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Amaç: Kanıta dayalı tıp uygulamaları gerçek bilgiye en güvenilir şekilde ulaşmak, bilimsel aynı zamanda eleştirel düşünceyi geliştirmek açısından önemlidir. Tıpta yeni bilgilere gereksinim, kanıta dayalı tıp uygulamalarının yaygınlaşmasına neden olmaktadır. Sürekli tıp eğitimi de kanıta dayalı tıbbın önemli bir parçası olarak kabul edilmektedir. Fakültemizdeki kanıta dayalı tıp uygulamalarının amacı, tıp fakültesi öğrencilerine kanıta dayalı tıbbın önemini kavratmak, bilimsel bir çalışmanın içinde yer almalarını sağlamak ve bu çalışma basamaklarını öğretmektir Gereç ve Yöntemler: Kanıta dayalı tıp kapsamında yapılan çalışmalar, Tıp Fakültesi Dönem 3 öğrencileri tarafından yürütülmektedir. Dersin sorumlu öğretim üyesi tarafından gruplara ayrılırlar. Her bir grup için de sorumlu araştırmacı öğretim üyesi belirlenir. Ders programında belirlenen tarihlerde öğrenciler bir araya gelip araştırma konusunun başlığını kesinleştirir. Etik kurul formu hazırlanıp etik kurula başvuru yapılır. Çalışma sonlandıktan sonra da özet/makale hâline getirilir ve özet hâline getirilen çalışmalar sunulur ve tartışılır. Bulgular: 2020-2021 Eğitim ve Öğretim döneminde gerçekleştirilen kanıta dayalı tıp kapsamında 194 sayıda Dönem 3 öğrencisi çalıştı. COVID-19 pandemisinin etkileri ve aşı üzerine olan çalışmalar başta olmak üzere; kanser, uyku, güneşin zararları, yeni sosyal hayat ve cinsel mitler gibi güncel konularda sorumlu öğretim üyesi gözetiminde toplam 15 farklı çalışma yapıldı. Bu çalışmaların başlıkları ve sorumlu öğretim üyeleri Tablo-1 de yer almaktadır. Hazırlanan özetler dijital platform üzerinden sunuldu ve tartışıldı. Sonuç: Tüm Dönem 3 öğrencileri, COVID-19 pandemisinden dolayı uzaktan eğitim aldıkları 2020-2021 Eğitim ve Öğretim döneminde çevrimiçi öğrenme ortamlarında bilimsel bir çalışmanın tüm aşamalarını yürüttüler ve çalışmalarını başarıyla sonlandırdılar.

Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesinde COVID-19 pandemi sürecinde eğitim deneyimlerimizi paylaşmayı amaçladık. Fakültemizde YÖK’ün 13 Mart 2020’de eğitim ilgili kararı sonrası tüm dönemlerde eğitim online dijital platformlar üzerinden senkron ve asenkron olarak başladı. Tüm sınavlar dijital platform üzerinden yapıldı. Bu süreçte hem öğretim üyeleri, hem de öğrencilerle düzenli aralıklarla dijital platformlar üzerinden toplantılar yapıldı ve geri bildirimleri alındı. Her ne kadar bu süreç içinde bazı yetersizlikler yaşandıysa da öğrenci ve öğretim üyelerinin adaptasyonu hızlı oldu. Eğitime ara verilmemesiyle öğrenci mağduriyeti yaşanmadı. Bundan sonraki süreçte uzaktan eğitimin tıp eğitiminin ayrılmaz bir parçası olacağını düşünmekteyiz.

