilaçlar, kortikosteroid kullanımı diğer risk faktörleridir. Bu yazıda, geç tanı konulan rinoorbitoserebral mukormikozise bağlı olarak görme kaybı ve serebral apse gelişen 62 yaşında diyabetik bir erkek sunuldu. Hastaya cerrahi debridman ile birlikte lipozomal amfoterisin-B tedavisi uygulandı.

Background: The aim was to evaluate the bacterial contamination rate of ultrasound probes and gels and the associated nosocomial infection risk. In this way, we aimed to assess whether our ultrasound probe disinfection protocols were effective in reducing the risk of hospital-wide infection. Material and Methods: Forty-eight swab samples were collected from the surfaces of transabdominal (TAP) and transvaginal ultrasound (TVP) probes and adhered to gel bottles, which were then cultured in the microbiology laboratory. In comparison, bacterial contamination of gynecology room door handles (12 swab cultures) was analyzed. These measurements were repeated every week for one month, so that each probe was cultured four times during the study period. Results: Non-pathogenic microorganisms (Staphylococcus epidermidis, S. hominis, S. haemolyticus, S. lugdunensis, Corynebacterium amycolatum, C. aurimucosum) common in human skin flora and the environment and two notable pathogens (Enterobacter cloacae, Escherichia coli) were isolated from the probe cultures. Non-pathogenic organisms (S. epidermidis, S. cohnii) were isolated from gel cultures. Also, no significant differences were also found between groups in contamination rates during various patient examinations and emergencies (p > 0.05). Conclusion: Bacterial contamination was found on ultrasound probes/gels in our department. Although the majority were non-pathogenic microorganisms, two pathogenic microorganisms were also identified. Hospital staff should remember that ultrasound probes can be a tool for bacterial infection and can lead to infectious complications. Decontamination of probes with dry, nonsterile paper towels is a cheap, simple, and effective method that does not damage the device and can also reduce bacterial exposure.

Bacterial and fungal infections can be seen with COVID-19.Besides, some infectious diseases may be confused with pneumonia due to COVID-19 infection. In this article, a 60-year-old male patient who was referred to our clinic with a preliminary diagnosis of COVID-19 pneumonia and finally diagnosed with Pneumocystis jirovecii pneumonia and pulmonary tuberculosis due to HIV infection is presented. The patient's complaints of fever, cough and sputum production at the time of admission completely resolved after Pneumocystis jirovecii and pulmonary tuberculosis treatments.

Legionella pneumophila, hafif seyirli pnömoniden, ağır seyirli pnömoni ve çoklu organ yetmezliğine kadar değişebilen klinik seyir gösteren, toplum ve hastane kaynaklı pnömonilere neden olabilen, sporadik veya salgınlar şeklinde ortaya çıkabilen bir bakteriyel pnömoni etkenidir. Legionella pneumophila, akla getirilmezse ve tanıya yönelik testler istenmezse gözden kaçabilir. Burada, Covid -19 pandemisi döneminde acil servise yüksek ateş, öksürük, nefes darlığı şikayetleri ile başvuran ve idrarda Legionella antijen pozitifliği ile Legionelloz tanısı konulan bir olgu sunuldu. Olguda Covid-19 infeksiyonu bilgisayarlı tomografide tipik tutulum saptanmaması ve Covid-19 polimeraz zincir reaksiyonu testinin negatif saptanması ile ile ekarte edildi. Olguya Legionella pneumophila yönelik levofloksasin tedavisi 21 gün süreyle uygulandı. Klinik ve laboratuvar bulguları düzelen hasta taburcu edildi. Sonuç olarak, Covid-19 pandemi döneminde Legionella pneumophila pnömonisinin Covid-19 pnömonisi ile karışabileceği ve anamnez ve klinik bulguları legionella ile uyumlu hastalarda akılda tutulması gerektiği görüşündeyiz.

Objective: Carbapenemase-producing strains of the Enterobacteriaceae family (CPE) are important agents of health-care associated infections in both our country and worldwide but their detection is difficult. The aim of this study was to compare RAPIDEC ® CARBA NP test and new chromogenic media, OXA-48 and CHROMID CARBA medium performances for detecting carbapenemase-resistant Enterobacteriaceae isolates. Material and method: This study was performed in intensive care units (ICU) of a tertiary care training and research hospital. Totally 67 Enterobacteriaceae strains (30 Escherichia coli, 37 Klebsiella pneumoniae) isolated from varies cultures including blood, urine and tracheal aspirate of ICU patients were included to the study. Identification and antibiotic susceptibility tests of the isolates were performed using VITEK 2 automated system as well disc diffusion test. All isolates were inoculated into chromogenic CHROMID CARBA medium and OXA-48 medium simultaneously. They are incubated at 37ºC for 24-72 hours. Color changes were evaluated at 24,48 and 72. hours. RAPIDEC ® CARBA NP test was also performed for all isolates according to the recommendations of the manufacturer and then its performance was compared with chromogenic media. When comparing the methods, carbapenem resistance values determined by disc diffusion and VITEK 2 automated system were accepted as reference.Results: Among 67 isolates, 28 (42%) were found carbapenem-sensitive and 39 (58%) carbapenem-resistant by using disc diffusion and VITEK-2 automated systems. When disc diffusion test and VITEK 2 automated systems were accepted as reference, compliance rate between Rapidec CARBA ® NP test and disc diffusion and VITEK-2 automated system was 93% (62/67) while it was 75% (50/67) between chromogenic media (CHROMID CARBA and OXA-48) and disc diffusion and VITEK-2. When chromogenic CHROMID CARBA and OXA-48 medium and RAPIDEC ® CARBA NP test were evaluated together, their compliance rate with disc diffusion and VITEK-2 automated system was 69% (46/67). Conclusions: In this study we found close to %70 compliance between CHROMID CARBA medium, OXA-48 medium and Rapıdec ® Carba NP test results. We believe that the studies involving more isolates should be performed on this subject. Moreover, we think that carbapenem resistance should be confirmed by genotypic tests which are the reference method., Amaç: Karbapenemaz üreten Enterobactericea (CPE) üyeleri ülkemizde ve dünyada önemli bir sağlık bakımıyla ilişkili infeksiyon etkenidir ve saptanmaları güçlük gösterirBu çalışmanın amacı; karbapeneme dirençli Enterobactericea üyelerini saptamada yeni bir kromojenik besiyeri olan CHROMagar CARBA ID ve OXA-48 besiyerleri ile RAPIDEC ® CARBA NP testin performansının karşılaştırılmasıdır Gereç ve Yöntem: Çalışmaya Ankara Eğitim ve Araştırma Hastanesi Yoğun Bakım ünitesinde yatan hastaların çeşitli klinik örneklerinden (Derin trakeal aspirat, kan, idrar vb.) izole edilen ve karbapenem direnci fenotipik olarak disk difüzyon ve otomatize sistemle (Vitek 2) ile saptanan 67 Enterobactericea suşu ( 30 E.coli, 37 Klebsiella pneumoniae) dahil edildi. İzole edilen 67 suşun disk difüzyon yöntemi ve VITEK-2 otomatize sistemi ile 28’inin (% 42) karbapeneme duyarlı , 39’unun (%58) ise karbapeneme dirençli olduğu saptandı. Şuslar eş zamanlı olarak CHROMagar CARBA ID ve OXA-48 besiyerlerine ekildi. Suşlar 37 ⁰C ‘de etüvde 24-72 saat süreyle inkübe edildi. Renk değişimleri 24,48 ve 72. saatlerde değerlendirildi. İzole edilen suşlarda RAPIDEC ® CARBA NP testi de çalışılarak kromojenik agar besiyerleri ile performansları karşılaştırıldı. RAPIDEC ® CARBA NP testi üretici firmanın önerileri doğrultusunda çalışıldı. Her iki yöntemin karşılaştırılmasında disk difüzyon ve otomatize sistemle (Vitek 2) ile saptanan karbapenem direnç sonuçları referans olarak kabul edildi.Bulgular: Toplam 67 izolatın , disk difüzyon ve VITEK 2 otomatize sistemle 28 (%42)’inin karbapeneme duyarlı, 39 (%58)’unun ise karbapeneme dirençli olduğu belirlendi. Disk difüzyon yöntemi ve VITEK 2 otomatize sistemi referans alındığında; Rapidec CARBA ® NP testin uyum oranı %93 (62/67) iken, kromojenik besiyerleri (CHROMID CARBA ve OXA-48) ile disk difüzyon yöntemi ve VITEK 2 yöntemi arasındaki uyum oranı %75 (50/67) idi. Disk difüzyon yöntemi ve VITEK 2 otomatize sistemi referans alındığında kromojenik CARBA ID ve OXA-48 besiyerleri ile RAPIDEC ® CARBA NP testi arasındaki uyum oranı %69 (46/67) olarak belirlendi. Sonuç: Karbapeneme dirençli Enterobactericea ailesi üyelerinin saptanmasında fenotipik yöntemlerin performansının değerlendirilmesi için bu testlerin referans yöntem olan genotipik testlerle karşılaştırıldığı daha fazla sayıda suş içeren in vitro çalışmalara ihtiyaç olduğu görüşündeyiz.

