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Background: The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria (CRGNB) is increasing worldwide. Several risk factors have been associated with such infections. The present study aimed to identify risk factors and determine the mortality rates associated with CRGNB infections in intensive care units., Methods: This retrospective case-control study was conducted at Erciyes University Hospital (Kayseri, Turkey) between January 2017 and December 2021. Demographic and laboratory data were obtained from the Infection Control Committee data and record system. Patients who had CRGNB infection 48-72 h after hospitalization were assigned to the case group, while those who were not infected with CRGNB during hospitalization formed the control group. Risk factors, comorbidity, demographic data, and mortality rates were compared between the two groups., Results: Approximately 1449 patients (8.97%) were monitored during the active follow-up period; of those, 1171 patients were included in this analysis. CRGNB infection developed in 14 patients (70.00%) who had CRGNB colonization at admission; in 162 (78.26%) were colonized during hospitalization, whereas 515 (54.56%) were not colonized. There was no significant difference in age, sex (male/female) or comorbidities. The total length of hospital stay was statistically significantly longer ( P =0.001) in the case group (median: 24 [interquartile range: 3-378] days) than the control group (median: 16 [interquartile range: 3-135] days). The rates of colonization at admission (25.5%; vs. 10.6%, P =0.001) and mortality (64.4% vs. 45.8%, P =0.001) were also significantly higher in the cases than in the control group, respectively. In the univariate analysis, prolonged hospitalization, the time from intensive care unit admission to the development of infection, presence of CRGNB colonization at admission, transfer from other hospitals, previous antibiotic use, enteral nutrition, transfusion, hemodialysis, mechanical ventilation, tracheostomy, reintubation, central venous catheter, arterial catheterization, chest tube, total parenteral nutrition, nasogastric tube use, and bronchoscopy procedures were significantly associated with CRGNB infections ( P <0 . 05). Multivariate analysis identified the total length of stay in the hospital (odds ratio [OR]=1.02; 95% confidence interval [CI]: 1.01 to 1.03; P =0.001), colonization (OR=2.19; 95% CI: 1.53 to 3.13; P =0.001), previous antibiotic use (OR=2.36; 95% CI: 1.53 to 3.62; P =0.001), intubation (OR=1.59; 95% CI: 1.14 to 2.20; P =0.006), tracheostomy (OR=1.42; 95% CI: 1.01 to 1.99; P =0.047), and central venous catheter use (OR=1.62; 95% CI: 1.20 to 2.19; P =0.002) as the most important risk factors for CRGNB infection., Conclusions: Colonization, previous use of antibiotics, and invasive interventions were recognized as the most important risk factors for infections. Future research should focus on measures for the control of these parameters., (© 2023 The Authors.)

Background: There is limited data concerning the prevalence of arrhythmias, particularly atrial fibrillation (AF), which may develop as a consequence of direct myocardial injury and the inflammatory state existing in COVID-19., Methods: This single-center study included data concerning 658 COVID-19 patients, who were hospitalized in our institute, between April 20th, 2020 and July 30th, 2020. Demographic data, findings of the imaging studies, and laboratory test results were retrieved from the institutional digital database., Results: New onset AF (NOAF) was identified in 33 patients (5%). Patients who developed AF were older (72.42 ± 6.10 vs 53.78 ± 13.80, p < 0.001) and had higher frequencies of hypertension and heart failure compared to patients without NOAF (p < 0.001, for both). The CHA2DS2-VASc score was higher in patients, who developed NOAF, compared to those who did not during hospitalization for COVID-19 (p < 0.001). Subjects, who developed NOAF during hospitalization, had a higher leukocyte count, neutrophil / lymphocyte ratio (NLR), C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels compared to those without NOAF (p < 0.001 for all comparisons). Diffuse lung infiltration was also more frequent in COVID-19 patients, who developed NOAF, during hospitalization (p = 0.015). Multivariate logistic regression analysis demonstrated that age, CHA2DS2-VASc score, CRP, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT were predictive for NOAF., Conclusion: The prevalence of NOAF in hospitalized COVID-19 patients is higher than the general population. Age, CHA2DS2-VASc score, C-reactive protein, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT may be used to identify patients at high risk for development of NOAF. Especially among these parameters, the presence of diffuse lung infiltration on thorax CT it was the most powerful independent predictor of NOAF development., Competing Interests: Declaration of Competing Interest No potential conflict of interest was reported by the authors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Patients in surgical intensive care units are thought to be at the highest risk for developing candidemia, especially patients undergoing abdominal surgery. The present study aims to investigate risk factors for candidemia in patients with abdominal surgery., Methods: A retrospective study was undertaken that involved patients admitted to the surgical ICU between January 2016 and January 2017. All postoperative adult patients (>18 years old) who underwent abdominal surgery were included in this study., Results: During the one-year study period, 49 patients developed candidemia. Thirty-five of candida isolates were non-albicans strains. Of them, 25 (51%) isolates were Candida parapsilosis , eight (16.3%) isolates were C. glabrata , one (2%) isolate was C. tropicalis and one (2%) isolate was C. kefyr . The median age of all patients enrolled in this study was 60.5±15.6 years. In univariate analysis, the duration of the hospital stays, intensive care unit stay, type of surgery, respiratory failure, total parenteral nutrition, transfusion and use of central venous catheter were significantly higher in patients with candidemia. In multivariate analysis, duration of hospital and intensive care unit stay and use of central venous catheter was associated with an increased risk of candidemia. The mortality rate of case patients was 36.7%., Conclusion: Patients undergoing abdominal surgery are at increased risk of candidemia, especially the patients with prolonged intensive care unit/hospital stay and the patients with a central venous catheters. Antifungal prophylaxis may be considered for patients with increased risk., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (Copyright: © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.)

Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Brucellosis is a common zoonotic disease with high morbidity. In the majority of human cases, the causative agent is B. melitensis. Infection is transmitted to humans by direct/indirect contact with the contaminated animal products (e.g., consumption of unpasteurized milk), infectious aerosols and aborted fetus. Brucellosis often affects middle-aged adults and young people. Patients with brucellosis tend to have non-specific symptoms, including fever, chills, night sweats, joint pain and myalgia. Brucellosis affects various organs and tissues. The osteoarticular system is one of the most commonly described affected systems in humans. In several clinical studies, the prevalence of Osteoarticular Brucellosis (OB) is reported as 2-77%. Most important osteoarticular clinical forms osteomyelitis, spondylitis, sacroiliitis, arthritis and bursitis. Spondylitis and spondylodiscitis are the most frequent complications. Spondylodiscitis often affects the lumbar (especially at the L4- L5 levels) and low thoracic vertebrae than the cervical spine. Back pain and sciatica radiculopathy are the most common complaints about patients. Sacroiliitis is associated with severe pain, especially back pain in affected individuals. Spinal destructive brucellar lesions are also reported in adults in previous studies. Brucellosis is diagnosed with clinical inflammatory signs (eg. tenderness, pain) of the affected joints together with positive serological tests and positive blood/synovial fluids cultures. Serological test measures the total amount of IgM/IgG antibodies. Standard agglutination test (SAT) titer ≥1:160 is in favor of brucellosis diagnosis. Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase chain reaction (PCR) are other types of diagnostic tests. Radiological assessments, such as joint sonography, computed tomography, magnetic resonance imaging, are the most helpful radiological methods to diagnose spinal brucellosis. The agents commonly used in the treatment of brucella spondylitis are doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifampicin. The recommended regimens for treatment of brucella involve two or three antibiotics combinations. No standard treatment, physicians prescribe drugs based on conditions of the disease. Patients need a long-term (usually at three months) antibiotic therapy for mainly aiming to prevent relapses. Surgery may be required for patients with spinal abscess. This review focused on physicians' awareness for osteoarticular involvement, clinical presentation, diagnosis and current treatment of OB., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (Copyright: © 2019 by Istanbul Northern Anatolian Association of Public Hospitals.)

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

The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7%): colistin-carbapenem (CC), 69 (32.2%): colistin-sulbactam (CS), and 43 (20.1%: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.