Introduction The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

WOS: 000481718600013, Objective: Leptospirosis is one of the most common zoonotic diseases worldwide. Transmission to humans usually occurs by mucosal inoculation of the bacteria or exposure of non-intact skin via contact with water or soil contaminated with urine or feces of rodents. Occupational groups such as farmers, rice plant workers, sewer workers, miners, hunters, military personnel, mariners, shepherds, milkers, slaughterhouse workers, veterinarians and laboratory personnel are under risk for leptospirosis. In this study, we aimed to determine the seroprevalence of leptospirosis in coal miners in Zonguldak region. Methods: Blood samples were obtained from total 185 volunteer coal miners, who worked in 5 coal mines of Turkish Hard Coal Authority in Zonguldak and Bartin provinces, during June and July 2013. Serum samples were stored at -80 degrees C. Additionally, we conducted an interview with each miner about demographical and epidemiological data such as age, location, duration of mining, other occupations, observing rodent or rodent excreta in the mine, noticing rodent contact with personal belongings or drinks or food in mine and hand hygiene compliance. Microscopic agglutination test (MAT), the reference diagnostic test for seroepidemiological studies of leptospirosis, was conducted in Spirochetal Diseases Diagnostic Laboratory, Veterinary Control Central Research Institute, Etlik, Ankara in June 2014. Anti-Leptospira antibody levels for 8 serotypes (Leptospira grippotyphosa Moskva V, L. australis Bratislava Jez Bratislava, L. canicola Hund Utrech IV, L. hardjo Hardjoprajitno, L. pomona Pomona, L. icterohaemorrhagiae Ictero 1, L. hebdomadis Hebdomadis ve L. patoc Patoc 1) was investigated with MAT. Results: All the miners were male and the mean age was 36 +/- 6. The mean duration of working in underground part of the mine was 11 +/- 6 years, the mean working hours was 44 +/- 6 hours a week on average. Distribution of the miners according to inhabiting location was 18.5% village, 50.3% county and 30.8% city. In addition to mining, some of the miners were also occupied with farming (7%), hunting (2.7%), seafaring (0.5%) and livestock raising (0.5%). 82.7% of the miners confirmed seeing rodents in the mine every day and 35.7% of the miners confirmed seeing rodent excreta in the mine. 68.1% reported observing sign of rodent bite on their clothes or food saving box. 91.9% of the miners reported that they saved their food in plastic or paper bags up to meal time. Hand washing rate in the mine was 76.2% among the miners and 94.3% of those were washing their hands without soap. Although, a risky environment for leptospirosis was defined, no seropositivity was detected in any of the serum samples of the miners. Conclusions: Miners reported risky environmental conditions and risky behavioral models for transmission of leptospirosis. However, no seropositivity was detected in any of the serum samples obtained from 185 miners in Zonguldak region.

BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex (ABC) strains are great problem for intensive care units. ABC strains can develop resistance to all the antibiotics available. Carbapenem resistance is common and colistin resistance is rare in our country. Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country. AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and -resistant Acinetobacter sp. Strains. METHODS During the study period, 108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively. Continuous variables were compared with the Mann-Whitney U test, and categorical variables were compared using Pearson's chi-square test or Fisher's Exact chi-square test for two groups. A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains. RESULTS High Acute Physiology and Chronic Health Evaluation II scores (OR = 1.9, 95%CI: 1.4-2.7; P < 0.001) and prior receipt of teicoplanin (OR = 8.1, 95%CI: 1.0- 63.3; P = 0.045) were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp. Different combinations of antibiotics including colistin, meropenem, ampicillin/sulbactam, amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains. Although the median duration of microbiological cure (P < 0.001) was longer in the colistin-resistant group, clinical (P = 0.703), laboratory (P = 0.277), radiological (P = 0.551), microbiological response (P = 1.000) and infection related mortality rates (P = 0.603) did not differ between the two groups. Among the patients with infections due to colistin-resistant strains, seven were treated with antibiotic combinations that included sulbactam. Clinical (6/7) and microbiological (5/7) response rates were quite high in these patients. CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp. infections. Although combinations with sulbactam seems to be more effective in our study patients, data supporting the usefulness of combinations with sulbactam is very limited. © The Author(s) 2019.

WOS: 000464106600010, Objective: Health care workers are exposed to many infectious agents when compared with general population. Immunization to vaccine-preventable diseases is an important part of infection control among health care workers, both for their own health and to prevent the spread of infections. The aim of this study is to detect the immune status of health care workers of our hospital to measles, mumps, rubella (MMR) and varicella and to define an appropriate vaccination program and also to analyze the cost efficiency of pre-vaccination screening. Methods: This study was conducted at Bulent Ecevit University Hospital between March 2014 and January 2015. The following data were recorded for each participant: age, gender, profession, department, duration of employment, childhood residence location, history of MMR and varicella, and status of vaccinations. The specific IgG antibodies were screened by immunosorbent enzyme-linked assay. Results: 184 health care workers participated in the study. 61.2% were female, and 38.8% were male. The mean age was 32.43 +/- 6.4. The serologic test results revealed that 92.2% of the health care workers were immune to measles, 98.2% were immune to rubella, 94% were immune to mumps and 94.3% were immune to varicella. The validity of the medical history of participants were high for mumps and measles (81.6% and 80.5%, respectively) and low for rubella (43.4%). The positive predictive values for the history of rubella, mumps, varicella and measles were 98.9%, 97.5% and 96.9%, 95.6%, respectively. Cost efficiency analysis showed that the cost of vaccination without screening was more expensive for varicella and MMR (cost difference 18 253 Turkish Lira and 1432 Turkish Lira, respectively) Our findings support that a negative medical history or serological screening before vaccination is cost effective especially for varicella. Conclusions: In conclusion, immune status of health care workers who worked in high-risk departments should be determined by serologic tests and susceptible health care workers must be vaccinated.