Hastanede yatan hastalarda COVID-19 pnömonisini ile birlikte veya takiben bakteriyel pnömoni gelişebilir. COVID-19 pnömonisi ile birlikte bakteriyel pnömoni gelişen hastalarda mortalite oranlarının yüksek olduğu bildirilmiştir. Bu yazıda, toraks bilgisayarlı tomografisi ile olası COVID-19 pnömonisi tanısı konulan ve sonrasında Klebsiella pneumoniae (K. pneumoniae) ’ya bağlı sekonder bakteriyel pnömoni 63 yaşında erkek hasta sunuldu. COVID-19 pnömonisi ve K. pneumoniae’ya bağlı uygun antimikrobiyal tedavi sonrasında klinik ve laboratuar bulguları düzelen hasta taburcu edildi. Sonuç olarak, COVID-19 pnömonisi tedavisine rağmen klinik ve laboratuar bulguları düzelmeyen hastalarda klinik tabloya sekonder bakteriyel pnömoni etkenlerinin eklenmiş olabileceği akılda tutulmalıdır., Bacterial pneumonia may develop with or following COVID-19 pneumonia in hospitalized patients. It has been reported that mortality rates are high in patients who develop bacterial pneumonia together with COVID-19 pneumonia. In this article, a 63-year-old male patient who was diagnosed with probable COVID-19 pneumonia by thorax computed tomography and then secondary bacterial pneumonia due to Klebsiella pneumoniae (K. pneumoniae) is presented. The patient, whose clinical and laboratory findings improved after COVID-19 pneumonia and appropriate antimicrobial therapy due to K. pneumoniae was discharged. In conclusion, it should be kept in mind that secondary bacterial pneumonia agents may be added to the clinical picture in patients whose clinical and laboratory findings do not improve despite the treatment of COVID-19 pneumonia.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis characterized by seizures, psychiatric symptoms, and movement disorder, which may present with an acute or subacute course. It has been reported that the production of anti-NDMA receptor antibodies can be triggered in the course of herpes simplex encephalitis and anti-NMDA receptor encephalitis may occur clinically. It has been reported that 25% of patients with HSV encephalitis have anti-NDMA receptor antibodies and are associated with impaired improvement in cognitive performance. In this article, we present a case of anti-NMDA receptor encephalitis associated with HSV-type 1 encephalitis in a 30-year-old woman and review the literature. After the patient's treatment for HSV encephalitis ended, her psychiatric symptoms such as anxiety, agitation, hallucinations and euphoria persisted and he was diagnosed with anti NMDA receptor antibodies detected in CSF. The patient was transferred to the neurology clinic and intravenous immunoglobulin treatment was started.

Aim: Staphylococcus aureus causes community-acquired and health care-related infections with high morbidity and mortality. The most common infections in which it is isolated are wound infections, urinary tract infections, pneumonia, septic arthritis, osteomyelitis and sepsis. Methicillin-resistant S. aureus was first identified in the 1960s and became an important factor in hospitals in the 1980s. Methicillin-resistant S. aureus, in healthcare-related infections, especially in hospitalized patients, is an important factor. In this study, the distribution of health care related S. aureus infections and MRSA isolates over a six-year period, by year, was examined. In the light of these data, it is aimed to evaluate compliance with infection control measures and rational antibiotic use.Material and Method: The data of S. aureus bacteria isolated from patients diagnosed with healthcare-associated infections and followed up in a tertiary hospital between January 2016 and December 2021 were obtained from the Infection Control Committee records. A total of 201 diagnosis of healthcare-associated infections caused by S. aureus bacteria was detected in a six-year period. S. aureus infections; Health care associated infection diagnoses were evaluated by considering the years, the diagnoses made by infectious diseases, and the clinics (Intensive Care Unit-Service) where the patients were followed. Results: According to the distribution of general healthcare-associated infectious agents in 2016, it was found that the rate, which was 1.29%, increased to 6.41% over the years. It was observed that there was a cumulative increase in the patients hospitalized and followed up in the wards until 2020, the rates were determined as 5%, 3.8%, 20.3%, 25.3%, 34.69% and 17.1%, respectively, over the years. The distribution in intensive care units (ICU) was determined as 3.9%, 10.3%, 11.9%, 19.4%, 20% and 23.5%, respectively. Health care-related S. aureus infections over the years were statistically significant compared to the increase observed in wards (p0.05).Conclusion: In the 6-year period, the rates of healthcare-associated infections caused by S. aureus increased approximately 5 times. However, it does not correlate with the increase in MRSA rates. We think that this increase can be prevented by providing hand hygiene trainings, increasing compliance with standard infection control measures and improving the rational use of antibiotics., Amaç: Staphylococcus aureus (S. aureus) morbidite ve mortalitesi yüksek toplum kaynaklı ve sağlık bakım ilişkili enfeksiyonlara neden olmaktadır. En sık izole edildiği enfeksiyonlar; yara yeri enfeksiyonları, üriner sistem enfeksiyonları, pnömoni, septik artrit, osteomyelit ve sepsistir. Metisiline dirençli S. aureus (MRSA) ilk olarak 1960’larda tanımlanmış olup ve 1980’lerde hastanelerde önemli bir etken haline gelmiştir. Özellikle hastanede yatan hastalarda, sağlık hizmeti kaynaklı enfeksiyonlarda metisiline dirençli S. aureus önemli bir etkendir. Bu çalışmada, sağlık bakım ilişkili S. aureus enfeksiyonlarının ve MRSA izolatlarının altı yıllık dönemde, yıllara göre dağılımı irdelenmiştir. Bu veriler ışığında enfeksiyon kontrol önlemlerine ve akılcı antibiyotik kullanımına uyumun değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2016-Aralık 2021 tarihleri arasında bir üçüncü basamak hastanede yatırılarak izlenen, sağlık bakım ilişkili enfeksiyon tanısı konulan hastalardan izole edilen S. aureus suşlarına ilişkin verilere Enfeksiyon Kontrol Komitesi kayıtlarından ulaşıldı. Altı yıllık dönemde 201 adet S. aureus suşlarının neden olduğu sağlık bakımı ile ilişkili enfeksiyon tanısı konuldu. Sağlık bakımı ile ilişkili S. aureus enfeksiyonlarının tutulum yaptığı organ ve sistemlere göre dağılımları, görüldüğü kliniklere (yoğun bakım ünitesi–servis) ve yıllara göre dağılımları değerlendirildi.Bulgular: Sağlık bakımı ilişkili genel enfeksiyon etkenlerinin yıllara göre dağılımı incelendiğinde; 2016 yılında %1,29 olan oranının yıllar içinde artarak %6,41’e çıktığı saptandı. Servislerde yatırılarak izlenen hastalarda 2020 yılına kadar kümülatif bir artış olduğu izlendi, oranlar yıllara göre sırasıyla; %5, %3,8, %20,3, %25,3, %34,69 ve %17,1 şeklinde saptandı. Yoğun bakım ünitelerindeki (YBÜ) dağılım ise yıllara göre sırasıyla; %3,9, %10,3, %11,9, %19,4, %20 ve %23,5 olarak saptandı. YBÜ’de izlenen sağlık bakım ilişkili S. aureus enfeksiyonlarının yıllar içindeki artışı, servislerde izlenen artışa göre istatistiksel olarak anlamlı saptandı (p0,05). Sonuç: Toplam 6 yıllık dönemde S. aureus’un etken olduğu sağlık bakımı ilişkili enfeksiyon oranlarında yaklaşık beş kat artış saptanmıştır. Ancak, bu artışın MRSA oranlarındaki artış ile korelasyon göstermediği belirlendi. El hijyeni eğitimleri, standart enfeksiyon kontrol önlemlerine uyumun artırılması ve akılcı antibiyotik kullanımda iyileştirme sağlanarak bu artışın önüne geçilebileceğini düşünmekteyiz.