Objectives: The aim of this study was to evaluate the epidemiological characteristics of tularemia outbreak and the effect of climate variability on this outbreak in Kayseri., Methods: The outbreak places, infection dates, source of infection, and the number of cases were recorded and analyzed. This information was obtained from the Regional Public Health Department. Climate data were supplied by the Regional Meteorological Service., Results: The first case in Sariz was recorded in 2005. Thereafter, 2 cases were reported in 2006 and 1 case in 2007. During 2010, 21 cases were recorded in 7 towns, 62 cases in 2011 and 27 cases in 2012. A total number of 110 cases were recorded in 12 out of 16 towns in Kayseri Province between 2010 and 2012. The majority of cases were seen in the north-eastern, east and south-eastern parts of Kayseri Province; located in higher altitudes (over 1000m from sea level). It was accepted that the outbreak was originated from water sources and was confirmed by few number of water samples collected from outbreak areas. Considering climate variations, the outbreak occurred between 1988 and 2009 during a dry, low humid, high temperature period after rainy season., Conclusion: A tularemia outbreak was observed between 2010 and 2012 with the initiation of rainy years. High temperature for a long period accompanied by low rainfall and low humidity may affect the vector's biology and initiate a tularemia outbreak in high plateaus in Kayseri Province and around., (Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.)

Cutaneous Candida infections may occur in patients with HIV/AIDS, cancer, receiving chemotherapy and solid organ transplantation. A 32-year-old woman was admitted to the department suffering from pruritic and erythematous plaque on left side of her face for the past two months. The patient was HIV positive, diagnosed five years previously, and had been on antiretroviral therapy (tenofovir/emtricitabine and lopinavir/ritonavir) for a year. She was not compliant with the medication. Elevated HIV RNA load and decreased CD4+ lymphocyte count were observed. Fungal elements were detected from the skin scraping sample taken from the facial plaque. Fluconazole-sensitive Candida glabrata was isolated from this sample. Topical clotrimazole ointment and systemic fluconazole 400 mg/day were used. After systemic fluconazole therapy was continued for two months, the plaque was cured. C. glabrata rarely causes cutaneous infection without involving the mucous membranes. Presentation of cutaneous fungal infections in HIV patients with decreased CD4+ T lymphocyte counts can be atypical and require extensive antifungal treatment.

Objective: To determine device-associated infection (DAI) rates, and the microbiological and antibiotic resistance profiles of infecting pathogens in our hospital., Methods: Prospective surveillance of healthcare-associated infections was performed from January 2007 to March 2010 in 4 different intensive care units (ICUs) of SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey., Results: During the study period, 6,005 patients were followed-up in ICUs for a total of 46,355 patient-days. The total number of DAIs was 969. Catheter-associated urinary tract infection (CAUTI) was the most common DAI (55.3% of DAIs; 11.9 cases per 1000 catheter-days), followed by ventilator-associated pneumonia (VAP) (38.9% of DAIs; 21.2 cases per 1000 ventilator-days), and central line-associated blood stream infection (CLABSI) (5.8% of DAIs; 2.8 cases per 1000 central line-days). The most frequently isolated pathogens in patients with VAP were Acinetobacter species (24.5%) and Escherichia coli in CAUTI (24.2%). Coagulase negative Staphylococci and Candida species were the leading pathogens in patients with CLABSI., Conclusion: We observed considerably high rates of VAP and CAUTI and a high rate of CLABSI in our ICUs when compared with the National Healthcare Safety Network data. These findings emphasize the need to improve infection control practices and management of invasive device use in our hospital.

Objective: To evaluate the clinical characteristics and certain risk factors that may be associated with fatal outcome in patients with H1N1 influenza., Methods: This retrospective study was conducted between October and December 2009 in the Department of Infectious Diseases and Clinical Microbiology, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. Data regarding the epidemiological and clinical characteristics of 74 hospitalized cases of confirmed pandemic H1N1 influenza were reviewed., Results: The median age was 49 (18-83) years, and 34 (46%) were males. The most common symptom and signs on admission were cough (91.9%) and fever more than 38 degrees Centigrade (71.7%). More than two-thirds of patients (68.9%) had at least one underlying condition; most frequently chronic respiratory disease, including asthma and diabetes. Seventy-seven percent had evidence of pneumonia on their chest x-rays at presentation. Of the 74 cases, 16 (21.6%) were followed up in the Intensive Care Unit, and 10 (13.5%) died. Obesity and oxygen saturation below 92% at the time of admission were found to be significantly related with fatal outcome. In addition, fatal patients had significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), urea, creatinine, d-dimer on admission and prothrombin time (PT), activated partial thromboplastin time, and the international normalized ratio (INR) was longer., Conclusion: Timely identification and management of patients with higher risk for fatality may improve outcomes.