Background: Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. Methods: We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. Results: In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. Conclusions: Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn't differ however, they were more efficacious than MPV. © 2018 The Author(s).

WOS: 000436365200003, PubMed: 29924770, Background: Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug-drug interactions associated with antimicrobials among hospitalized patients. Material/Methods: This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged (3) 18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex (R) online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. Results: Potential drug-drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237-3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943-1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035-3.1564) were independent risk factors for developing drug interactions. Conclusions: Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides.

WOS: 000437936900017, Introduction: This study investigated differences in clinical features, types, etiology, and risk factors for complications between young and older patients with skin and soft tissue infections. Futhermore, age-related differences in healthcare-associated and complicated infections were identified. Materials and Method: This retrospective study included 206 skin and soft tissue infection patients hospitalized during an 8-year period. Data were collected using a form: patients' characteristics, clinical features, laboratory values, prior antibiotic use, causative microorganisms, and antibiotic treatment. For cases with clinically diagnosed, samples were taken from the suspected infection sites. Gram staining, deep swab, deep tissue and blood culture results were evaluated. Results: The incidence of diabetes mellitus was significantly higher among patients aged >= 65 years. Among these old patients, Escherichia coli (11/31, 35.5%) and Pseudomonas aeruginosa (8/31, 25.8%) were the most frequently isolated pathogens. Approximately half of the Staphylococcus aureus and Staphylococcus epidermidis strains isolated from patients with health care-associated infection were resistant to methicillin (8/15, 53.3%), and these patients produced higher levels of extended-spectrum beta-lactamase. Venous insufficiency (p=0.008) and prior hospitalization (p=0.001) were identified as risk factors for complication in patients aged >= 65. The median time-to-clinical response was 7 days in older patients with non-complicated infection (p=0.007). Conclusion: Diabetes mellitus was the most common co-morbid factor in older patients. Risk factors for complication may differ by age. Gram-negative pathogens were more commonly isolated in older patients. The time-to-clinical response was significantly longer in older patients with non-complicated infection than young patients.

Diabetic foot infections cause substantial morbidity and mortality. We analysed laboratory and clinical findings of diabetic foot infections in 35 patients treated at Karaelmas University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Zonguldak Turkey between January 2004 and November 2006. Eleven (31.4%) of the patients had osteomyelitis in addition to soft tissue infection. Erithrocyte sedimentation rate was ≥ 70 mm/hour in 27 (77.1%) of the patients. C-reactive protein values were negative in 4 (11.4%) of the patients and it was highly elevated in 31 (88.6%) of them. Five (14.3%) of the patients were administered medical treatment only and in 30 (85.7%) of the patients both medical and surgical treatment were performed. Amputation was performed in 19 (54.3%) patients. Mean treatment duration was 28.6 ± 26.6 (3-90) days. There was no microbiological evidence of infection in 11 (%31.4) of the patients. Diabetic foot infections are the leading cause of nontraumatic foot amputations. In the presence of osteomyelitis, amputation ratio is higher and achieving cure is more difficult. Diabetic foot infections require a coordinated management by a multidiciplinary foot-care team. For obtaining long term problem free survival, prevention of infection through patient training about foot care, and early treatment of infection for prevention of osteomyelitis is important.

Yaman, Ferda/0000-0001-6847-1720; Kuscu, Ferit/0000-0001-5662-8305 WOS: 000373245600004 PubMed: 26166495 The aim of this study was to investigate the incidence of acute kidney injury (AKI) and risk factors due to colistin use in patients infected with multidrug-resistant pathogens. This multicenter, retrospective, observational study was conducted in Turkey, at 5 different research and university hospitals. Cox regression analyses were performed, to determine independent predictors of AKI. From April 2012 to July 2014, a total of 216 patients aged between 18-94 years, treated with colistimethate sodium (CMS) were included in the study. The mean age of the patients was 60.3 +/- 20.1 years. The overall incidence of AKI was 34.3% (74/216) at any time during treatment. Concomitant use of loop diuretics, baseline creatinine level, and CMS dosage were independently associated with AKI. According to our results, patients with higher baseline creatinine levels, or patients who had to use concomitant loop diuretics may need to be monitored more closely, and dose adjustment should be done promptly. More comprehensive studies are, however, still needed to evaluate the efficacy of low-dose colistin since higher doses tend to increase the risk of AKI.