Streptococcus intermedius is part of the normal oropharyngeal, genitourinary and gastrointestinal flora, and can cause purulent infections characterized by abscess formation involving the brain and the liver tissue In this report, multiple pyogenic liver abscesses due to S intermedius in a 46-year-old male admitted to the emergency department with complaints of fever, cough, and weakness, and hospitalized with a diagnosis of suspected COVID-19 with pneumonia, is presented The diagnosis was made by isolating the agent from the abscess After percutaneous abscess drainage and antimicrobial treatment, the patient fully healed

Metisiline dirençli Staphylococcus aureus (MRSA)’ya bağlı toplum kaynaklı deri ve yumuşak doku infeksiyonları oldukça nadirdir. Bu yazıda, son 6 ay içinde hastanede yatış öyküsü olmayan 74 yaşında diyabetik bir kadın hastada boyun bölgesinde toplum kaynaklı MRSA bağlı olarak gelişen karbonkül sunuldu. Teikoplanin tedavisi ve aralıklı karbonkül drenajı sonrasında hastanın şikayetleri ve laboratuvar bulguları düzeldi.

Kateter enfeksiyonlarının en sık etkeni cilt florasında yer alan stafilokoklar ve diğer Gram-pozitif bakterilerdir. Citrobacter freundii çoğunlukla nozokomiyal enfeksiyon etkeni olup, nadiren kateterle ilişkili kan dolaşımı enfeksiyonuna neden olur. Bu yazıda, hemodiyalize giren 39 yaşında bir erkek hastada Citrobacter freundii’ye bağlı olarak gelişen kateterle kan dolaşımı enfeksiyonu gelişen bir olgu sunuldu. Hastanın periferik kan ve kateter içinden alınan kan örneklerinde Citrobacter freundii üredi. Hastaya 10 gün süreyle seftriakson tedavisi uygulandı, tedavi sonrası klinik ve laboratuvar bulguları düzeldi. Sonuç olarak, özellikle hemodiyalize giren hastalarda nadirde olsa Gram-negatif bakterilerden Citrobacter freundii’nin de kateterle ilişkili kan dolaşımnı enfeksiyonu etkeni olabileceği akılda tutulmalıdır.

Chronic hepatitis B (CHB) is an important public health problem in the world and Turkey. The aim of this study was to evaluate the histological, virological, serological and biochemical response rates in CHB patients receiving tenofovir or entecavir therapy. Control liver biopsies were performed on patients who received tenofovir or entecavir therapy for one year or longer. Histopathological grading was scored according to the modified Knodell system. Eighty-seven CHB patients were included in this study, 56 patients were receiving tenofovir and 31 patients were receiving entecavir therapy. Patients in two treatment groups were similar in terms of baseline parameters (p> 0.05). At the end of the treatment, there was a significant decrease in mean values of HBV DNA, alanine aminotransferase and necroinflammatory scores for both groups (p 0.05). Histological responses were obtained 66.1% from the tenofovir group and 54.8% from the entecavir group. Treatment with tenofovir and entecavir resulted with improvement in Ishak fibrosis scores in 12.5% and 12.9% of the patients, respectively. For 14.3% of the tenofovir-treated patients and for 22.6% of the entecavir-treated patients, the Ishak fibrosis scores worsened. Baseline intermediate/ advanced fibrosis stage (Ishak fibrosis score: 3-6) was found as independent determinant factor on histological response and improvement of fibrosis score (OR= 3.99, p= 0.01; OR= 31.67, p= 0.002; respectively) and treatment duration longer than five years is an independent determinant for improvement of necroinflammatory score (OR= 5.79, p= 0.02). There was no significant difference in the virological, serological, biochemical and, histological responses and improvement of necroinflammatory and fibrosis scores between tenofovir and entecavir groups (p> 0.05). Similar histological, virological, serological and biochemical responses were obtained in patients with CHB receving tenofovir and entecavir treatments. Further studies involving a large number of patients receiving long-term therapy should be done to understand the effects of antiviral treatments on healing of liver histology.

İntrakraniyal tüberkülom,tüberküloza bağlı santral sinir sistemi infeksiyonunun önemli komplikasyonlarındanbirisidir. İntrakraniyal tüberkülomlar görüntüleme yöntemlerinde beyintümörleri ile karışabilir. Tanıda etkenin kültürden izolasyonu vehistopatolojik inceleme kullanılabilir. Tedavide cerrahi girişim veantitüberküloz tedavi uygulanır. Bu yazıda, Cibuti, Afrika’dan gelen ve intrakraniyalkitle nedeni ile opere edilen ancak biyopsi materyalinin histopatolojikincelemesi sonucunda tüberkülom olduğu saptanan 34 yaşında bir kadın hastasunuldu., Intracranial tuberculoma is one of the significant complicationsof central nervous system infection due to tuberculosis. Intracranialtuberculomas may be confused with brain tumors in imaging modalities. Diagnosisis made with the isolation of the causative agent from culture orhistopathological examination. Surgical intervention and antituberculosistreatment are used in the treatment. In this article, 34 years old femalepatient from Cibuti, Africa, who is operated with the diagnosis of intracranialmass is presented. The definite diagnosis of tuberculosis is made with thehistopathologic examination of biopsy specimens.