Objective: The evaluation of risk factors in patients with Nosocomial pneumonia (NP) may provide useful guidance for patients who need intensive care. The aim of this study was to identify risk factors of NP in ICU. Methods: During the six months period of time, patients who stayed in ICUs for at least 48 hours were included in a tertiary medical center. A total of 304 patients were prospectively followed and 78 of them who developed NP made up the NP group. Patients who did not develop any infection were defined as control group. Variables which was thought or detected as a risk factor of NP in univariate analysis were analyzed with multivariate logistic regression analysis. Results: Among 304 patients, 78 (25.6%) had NP. Multivariate analysis revealed that advanced age (odds ratio [OR] 1, 95% confidence interval [CI] 1.00-1.06), length of stay (LOS) in the ICU (OR 1.3, 95% CI 1.17-1.39), prior infection on admission to ICU (OR 6.7, 95% CI 1.52-29.94), transfusion of blood and blood products (OR 4.0, 95% CI 1.43-11.46) and prior antibiotic usage within the last two weeks before admission (OR 3.3, 95% CI 1.28-8.48) were independent risk factors for NP. Additionally, the mean APACHE II score of cases with NP (16.7±6.7) was significantly higher than that of controls (11.5±8.1; p, Amaç: Nozokomiyal pnömoni (NP) yoğun bakım ünitesi (YBÜ)’nde en sık karşılaşılan nozokomiyal enfeksiyondur. NP gelişen hastalardaki risk faktörlerinin değerlendirilmesi YBÜ ihtiyacı olan hastalar için yol gösterici olabilir. Bu çalışmanın amacı YBÜ’de gelişen NP risk faktörlerinin belirlenmesidir. Yöntemler: Altı aylık süre içerisinde, bir üniversite hastanesinin YBÜ’lerinde 48 saatten uzun kalan hastalar çalışmaya alındı. Toplam olarak 304 hasta prospektif izlenirken, bu hastaların NP gelişen 78’i NP grubunu oluşturdu. Herhangi bir enfeksiyon gelişmeyen hastalar ise kontrol grubu olarak tanımlandı. Tek değişkenli analiz ile NP risk faktörü olabileceği düşünülen veya saptanan değişkenler çok değişkenli lojistik regresyon analizi ile incelendi. Bulgular: 304 hastanın 78’inde (% 25,6) NP gelişti. Çok değişkenli analiz ile ileri yaş (odds ratio [OR] 1, %95 güven aralığı [CI] 1,00-1,06), YBÜ’de yatış süresi (OR 1,3, % 95 CI 1,17-1,39), YBÜ öncesi enfeksiyon varlığı (OR 6,7, %95 CI 1,52-29,94), kan ürünü transfüzyonu (OR 4, %95 CI 1,43-11,46) ve YBÜ yatışından önceki 2 hafta içerisinde antibiyotik kullanım öyküsü (OR 3,3, %95 CI 1,28-8,48) NP için bağımsız risk faktörleri olarak tanımlandı. Ayrıca, NP gelişen hastaların ortalama APACHE II skoru (16,7±6,7) kontrol grubundan anlamlı olarak yüksek bulundu (11,5±8,1; p

Clinical, laboratory, treatment characteristics and complications of 72 patients with brucellosis treated in our clinic between January 2000 and December 2004 have been investigated retrospectively. The main symptoms were artralgia (80.6%), malaise (80.6%), fever (76.4%), sweating (63.9%), myalgia (62.5%), lumbar and back pain (62.5%), headache (22.2%) and anorexia (19.4%). There were signs of fever (30.5%), hepatomegaly (15.3%), splenomegaly (9.7%), lymphadenopaty (5.6%). Osteoarticular involvement in 30 (41.6%) patients, neurobrucellosis in 10 (13.9%) patients, orchitis in 2 (2.8%) patients, hepatitis in 2 (2.8%) patients, pancytopenia in 2 (2.8%) patients were determined as complications.

In this study, etiologic factors, morbidity and mortality ratio were evaluated retrospectively in a total of 244 central nervous system infection cases, between January 1998 and December 2004, in S.B. Ankara D›flkap› Teaching Hospital, Department of Infectious Diseases and Clinical Microbiology. Of 244 cases, 133 (54.5%) were bacterial, 81 (33.2%) were viral, 21 (8.6%) were tuberculous, 8 (3.3%) were Brucella meningitis and 1 (0.4%) was neurosyphilis. Cerebrospinal fluid cultures of 133 bacterial meningitis revealed Streptococcus pneumoniae in 16 (12%) cases, Neisseria meningitidis in 1 (0.8%) case, Acinetobacter spp. in 1 (0.8%) case, methicillin resistant Staphylococcus aureus in 2 (1.5%) cases, Pseudomonas aeruginosa in 2 (1.5%) cases, and Escherichia coli in 1 (0.8%) case. With regard to tuberculous meningitis cases, Mycobacterium tuberculosis was cultured in 2 (9.5%) cases. The highest morbidity ratio was in tuberculous meningitis cases followed by acute bacterial and viral meningitis cases. Of the 21 tuberculous meningitis cases, 7 (33.3%) cases had visual disability, 9 (42.9%) cases had confusion, 8 (38.1%) cases had focal neurological deficit, 10 (47.6%) cases had hydrocephalus. In the patients with bacterial meningitis 3 (2.3%) cases had hearing loss, 5 (3.8%) cases had visual disability, 7 (5.3%) cases had focal neurological deficit. Four of the patients with herpes encephalitis had behavioral disability. Sixteen (6.6%) bacterial meningitis, 8 (1.6%) tuberculous meningitis and 7 (2.9%) viral encephalitis were died. Case fatality rate was 11.1%.

Tetanus is an acute-onset disease that results from exposure to the exotoxins produced by Clostridium tetani. It is characterized by tonic muscle spasms and has high morbidity and mortality. Respiratory failure is the most severe problem causing mortality in generalized tetanus. Mechanical ventilation is almost always mandatory for tetanus patients with respiratory failure and airway obstruction. Here, we report a 60-year-old man with generalized tetanus. He was admitted to the emergency department with jaw stiffness, dysphagia, breathlessness, and fever. His history revealed that he had suffered an injury to his left toe by a rusted nail seven days ago. He had received one dose of tetanus vaccine but no anti-tetanus immunoglobulin was given. He also did not know his prior vaccination history. He was diagnosed as tetanus and was followed up in the intensive care unit. He was treated with intravenous metronidazole and 60.000 IU equine tetanus antiserum. Midazolam was given for generalized muscle spasms. He was put on mechanical ventilation for 11 days and was discharged from the hospital 28 days after admission with recovery. In conclusion, although tetanus is now rare for our country, it should not be forgotten. Prior vaccination should be queried in patients who are admitted to hospitals with injury, and they should be accurately evaluated for vaccination and immunoglobulin.

Objective: The aim of this study was to determine the epidemiology, clinical manifestations, and outcome of health-care associated bacteremia in geriatric cancer patients with febrile neutropenia. Materials and Methods: We retrospectively evaluated cancer patients with febrile neutropenia aged ? 60. years with culture proven health-care associated bacteremia between January 2005 and December 2011. The date of the first positive blood culture was regarded as the date of bacteremia onset. Primary outcome was the infection related mortality, defined as the death within 14. days of bacteremia onset. Results: The two most common pathogens responsible for bacteremia were Staphylococcus epidermidis (36.1%) and Escherichia coli (31.5%), with high rates of methicillin resistance and extended-spectrum ß-lactamase (ESBL) production, respectively. There were no statistically significant differences in infection related mortality rate according to the type of malignancy (p. =0.776). By the univariate analysis, factors associated with 14. day mortality among febrile neutropenic episodes were prolonged neutropenia (p. =0.024), persistent fever (p. =0.001), hospitalization in ICU (p < 0.001) and the initial clinical presentations including respiratory failure (p < 0.001), hepatic failure (p. =0.013), hematological failure (p < 0.001), neurological failure (p < 0.001), severe sepsis (p < 0.001), and septic shock (p. =0.036). Multivariate analysis showed that persistent fever was an independent factor associated with infection related mortality (odds ratio, 18.0; 95% confidence interval, 5.2-62.6; p < 0.001). Conclusions: The only independent risk factor for mortality was persistent fever. Although the most frequently isolated pathogens were S. epidermidis and E. coli, high rates of methicillin resistance and ESBL production were found respectively. © 2012 Elsevier Inc.