Gunal, Ozgur/0000-0002-7744-4123; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000490537600009 PubMed: 31580558 Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%. WOS:000617831800002 2-s2.0-85101454721 PubMed: 33586014

Amaç: Bu çalışmanın amacı, Ankara Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon yoğun bakım ünitesinde yatan hastalarda gelişen kateter ilişkili üriner sistem infeksiyonlarının hızlarının ve infeksiyon etkenlerinin retrospektif değerlendirilmesidir.Gereç ve Yöntemler: Çalışmaya, 1 Ocak 2018-31 Aralık 2019 tarihleri arasında Anesteziyoloji ve Reanimasyon yoğun bakım ünitesi (ARYBÜ)’nde yatan ve kateter ilişkili üriner sistem infeksiyonu tanısı konulan hastalar dahil edildi. Hasta verileri enfeksiyon kontrol hemşirelerinin günlük vizitleri ve enfeksiyon hastalıklarının günlük konsültasyon kayıtlarından ve Ulusal Hastane Enfeksiyonları Sürveyans Ağı İNFLİNE programı verilerinden, laboratuvar verileri ise Mikrobiyoloji laboratuarından elde edildi. Hastaların demografik verileri, üriner kateterle ilişkili enfeksiyonları, enfeksiyon etkenleri, hastalardaki komorbid durumların varlığı kaydedildi.Bulgular: Anesteziyoloji ve Reanimasyon yoğun bakım ünitesinde iki yıllık sürede 17910 hasta gününde 1243 hasta takip edilmişti. Hastaların üriner kateter günü 17470 gün idi. Çalışmanın yapıldığı dönemde toplam 85 hastaya 116 Kİ-ÜSİ tanısı konuldu. Üriner kateter kullanım oranı 0.97, kateterle ilişkili üriner sistem infeksiyonu hızı (Kİ-ÜSİ) ise 6.63 olarak saptandı. 2019 yılı Sağlık Bakanlığı Eğitim ve Araştırma Hastaneleri ARYBÜ’lerinin sürveyans verileri ile karşılaştırıldığında; hastanemizin ARYBÜ üriner kateter kullanım oranının %25 persentil ile uyumlu olduğu, Kİ-ÜSE hızının ise %90 persentilin üzerinde olduğu saptandı.Hastaların 47 (% 55)’si kadın, 38 (%45)’i erkek, yaş median değeri 66 idi. Hastaların tümünde üriner kateter mevcuttu. Hastalarda görülen komorbid hastalıklar; 44 (%51.8) hastada nörolojik hastalık (serebrovasküler olay, demans vb.), 40 (%47.1) hastada hipertansiyon, 28 (%32.9) hastada diyabetes mellitus, 20 (%23.5) hastada KOAH ve iki (%2.4) hastada kronik böbrek hastalığı olarak belirlendi. Hastaların 72 (%84.7)’si entübe idi ve 19 (%22.4)’unda dekübit ülseri mevcuttu. Kİ-ÜSİ etkenlerinin dağılımı incelendiğinde 27 (%31.8) hastada birden fazla etkenin izole edildiği görüldü. Üriner sistem etkenleri 18 (%21.2) hastada Klebsiella türleri (spp.), 10 (%11.8) hastada Escherichia coli, dokuz (%10.6) hastada Enterococcus spp.,sekiz (%9.4) hastada Pseudomonas spp., yedi (%8.2) hastada Proteus spp., dört (%4.7) hastada Acinetobacter spp., bir (%1.2) hastada Staphylococcus aureus ve bir (%1.2) hastada Enterobacter spp. olarak belirlendi. Kİ-ÜSİ saptanan 85 hastanın 19’unda kan kültüründe de aynı etken izole edildi. Kan kültüründen en sık izole edilen etkenler sırasıyla; altı olguda birden fazla etken, yedi Klebsiella spp., iki E. coli ve iki Enterococcus spp., bir Acinetobacter spp., bir Proteus spp. olarak belirlendi. Sonuç: Yoğun bakım ünitelerinde kateter ilişkili üriner sistem infeksiyonu oranlarının azaltılması için üriner kateter takılması endikasyonlarının iyi belirlenmesi, gereklilik ortadan kalktığında kateterin çekilmesi ve enfeksiyon kontrol önlemlerine dikkat edilmesi uygun bir yaklaşım olacaktır. Yoğun bakım ünitesinde yatan hastalarda hastane infeksiyonu etkenlerinin belirlenmesi, ampirik tedavide yol gösterici olacağından mortalite ve morbidite oranlarının azaltılmasına da katkı sağlayacaktır., Aim: The aim of this study is to retrospectively evaluate the rates and infectious factors of healthcare-associated urinary tract infections in patients with Ankara Training and Research Hospital, Anesthesia and Reanimation intensive care unit.Material and Methods: Patients hospitalized in the Anesthesia and Reanimation intensive care unit (ICU) between January 1, 2018 and December 31, 2019 and diagnosed with healthcare-related urinary tract infection were included in the study. Patient data were obtained from the daily visits of infection control nurses and daily consultation records of infectious diseases, while laboratory data were obtained from the Microbiology laboratory. The rate of infection associated with urinary catheter, distribution of infectious agents, and presence of comorbid conditions in patients were recorded.Results: Totaly 1243 patients were followed up for 17,910 patient days in the Anesthesia and Reanimation intensive care unit for two years .The urinary catheter day of the patients was 17470 days. A total of 85 patients were diagnosed with 116 urinary catheter-related urinary tract infections. Forty- seven of the patients (55%) were female, 38 (45%) were male, age median value was 66.During the period of the study, it was found that the rate of urinary catheter use was 0.97, and the rate of catheter-related urinary tract infection (CI-UTI) was 6.63.When the rate of urinary catheter use in the Anesthesia and Reanimation intensive care unit in our hospital is compared with the 2019 Ministry of Health Education and Research Hospitals Anesthesia ICU surveillance data; it was found that the rate of urinary catheter use was consistent with the 25th percentile (0.97), and the rate of CI-UTI was above the 90th percentile (3.8).The most common comorbid diseases in patients were at least one neurological disease (cerebrovascular event, dementia, etc.) in 44 (51.8%) patients, hypertension in 40 (47.1%), diabetes mellitus in 28 (32.9%), chronic obstructive pulmonary diseases in 20 (23.5%) patients and 2.4% of the patients were identified as chronic kidney disease. All patients had urinary catheters. 72 (84.7%) of the patients were intubated and 19 (22.4%) had decubitus ulcers.Distribution of agents causing urinary tract infection; multiple agents in 27 (31.8) patients, Klebsiella species (spp.) in 18 (21.2%) patients, E.coli in 10 (11.8%) patients, Enterococcus spp. in nine (10.6%) patients, Pseudomonas spp in eight (9.4%) patients, Proteus spp. in seven (8.2%) patients, Acinetobacter spp. in four (4.7%) patients, Staphylococcus aureus in one (1.2%) patient, Enterobacter spp. in one (1.2%) patient were determined.In 19 of 85 patients with urinary system infection, the agent was also isolated from the blood culture. The most common factors isolated from blood culture are; 36.8% Klebsiella spp., 31.6% multiple agents, 10.5% E.coli and 10.5% Enterococcus spp. was determined.Conclusion: As a result, it would be an appropriate approach to determine the indications for urinary catheter insertion well and withdraw the catheter when the necessity is eliminated in order to reduce the urinary system infection rates associated with healthcare in the ICU. Determining the factors of nosocomial infection in patients hospitalized in the intensive care unit will contribute to the reduction of mortality and morbidity rates as it will be a guide in empirical treatment.