SUMMARYThe aim of this study was to compare the responses of colistin treatment alone vs. a combination of colistin and rifampicin in the treatment of ventilator-associated pneumonia (VAP) caused by a carbapenem-resistant A. baumannii strain. Forty-three patients were randomly assigned to one of two treatment groups. Although clinical (P = 0·654), laboratory (P = 0·645), radiological (P = 0·290) and microbiological (P = 0·597) response rates were better in the combination group, these differences were not significant. However, time to microbiological clearance (3·1 ± 0·5 days, P = 0·029) was significantly shorter in the combination group. The VAP-related mortality rates were 63·6% (14/22) and 38·1% (8/21) for the colistin and the combination groups (P = 0·171), respectively. Our results suggest that the combination of colistin with rifampicin may improve clinical and microbiological outcomes of VAP patients infected with A. baumannii.

The aims of this study were to evaluate the kinetics of platelet counts and mean platelet volume (MPV) in adults with sepsis and to determine whether the responses are infection-specific. This retrospective cohort study included patients admitted to a tertiary-care teaching hospital with microbiologically proven nosocomial sepsis between January 2006 and January 2011. Platelet counts and MPV measurements were examined daily for 5 days after the onset of sepsis. During the study period, 151 of the 214 sepsis episodes were associated with thrombocytopenia. Gram-positive microorganisms were the most frequently isolated. The decrease in platelet counts was statistically significant for the first 3 days of sepsis in Gram-positive septic patients, for 4 days in Gram-negative septic patients and for all 5 days in fungal septic patients (p

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. Methods: Between April and October 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. Results: Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 developed nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional hazard model showed that in the presence of other site nosocomial infections, immune suppression (hazard ratio (HR) 3.73, 95% CI 1.47-9.46; p = 0.006), previous antibiotic usage (HR 2.06, 95% CI 1.11-3.83; p = 0.023), and the presence of a nosocomial infection at another site (HR 1.82, 95% CI 1.04-3.20; p = 0.037) were the factors associated with the acquisition of CAUTIs with or without a nosocomial infection at another site. When we excluded the other site nosocomial infections to determine if the risk factors differed depending on the presence of other nosocomial infections, female gender (HR 2.67, 95% CI 1.03-6.91; p = 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01-1.13; p = 0.019) were found to be the risk factors for the acquisition of CAUTIs alone. Conclusions: Our results showed that the presence of nosocomial infections at another site was an independent risk factor for the acquisition of a CAUTI and that their presence alters risk factors. © 2012 Informa Healthcare.

Background Initial antimicrobial therapy (AB) is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation (MV) are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia (VAP) and hospital acquired pneumonia (HAP). Methods We retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test. Results Sixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP (OR = 2.35 (95% CI, 1.05-5.22; p = 0.037) and APACHE II score at onset of HAP (OR = 1.06 (95% CI, 1.01-1.12); p = 0.018). In VAP patients; antibiotic usage in the previous three months (OR = 3.16 (95% CI, 1.27-7.81); p = 0.013) and admission to a surgical unit (OR = 2.9 (95% CI, 1.17-7.19); p = 0.022) were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP. Conclusion Our data suggests that the risk factors for inadequate initial AB are indirectly associated with the acquisition of resistant bacteria for both VAP and HAP. Although we could not find a positive correlation between adequate initial AB and survival; empirical AB with a broad spectrum should be initiated promptly to improve secondary outcomes.

Visceral leishmaniasis (VL) which is a chronic disease caused by the protozoon, Leishmania, occurs widely worldwide and it is widespread in most of the countries in the Mediterranean basin. The infection which is transmitted by a sandfly (Phlebotomus) vector, has a prolonged incubation period and insidious onset. VL generally affects children and may be fatal if not treated. In this report, a 31 years old male patient, who was the first adult VL case from Zonguldak (a province located at western Black-Sea region of Turkey) was presented. He was admitted to the hospital with two-months history of fever, chills, sweating and weight loss. There was no history of travel outside the city nor insect bites, however, he indicated that there would be unnoticed sandfly bites since sandflies were very common in the coal mines he worked. His physical examination revealed body temperatue of 39.2°C and hepatosplenomegaly, while laboratory findings yielded anemia, leucopenia, hypoalbuminemia and hypergamaglobulinemia. Erythrocyte sedimentation rate was 62 mm/h, C-reactive protein was 113 mg/L and liver transaminases were 2 to 5 folds higher than the reference values. The only pathological finding was hepatosplenomegaly in the abdominal ultrasound and computerized tomography. He was further examined to rule out infections with similar signs and symptoms, connective tissue diseases and malignancies and all were found negative. Hypercellular bone marrow were detected in the aspiration material. Bone marrow smears, bone marrow samples inoculated in NNN medium and serum samples of the patient were sent to the reference parasitology laboratory of Refik Saydam National Public Health Agency for evaluation in terms of VL. The diagnosis was confirmed by the detection of Leishmania IgG titer as 1/512 with in-house indirect immunofluorescence antibody test, by positivite rK39 Dipstick (InBios, USA) test and by the observation of Leishmania amastigote forms in the bone marrow smears. Bone marrow culture in NNN medium also revealed positive result by the determination of Leishmania promastigote forms on the 7th day. The treatment was initiated by pentavalent antimony [glucantime 1 x 10 mg/kg/day intramuscular (IM)] however, due to severe adverse effects it has switched to liposomal amphotericin B (3 mg/kg/day). The patient completely recovered without complication. In conclusion VL should be considered in the differential diagnosis of patients, even adults, with persistent fever, hepatosplenomegaly and pancytopenia, in endemic countries such as Turkey.

Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality. In this study, demographic features, underlying conditions, causative pathogens and factors affecting length of hospital stay and mortality were retrospectively investigated in patients who were diagnosed as CAP and followed-up in our unit between January 2005-December 2007. Among 97 patients 65 (67%) were male, 32 (33%) were female and the mean age was 62.7 (age range: 18-94) years. Patients were grouped according to criteria of Turkish Thoracic Society into four groups; 22 were group 2 (patients with risk factors, without aggrevating factors), 59 were group 3 (patients with aggrevating factors), and 16 were group 4 (patients who have necessity for intensive care) CAP. The patients have also been grouped according to criteria of American Thoracic Society (CURB-65 score = Confusion, Urea7 mmol/L, Respiratory rateor = 30/min, low Blood pressure and beingor = 65 years old), as group I (n = 65), group II (n = 20), and group III (n = 12). During follow-up 11 (11.3%) patients required mechanical ventilation support and 6 (6.2%) patients have died. Causative pathogens were isolated from 14 (23.3%) out of 27 well-qualified sputum samples obtained from 60 patients who could produce sputum (8 Streptococcus pneumoniae, 2 methicillin-sensitive Staphylococcus aureus, 2 Klebsiella pneumoniae, 1 Haemophilus influenzae, 1 Moraxella catarrhalis). Thirty-seven of cases were treated with levofloxacin, 10 with moxifloxacin, 24 with ceftriaxone +/- clarithromycin, 16 with sulbactam-ampicillin +/- ciprofloxacin, 10 with beta-lactam/beta-lactamase inhibitor combinations, and fever declined within 2.5 days in 83 (85.6%) of them. The mean duration of hospital stay was estimated as 11.1 days. In the evaluation of the factors that affect the length of hospital stay, beingor = 65 years old, gender, underlying conditions, central venous catheterisation, presence of nasogastric tube, positive culture result, previous antibiotic treatment, fever continuing for3 days despite antibiotic therapy and scoring groups were not determined as risk factors (p0.05 for all of these parameters). However, mechanical ventilation was found as a significant risk factor (p0.05). In the evaluation of the factors that affect mortality, mechanical ventilation (p0.001), staying in intensive care unit (p0.001), being group 4 CAP (p0.001) and fever continuing for3 days despite antibiotic therapy (p = 0.05) were found to be significant risk factors. In conclusion, length of hospital stay, mortality and treatment costs in CAP patients could be reduced by defining the risk factors and starting empirical antibiotic therapy according to the national and international guidelines.

Objective: Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. Methods: In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin-tazobactam (4 × 4.5 g IV/day) or carbapenem [meropenem (3 × 1 g IV/day) or imipenem (4 × 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at completion of therapy. Results: One hundred and twenty episodes were assessable for efficacy (59 piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 ± 9.6 days in the piperacillin-tazobactam group and 14.7 ± 8.8 days in the carbapenem group (P> 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin-tazobactam and carbapenem groups, respectively (P> 0.05). Similar rates of success without modification were found in the piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05). Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14% (6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.08). Conclusions: The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients. © The Author (2010). Published by Oxford University Press. All rights reserved.

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S. lugdunensis endocarditis. In this report the first case of S. lugdunensis endocarditis from Turkey was presented. A 37-year-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S. lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21st day of the therapy (9th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S. lugdunensis.