Amac: Altmis bes yas uzeri, kronik hastaliklari bulunan ve immunsupresif hastalar influenza ve pnomokok asisi endikasyonu olan hasta gruplaridir. Bu calismada HIV pozitif hastalarla ve 65 yas uzeri HIV negatif hastalarin influenza ve pnomokok asisi yaptirma oranlarinin ve bu asilara karsi tutumlarinin belirlenmesi amaclandi. Gerec ve Yontem: Ocak 2017 - Ocak 2018 tarihleri arasinda Enfeksiyon Hastaliklari poliklinigine basvuran HIV pozitif hastalara ve 65 yas uzeri HIV negatif hastalara 10 sorudan olusan bir anket uygulandi. Anket sorularina verilen cevaplar degerlendirildi. Bulgular: Calismaya dahil edilen 97 katilimcinin 67'si (%69) HIV negatif 65 yas uzeri hastalar, 30’u (%31) HIV pozitif hastalardi. Hastalarin 53’u erkek (%55), yas ortalamasi 62±18 yas idi. Tum hastalarda influenza ve pnomokok asilari ile asilanma oranlari sirasiyla %30 ve %29 olarak bulundu. HIV pozitif hastalarin, 65 yas uzeri HIV negatif hastalara oranla influenza ve pnomokok asilarini daha yuksek oranda yaptirdigi belirlendi (p=0,000). Her iki grupta da eslik eden diger hastaliklari olanlar ve olmayanlar arasinda influenza ve pnomokok asisi yaptirma oranlari acisindan fark mevcuttu (p≤0.05). Tum hastalarin egitim duzeyleri ile influenza asisi yaptirma oranlari arasinda fark saptanmadi (p>0.05), ancak pnomokok asisi yaptirma orani universite mezunlarinda daha yuksek idi (p= 0.000). Ankete katilan tum hastalar arasinda influenza asisinin 65 yas uzerine ve risk gruplarina ucretsiz yapildigini bilenlerin orani %38 idi. Influenza ve pnomokok asisini yaptirmamanin en sik nedeni, asinin hekim tarafindan onerilmemesiydi (sirasiyla %64,7 ve %61,3). Sonuc: Calismamizda tum hastalarda influenza ve pnomokok asilanma oranlari sirasiyla %30 ve %29 olarak bulunmustur. Hem influenza asisi hem de pnomokok asisi yaptirma oranlarinin HIV pozitif hastalarda, 65 yas uzeri HIV negatif hastalara gore daha yuksek oldugu belirlenmistir. Influenza ve pnomokok asisini yaptirmayan hastalarda en sik nedenin asinin hekim tarafindan onerilmemesi oldugu saptanmistir. Risk gruplarinda yer alan bireylerin ve 65 yas uzeri hastalarin influenza ve pnomokok asilari yonunden hekimler tarafindan bilgilendirilmeleri ve asilamaya tesvik edilmeleri gerektigi sonucuna varilmistir.

Serratia marcescens (S. marcescens) is a Gram negative bacilli in the family Enterobactericea and is an important cause of health care-related infections and intensive care outbreaks. In this article, an 82-year-old female patient admitted to bed, who was a persistent urinary tract infection due to bacteremic urinary tract infection due to S. marcescens, was referred to the literature. In conclusion, it should be kept in mind that S. marcescens and other Gram-negative bacteria may cause bacteraemia-induced urinary tract infections especially in bedridden patients who have persistent urinary incontinence, and urine culture and blood cultures should be taken in these patients.

Listeria monocytogenes, fekal-oral yolla bulaşan zoonotik bir enfeksiyon etkeni olup, gebelerde, 50 yaş üzeri hastalarda, immün yetmezlikli hastalarda ve alkolik hastalarda menenjit, ensefalit, meningoensefalit ve rombensefalit gibi santral sinir sistemi enfeksiyonlarına neden olabilir. Gebelik, Listeria monocytogenes enfeksiyonları için önemli bir predispozan durumdur ve gebelerde enfeksiyon ağır seyredebilir. Bu yazıda, 3 gündür ateş, baş ağrısı, baş dönmesi, bulantı, kusma yakınmaları ile başvuran ve hiperemezis gravidarum ön tanısıyla kadın hastalıkları ve doğum kliniğine yatırılan, Listeria monocytogenes ’e bağlı olarak gelişen rombensefalit tanısı konulan 28 yaşında 8 haftalık gebe kadın hasta sunuldu. Hastanın tanısı, klinik bulgularla birlikte kan kültüründen etkenin izole edilmesi ve manyetik rezonans görüntülemede rombensefalit saptanması ile konuldu. Gebeliği medikal abortusla sonlandırılan hastaya antimikrobiyal tedavi toplam 6 ay süreyle uygulandı, tedavi bitiminde klinik bulguları ve manyetik rezonans görüntülemede saptanan lezyonları tamamen düzeldi., Listeria monocytogenes is a fecal-orally transmitted zoonotic agent, and can cause central nervous system infections such as meningitis, encephalitis, meningoencephalitis, and rhomboncephalitis in pregnant women. Pregnancy is an important predisposing condition for Listeria monocytogenes infections and infection may be severe in pregnant women. In this article, we presented a 28-years-old 8-weeks pregnant woman who was admitted to gynecology and obstetrics clinic with the diagnosed of hyperemesis gravidarum with the complaints of fever, headache, dizziness, nausea and vomiting for 3 days and diagnosed as Listeria monocytogenes. The diagnosis of the patient was made by isolating the bacteria from blood culture together with clinical fndings and detection of rhombencephalitis in magnetic resonance imaging. Antimicrobial treatment was applied to the patient, her pregnancy was terminated with medical abortion. After 6 months therapy, the clinical findings and lesions detected in magnetic resonance imaging were completely recovered.

Background: The hepatitis B virus (HBV) is one of the major causes of chronic liver disease. From the perspective of hospital workers (HWs), employees are at risk of hepatitis B infection because of occupational exposure. Apart from this occupational risk, health professionals may still be affected by HBV, depending on the epidemiological characteristics of the country and geographical region they live in. Objectives: This study aimed to determine HBV, HCV, and HIV seroprevalence among HWs using data obtained from 21 hospitals located in six geographical regions in Turkey and the Turkish Republic of Northern Cyprus. Methods: The study was designed as a retrospective, multicentre, descriptive study. Twenty hospitals from Turkey and one hospital from the Turkish Republic of Northern Cyprus were involved in the study. The variables of the study were vaccination status against HBV and hepatitis A and HBsAg, anti-HBs, anti-HBcIgG, anti-HAVIgG, anti-HCV, anti-HDV, and anti-HIV serology results belonging to the previous year. Results: Women constituted 58.9% (n = 5,622) of the HWs included in the study. The mean age was 36.3 +/- 9.09 years (min =18, max = 72). In terms of occupation, 42.5% (n = 4, 064) were nurses/health officers, and 24.8% (n = 2365) were physicians. HBsAg seroprevalence was found to be 1.8% (n =169; 95% CI = 1.5% - 2.0%), while anti-HBs seropositivity was 75.7% (n = 7,234). About 7.3% (n = 701) had natural immunity to hepatitis B. About 21.6% (n = 2,066) of the HWs did not receive hepatitis B vaccine. Conclusions: This study is the first study involving a large sample size from different locations of Turkey. According to the results, hepatitis B and hepatitis A vaccines should be administered to susceptible individuals and HWs. WOS:000534475500002 2-s2.0-85085751514

Kronik alkol kullanan bireylerde santral sinir sistemi infeksiyonu bulguları baskılanabilir veya alkol yoksunluk sendromu gibi klinik durumlarla karışabilir. Alkolik hastalarda mikroorganizmalara karşı immun yanıtın etkilenmesi, malnutrisyon ve vitamin eksikliği gibi nedenlerle infeksiyon etkenlerine karşı duyarlılık artar. Bu hastalarda en sık görülen menenjit etkeni Streptococcus pneumoniae’dır. Pnömokoklarda penisilin direnci son yıllarda tüm dünyada ve Türkiye’de önemli bir endişe kaynağıdır. Penisiline yüksek düzey dirençli pnömokok infeksiyonlarının tedavisinde üçüncü kuşak sefalosporinler (seftriakson, sefotaksim) ve vankomisin kombinasyonu ile birlikte deksametazon tedavisi tercih edilir. Pnömokokal menenjitte tanı ve tedavide gecikme olması durumunda mortalite oranı yüksektir. Bu yazıda, kronik alkol kullanımı öyküsü olan 40 yaşında bir erkek hastada kafa travmasını takiben gelişen, geç tanı konulan ve mortal seyreden penisiline dirençli Streptococcus pneumoniae menenjiti olgusu sunuldu.