Cryptococcosis caused by Cryptococcus neoformans has a wide range of clinical presentations, varying from asymptomatic colonization of the respiratory airways to the dissemination of infection into different parts of body. It is more common among immunosupressed patients such as human immunodeficiency virus (HIV) positive ones. In this report we present a case with C. neoformans meningitis and miliary pulmonary infiltrates suggesting pulmonary tuberculosis without HIV infection. A-70-years-old male was admitted to the hospital with mental confusion, 3-weeks history of headache, weight loss, dry cough and fatigue. Physical examination was normal except neck stiffness. Cerebrospinal fluid (CSF) white cell count was 120/mm3 (80% polimorphonuclear cells). Gram staining of CSF revealed poorly stained gram-positive yeast cells. Empirical therapy with lipozomal amphotericin B, ceftriaxone and ampicillin combination was started. When C. neoformans growth was detected on CSF culture, ceftriaxone and ampicillin were discontinued. Patient became conscious at 24th hour of the treatment. Peripheric blood flow-cytometric analysis revealed a significant decrease in absolute CD4+ T lymphocytes, and in CD8+28+ T lymphocytes in addition a significant increase in natural killer cell ratio. Blood immunoglobulin and complement levels were found normal. Cranial magnetic resonance imaging and computerized tomogralphy (CT) of the abdomen were normal, however, chest CT revealed multiple parenchymal millimetric nodular infiltrations on both sides and minimal fibrotic alterations. Acid-fast staining of CSF, tuberculosis culture, tuberculosis PCR results and repeated HIV serology were found negative. Despite the lack of microbiological confirmation, empirical antituberculosis treatment was also started with the suspicion of miliary tuberculosis as the patient had a symptom of long-term dry cough, miliary infiltrations on chest CT, anergic tuberculin skin test and a history of pulmonary tuberculosis in childhood. After two weeks, amphotericin B was changed to oral fluconazole which was continued for an additional eight weeks. Antituberculosis therapy was given for nine months. Control chest CT taken after four months of antituberculosis therapy revealed improvement of the lesions. This presentation emphasizes the fact that cryptococcal infections may develop in HIV negative patients, even together with tuberculosis in certain cases and radiological findings of the two infections may be confusing when both of them invade the lungs.

Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been presented. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12th day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 x 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20th day of ampicillin therapy showed waning of the vegetation. On 42nd day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified.

Herpes simplex encephalitis (HSE), which is an uncommon condition, is a significant cause of neurological impairment in pregnant women. Assessment of fetal contamination remains a problem. Up to no...

Leptospirosis which is caused by Leptospira species, may present with clinical features that vary from a mild flu-like illness to an acute life-threatening condition. Weil's disease, the most severe form of leptospirosis is characterized by multiorgan involvement including liver, kidney and lungs. In this report a severe Weil's disease was presented. A 43 years old male patient who had a history of swallowing water while swimming in the creek, was admitted to the hospital with the complaints of weakness, cough, bloody sputum, generalized jaundice and dark urine. Acute renal failure, bilateral lung infiltration, hyperbilirubinemia, leukocytosis and thrombocytopenia were detected, and the patient has undergone to hemodialysis. Ceftriaxone and ciprofloxacin treatment was applied to the patient after collection of blood, urine and sputum cultures and serum samples for serological tests. None of the cultures yielded pathogenic microorganisms. Microscopic agglutination test (MAT) was applied to two serum samples which were collected with 10 days interval. The first serum sample revealed antibody positivity at 1/200 titer against L. semeranga Patoc I, while the second serum revealed antibody positivity at 1/400 titer against both L. semeranga Patoc I and L. icterohaemorrhagiae Wijnberg. By the administration of antibiotic therapy and early supportive care the patient was cured completely. In conclusion Weil's disease should be taken into consideration in the patients with multiple organ involvements.

The aim of this study was to evaluate the clinical, epidemiological and demographical features of adult measles cases admitted to our hospital, during the measles epidemic which emerged in Europe and in our country in the year 2001. A total of 35 adult measles cases (10 male, 25 female) ages between 16-36 (mean age: 23.1 +/- 4.6) years were detected between January and June 2001. The diagnosis was based on the clinical findings, however only 11 of the cases could be serologically confirmed with the presence of measles IgM antibody positivities. Fever (91.4%), cough (94.3%) and conjunctivitis (77.1%) were the most common symptoms. All of the patients had maculopapular rash, and the presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 77.1%, 57.1%, and 5.7% of patients, respectively. Leukopenia and elevated liver enzymes were detected in 28.5% and 37.2% of the patients, respectively. Pneumonia was the most common complication which was seen in 20% of the patients. Of the cases 2.9% exhibited otitis media and 17.1% diarrhea. Spontaneous abortus occurred in one of the three pregnant women. In conclusion, measles is still an important public health problem in our country, and since it may lead to severe complications and economic and labor loss, an effective elimination programme should be obtained by the use of vaccine in two doses and effective strategies for the immunization of the target populations.