Introduction: The number of persons diagnosed as HIV positive is increasing rapidly in Turkey. Although the overall prevalence of the disease is still low, the increase of newly diagnosed persons emerges an important concern dealing with the awareness of the clinicians, and especially the surgeons. The aim of the study is to evaluate the approach of surgeons to HIV infection in the hospital. Materials and Methods: A 12-item self-administered anonymous questionnaire about the HIV infection with true and false options was developed. The questionnaire also included the specialty, age, duration of occupation and position of the surgeons. The questions were targeted to learn the knowledge and attitude about transmission route, occupational risk of acquiring HIV infection, prophylaxis for prevention, reluctance for operation and current drug therapy. The questionnaires were voluntarily filled by surgeons in November 2017. The descriptive statistics of the study were calculated as numbers and percentages. Yates’ corrected chi-square and Fisher’s exact tests were used in comparative analysis. Mann-Whitney U test and Spearman correlation test was used for comparison of continuous variables and correlation, respectively. Results: The total number of filled questionnaires was 90. In 90 of them, the demographic fields were filled. Among 90 surgeons, 37% (33/90) were assistant doctors between the ages of 25-31 years, and the duration of occupation was between 1-6 years. The remaining was older than 31 years of age and the duration of occupation as surgeon was 5-40 years. Specialties were urology, orthopedics, plastic surgery, obstetrics and gynecology, ophthalmic surgery, ear-nose-throat surgery, cardiovascular, general surgery, and neurosurgery. The results generally denote that the surgeons are aware of the occupational risk of HIV infection. Current knowledge about transmission risk evaluation, existence of prevention prophylaxis, advance in HIV treatment and prolonged life expectancy were less than expected. Correspondingly, half of the surgeons were reluctant to touch the patients. For each question, there was no statistically important difference between the answers of the surgeons according to position (residency doctor or specialist) (p> 0.05). There was also no statistically important difference between the answers of the surgeons according to age and duration of occupation (p> 0.05). Any significant correlation was not detected when age and duration of occupation were evaluated according to the total number of true answers (p= 0.802, r= -0.028 and p= 0.831, r= 0.023 respectively) Conclusion: The survey revealed the need for a meeting to be held with the surgeons of our hospital regarding the current status of the disease in the near future.

Q ateşi, Coxiella burnetii’nin neden olduğu zoonotik bir enfeksiyondur. Başlıca enfeksiyon kaynağı sığır, koyun ve keçi gibi çiftlik hayvanlarıdır. İnsanlara bulaş genellikle enfekte partiküllerin solunması, kontamine süt veya süt ürünlerinin ağız yoluyla alınmasıyla olur. Q ateşi geniş bir yelpazede klinik bulgularla ortaya çıkabilir. Akut Q ateşi kliniğinin genelde asemptomatik veya hafif seyirli ateşli hastalık şeklinde olması nedeni ile akut olgularının tanısı atlanabilir. Akut enfeksiyonlar sporadik veya bazen salgınlar şeklinde ortaya cıkabilir. Ateşle birlikte pnömoni, hepatit veya diğer hastalık bulgularıyla başvuran olgularda epidemiyolojik ilişki de varsa Q ateşi ayırıcı tanıda akla gelmelidir. Kırım Kongo kanamalı ateşi (KKKA) ile Q ateşi semptom, klinik ve laboratuvar bulguları ile karışabilmektedir. Bu yazıda; Bolu ili ilçesinde yaşayan ve hayvancılıkla uğraşan ateş, üşüme-titreme, baş ağrısı, göz arkasında ağrı şikayetleri ile başvuran, Q ateşi tanısı konulan bir erkek hasta sunuldu. Laboratuvar testlerinde; trombositopeni, transaminaz değerlerinde ve CPK değerinde yükseklik olması nedeniyle başlangıçta KKKA ön tanısı konan hastada KKKA için PZR ve serolojik testleri negatifti, Q ateşine yönelik istenen indirekt floresan antikor testinde Coxiella burnetii IgG (Faz 2) 1/128 pozitif saptanması ile tanı konuldu. Doksisiklin tedavisi başlanan hastanın klinik ve laboratuvar bulguları düzeldi. Sonuç olarak, hayvancılıkla uğraşan, yüksek ateş, baş ağrısı ve karaciğer enzim testlerinde yükseklik saptanan olgularda ayırıcı tanıda Q ateşi de akılda tutulmalıdır.

Amaç: Candida enfeksiyonlarının tedavisi Candida türlerine göre farklılık göstermektedir. Rutin ve klasik yöntemlerle identifikasyon birkaç günü alabilmektedir. Bu nedenle, etkili antifungal tedavinin başlanabilmesi için Candida türlerinin hızlı tanısı önemlidir. Gereç ve Yöntem: Çalışmaya dahil edilen 61 Candida suşu CHROMagar Candida besiyerine ekilip üreticinin önerileri doğrultusunda uygun şartlarda inkübe edildikten sonra, 24. ve 48. saatlerde değerlendirildi.Bulgular: Çalışmada CHROMagar Candida besiyeri ile referans yöntemler karşılaştırıldığında, CHROMagar Candida ile 61 örneğin 36’sında (%40,9) referans yöntemle aynı tür tayini saptanmıştır. Yirmi beş örnekte (%59,1) ise CHROMagar Candida besiyerinde Candida türleri üremiş ancak tür tayini yapılamamıştır. Sonuç: CHROMagar Candida besiyeri germ tüp testine göre Candida albicans‘ın yanısıra, Candida parapsilosis türlerinin ayrımına imkan sağlamasına rağmen, diğer Candida türlerin ayrımına imkan sağlamaması, farklı renkler nedeniyle sorunlar yaşanması ve maliyetinin yüksek olması dezavantajlarıdır.

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy. Amaç: Komplike intraabdominal enfeksiyonlar, deri ve yumuşak doku enfeksiyonları ve toplum kökenli pnömoni tedavisi için Tigesiklin kullanımına Gıda ve İlaç Dairesi tarafından onay verilmiştir. Çalışmamızda; beş yıllık süreçte hastanemiz bünyesinde tigesiklin kullanımının klinik pratikteki yeri irdelenmiş ve gerçek yaşam verileri sunulmuştur. Yöntemler: Çalışma, 2008 ve 2013 yılları arasında, Ankara Eğitim ve Araştırma Hastanesi’nde, 48 saatten daha uzun süre ile tigesiklin kullanılan hastaların verileri retrospektif olarak değerlendirilmiştir. Klinik başarı, tigesiklini tek başına veya kombinasyonda kullanan hastaların tümünde klinik iyileşme ve mikrobiyolojik kür sağlanması olarak tanımlanmıştır. Herhangi bir nedenle tigesiklin tedavisinin kesilmesi klinik başarısızlık olarak tanımlanmıştır. Bulgular: Hastanemizde, 2008-2013 tarihleri arasında 320 hastaya tigesiklin kullanılmıştır. Tigesiklin en sık pnömoni ve deri-yumuşak doku enfeksiyonlarının tedavisinde kullanılmıştır. Hastaların 173’ünde (%54,1) monoterapi olarak kullanılmıştır. Hastalarda en sık izole edilen etken Acinetobacter baumannii olup (%43,4), ikinci sıklıkta Enterococcus izole edilmiştir (%6,9). Tedavi alan hastaların 243’ünde (%75,9) tedavi değişikliğine gerek görülmemiş olup 77 hastada (%24,1) tedavi değiştirilmiştir. Sonuç: Sonuç olarak, çoğul dirençli bakteri enfeksiyonlarının tedavisinde, monoterapi ya da kombinasyon olarak kullanıldığında tigesiklin bir seçenek olarak düşünülmelidir.

Brucellosis is a zoonotic infectious disease that involves the tissues andorgans of the reticuloendothelial system. Although splenomegaly may be seen inbrucellosis, spleen abscess or spleeninfarction has rarely been reported. Left upper quadrant pain and fever are themost common symptoms in splenic infarction. In this article, we present a79-year-old woman with splenic infarction due to brucellosis; she hadsplenectomy and was treated with antimicrobial therapy for brucellosis., Bruselloz retiküloendotelyalsistem doku ve organlarını tutan zoonotik bir infeksiyondur. Brusellozdasplenomegali görülebilmesine rağmen dalak apsesi veya dalak infarktı nadirenbildirilmiştir. Dalak infarktında sol üst kadran ağrısı ve ateş en sık görülensemptomlardır. Bu yazıda, bruselloza bağlı dalak infarktı gelişen vesplenektomi ve bruselloza yönelik antimikrobiyal tedavi uygulanan 79 yaşındabir kadın hasta sunuldu.

Renal tüberküloz akciğer tüberkülozunun lenfohematojen yayılımı sonucunda gelişir. Renal tüberkülozun en önemli bulgusu steril pyüridir. Gelişmekte olan ülkelerde Addison hastalığının %10-15’inden tüberküloz hastalığı sorumludur. Tüberküloza bağlı adrenal tutulum bilateral adrenal genişleme, atrofi ve kalsifikasyon şeklinde görülebilir. Mycobacterium tuberculosis komplekse bağlı adrenal bezlerin infeksiyonu hematojen yaylılım sonucu gelişir. Klinik bulguları yıllar sonra belirgin olabilir, asemptomatik infeksiyon oldukça sıktır. Bu yazıda, önceden Addison hastalığı (adrenokortikal yetmezlik) tanısı alan 60 yaşında bir kadın hastada saptanan renal tüberküloz sunuldu .

Peritonit, surekli ayaktan periton diyalizi (SAPD) yapilan hastalarda yaygin ve onemli bir komplikasyon olup, anlamli oranda morbidite ve mortalite ile iliskilidir. Gram negatif bakteriler, periton diyalizi ile iliskili peritonitlerin %20-30’undan sorumlu etkenlerdir. Moellerella wisconsensis ( M.wisconsensis ), yakin zamanda izole edilmis bir Enterobacteriaceae ailesi uyesidir. Bakterinin insanlardaki patojenitesi tam olarak bilinmemesine ragmen; birkac olguda, diyare ve bazilarinda sekonder bakteriyeminin eslik ettigi akut kolesistit olgulari raporlanmistir. Bu calismada, M.wisconsensis ’e bagli olarak gelisen periton diyalizi ile iliskili peritonit gelisen bir olgu sunulmustur.

Human Immunodeficiency Virus (HIV) infection and AIDS are known to cause cardiovascular diseases such as premature coronary artery disease, cardiomyopathy, and arrhythmias. Recently, Tp–e interval and Tp–e/QT ratio has been shown as a novel marker of ventricular repolarization. We aimed to evaluate the ventricular repolarization using Tp–e interval and Tp–e/QT ratio in patients with Human Immunodeficiency Virus (HIV) infection. Totally 48 patients with HIV and 60 control subjects were enrolled to the study. Tp–e interval, Tp–e/QT and Tp–e/QTc ratio were measured from the 12-lead electrocardiogram. Tp–e interval, Tp–e/QT ratio and Tp–e/QTc ratio were significantly higher in patients with HIV than control subjects (all p

The relationship between atrial fibrillation and human immunodeficiency virus (HIV) infection was evaluated. Electro-echocardiographic methods can be used to predict the development of atrial fibrillation (AF). In this study, we aimed to investigate the atrial electromechanical delay (AEMD) parameters of HIV (+) patients. Forty-two HIV (+) patients and 40 HIV (−) healthy volunteers were prospectively enrolled in this study. The electromechanical properties of the subjects’ atria were evaluated with tissue Doppler imaging. The left-AEMD, right-AEMD and inter-AEMD were increased in the HIV (+) patients relative to the controls (p = 0.003, p

Hantaviruses,a genus of the Bunyavirus family, are enveloped viruses with a genome that consistsof RNA segments. The genus has several subtypes causing infection in differentregions. Rodents such as rats are the natural reservoir for hantaviruses.People can become infected with these viruses after exposure to aerosolized urine,droppings, saliva of infected rodents or food contamineted with these infectiousmaterials. Infected rodent bites of a person is another tranmission way.Individuals who work with live rodentslike farmers, long, shoremen, foresters havehigh risk of infection. Here, we report a 33 year-oldmale farmer who lived in awillage of Kastamonu and did not have any history of direct contact with arodent. The infection of ourpatient was characterized by mild deteriation in kidneyfunction tests. Indifferential diagnosis, it is thought that Crimean-Congo haemorrhagicfever and leptospirosis may also be the causes of thrombocytopenia, elevationsin liver enzymes, abnormal kidney function test results of the case. Hantavirusrenal syndrom diagnosis was confirmed by hantavirus IgM and IgG positivity withELISA and abnormal laboratory tests improved after symptomatic treatment. Consequently,hantavirus infections should be thought twhen symtoms and laboratory tests are compatiblewith infection for patients in living endemic areas even if no history ofrodent contact and spesific tests for final diagnosis must be performed., Hantavirüs ülkemizde bazı bölgelerde görülebilen zoonotik birinfeksiyondur. Hantavirüs Bunyaviridae ailesinde yer alan segmenter yapıda RNAvirüsüdür ve hantavirüsün coğrafi olarak farklı dağılım gösteren çok sayıda alttipi bulunmaktadır. Hantavirusların doğadaki başlıca rezervuarı fare vesıçan gibi çeşitli kemirgenlerdir. Virus bu kemiricilerin id­rar veyadışkısıyla çevreye atılır. İnsanlara bulaşma gıda­lara bulaşmış virusun ağızyoluyla alınması veya çevreye bu­laşmış virüs içeren tozların solunum yoluylaalınmasıyla olur. Virüsü taşıyan kemirgenin insanı ısırması sonucu da hastalıkbulaşabilmektedir. Kemi­rgenle temas olasılığı yüksek olan çiftçiler,hayvancılıkla uğraşanlar, liman işçileri gibi meslek grupları infeksiyon açı­sındanrisk grubunda yer alır. Bu yazıda Kastamonu ilinde hayvancılık ve ormancılıklauğraşan, kemirgen teması olmayan 33 yaşında erkek olguda böbrek fonksiyontestlerinde hafif bozuklukla seyreden hantavirüs infeksiyonunu bildirilmiştir. Olgudatrombositopeni, transaminaz testlerinde yükseklik, böbrek fonksiyon testlerindebozulma, proteinüri olması nedeniyle başlangıç ayırıcı tanıda Kırım Kongokanamalı ateşi ve leptospiroz düşünülmüştür. Olgunun tanısı ELISA testiyle hantavirüsIgM ve IgG pozitif saptanması ile konmuş, başlangıçta yüksek olan kreatindeğerleri ve transaminaz değerleri semptomatik tedavi sonrasında normaldeğerlerine gelmiş, proteinürisi ve trombositopenisi de düzelmiştir. Sonuç olarak, hantavirüsinfeksiyonunun endemik olduğu bölgelerden gelen, hantavirüs renal sendromlauyumlu klinik ve laboratuvar bulguları olan olgularda kemirgen teması öyküsüolmasa bile hantavirüs infeksiyonu akla gelmeli ve tanıya yönelik testleristenmelidir.

Amaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP) sonrası bakteriyemi ciddi bir komplikasyondur, ancak bu komplikasyon için risk faktörleri henüz net olarak tanımlanmamıştır. Bu çalışmada ERCP sonrası bakteriyemi ve ilişkili risk faktörlerinin insidansını belirlemeyi amaçladık.Yöntemler: Bu retrospektif-kohort çalışma Ocak 2017-Aralık 2018 tarihleri arasında yapıldı. İşlem öncesi enfeksiyon belirtisi olmayan ve işlem sonrası bakteriyemi gelişen hastalar çalışmaya alındı. Bakteriyemi gelişen her hasta için ERCP uygulanan ve bakteriyemi geliştirmeyen iki randomize kontrol hastası risk faktörlerini, klinik ve laboratuvar bulgularını karşılaştırmak için seçildi.Bulgular: ERCP prosedürü uygulanan 4237 hastanın 86'sında toplam 91 bakteriyemi atağı tespit edildi. ERCP sonrası bakteriyemi oranı % 2 olarak bulundu. Çok değişkenli analizde, hastanın yaşı, safra yolları kanseri, kolesistit / kolanjit, pankreatit ve biyopsi bakteriyemi için anlamlı risk faktörleri olarak bulundu (sırasıyla P=0,009, P, Aim: Bacteremia after endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication, but its risk factors have not yet been clearly defined. In this study, we aimed to determine the incidence of bacteremia and associated risk factors after ERCP.Methods: This retrospective-cohort study was conducted between January 2017 and December 2018. Patients who had no signs of infection before the procedure and who developed bacteremia after the procedure were included in the study. For each patient who developed bacteremia, two randomized control patients who underwent ERCP and did not develop bacteremia were selected to compare risk factors, clinical and laboratory findings. Results: A total of 91 bacteremia attacks were detected in 86 of the 4237 patients who underwent ERCP procedure. Bacteremia rate after ERCP was 2%. In multivariate analysis, the age of the patient, presence of biliary tract cancer, cholecystitis / cholangitis, pancreatitis and biopsy were determined as significant risk factors for post-ERCP bacteremia (P=0.009, P

Gram negatif basillere bagli olarak osteomyelit gelisimi nadiren bildirilmektedir; ozellikle orak hucreli anemi, intravenoz ilac bagimliligi gibi altta yatan hastaligi olan olgularda gorulmektedir. Citrobacter freundii , Enterobacteriaceae ailesinde yer alan Gram negatif bir basil olup, uriner sistem infeksiyonu, pnomoni, bakteriyemi, sepsis, intraabdominal enfeksiyonlari ve santral sinir sistemi enfeksiyonlarina neden olabilmektedir; nadiren osteomyelite neden olabilir. Bu yazida, silahli yaralanma sonrasi amputasyon uygulanan, amputasyon bolgesinde C. freundii’ ye bagli olarak postoperatif osteomyelit gelisen, 38 yasinda bir erkek hasta sunulmustur.

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.

WOS: 000463053800027, Introduction: Hand hygiene is one of the most cost-effective infection control measures. In this multicenter Study we analysed the hand hygiene compliance observation results of 15 hospitals in Turkey. Materials and Methods: This study was performed in intensive care units (ICUs) of 15 hospitals (Eight terriary-care educational hospitals, six state hospitals and one private hospital) from 11 cities from six regions of Turkey The observations were made by infection control practitioners according to the World Health Organization - Five Moments for Hand Hygiene (WHO-5) indications rule for hand hygiene and overall compliance rates were calculated. Observations were unblinded (healthcare professionals knew that they were observed). The study period included 2015 and 2016 calendar years. Results: There was a statistically significant increase in hand hygiene compliance rates in 2016 versus 2015. The overall number of hand hygiene indications and compliance in 2015 and 2016 were 60071/78116-76,9% and 66551/83607-79,6% (p=0.0001), respectively. Nurses were the most compliant group in both years. The highest compliance was in after body fluid exposure indication (88.2%-2015 and 91.4%-2016) while the lowest compliance was in before patient contact indication (61.3%-2015 and 65%-2016). Conclusion: The presented data suggest that under unblinded observations, hand hygiene compliance seems to be in relatively acceptable rates in Turkey. Centers with compliance rates below 50 percentile rates in any of the 5 moments should increase efforts to enhance compliance in that indication.

Hasan, M. Shahnaz/0000-0002-7493-7416; Abouqal, Redouane/0000-0002-6117-4341; Altindis, Mustafa/0000-0003-0411-9669; Masjedi, Mansoor/0000-0001-6175-9289; Popescu, Roxana/0000-0002-9387-1141; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; Meco, Basak Ceyda/0000-0003-2951-9634; Kumar, Perikala Vijayananda/0000-0001-8315-7000; Zand, Farid/0000-0003-3489-3372; Maghsoudi, Behzad/0000-0002-1279-8799; KAMARUL ZAMAN, MAZUIN/0000-0002-7920-6399; Gan, Chin Seng/0000-0002-6758-4798; Horoz, Ozden Ozgur/0000-0001-7590-650X; Medeiros, Eduardo A/0000-0002-6205-259X; Sabetian, Golnar/0000-0001-8764-2150; UNAL, SERHAT/0000-0003-1184-4711; Gan, Chin Seng/0000-0002-6758-4798; Delia, Muntean/0000-0001-9100-4530; Yalcin, Ata Nevzat/0000-0002-7243-7354; Leblebicioglu, Hakan/0000-0002-6033-8543; Horhat, Florin George/0000-0001-6133-0204; Yousef, Reham H. A./0000-0003-4004-3008; Delgado Aguirre, Hector Alberto/0000-0001-5448-7975; El Kholy, Amani/0000-0002-0645-7664; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Sanaei Dashti, Anahita/0000-0002-2827-3575; KARABAY, OGUZ/0000-0003-1514-1685; Barahona G., Nayide/0000-0003-3559-6900; Stagnaro, Juan Pablo/0000-0003-3836-9957; Alexandru Florin, Rogobete/0000-0003-1286-4431; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Jayatilleke, Kushlani/0000-0002-3931-6630; Unal, Necmettin/0000-0002-9440-7893; Duszynska, Wieslawa/0000-0002-5880-4904; Ngo, Quy Chau/0000-0002-6787-2757; Elmanakhly, Arwa/0000-0001-8557-0536; yildizdas, dincer/0000-0003-0739-5108; Kanj, Souha/0000-0001-6413-3396; Gupta, Umesh/0000-0001-7717-1404 WOS: 000392626300014 PubMed: 27742143 Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DAHAI), we collected prospective data from861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central lineassociated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheterassociated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. VDR; Foundation to Fight against Nosocomial Infections The funding for design, development, maintenance, technical support, data validation, and report generation of the Surveillance Online System, and the activities carried out at International Nosocomial Infection Control Consortium headquarters, were provided by VDR and the Foundation to Fight against Nosocomial Infections.

Introduction: Pulmonary arterial hypertension and human immunodeficiency virus (HIV) infection is a well-known association. Pulmonary pulse transit time (pPTT) is a recent echocardiographic marker that might be used for evaluation of pulmonary arterial stiffness (PAS) in patients with HIV infection. We aimed to investigate whether pPTT elevated in patients with HIV infection compared to healthy controls and its association with echocardiographic indices of right ventricular functions. Materials and Methods: Fifty HIV (+) patients from infectious disease outpatient clinics and fifty age- and sex-matched HIV (−) healthy volunteers were enrolled in this study. pPTT was measured from pulmonary vein flow velocity as the time interval between the R-wave in the electrocardiography and corresponding peak late systolic was then calculated as the mean from two separate pw-Doppler measurements. Results: pPTT, tricuspid annular peak systolic excursion (TAPSE) and right ventricle fractional area change (FAC) were significantly lower in patients with HIV than control patients (177.1 ± 34.9 vs. 215.7 ± 35.7 msn, P < 0.001; 2.33 ± 0.28 vs. 2.19 ± 0.22, P = 0.039; 45 [4.25] vs. 41.1 [4.0], P = 0.032, respectively). pPTT was positively correlated with FAC, TAPSE and cluster of differentiation 4 count (r = 0.210; P = 0.036, r = 0.256; P = 0.041, r = 0.304; P = 0.044, respectively). Conclusion: Our study showed that pPTT, TAPSE, and right ventricle FAC levels were lower in patients with HIV infection. pPTT is an important predictor in patients with HIV expected to develop pulmonary vascular pathology.