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Introduction: Although diabetic foot infections are polymicrobial, gram-positive microorganisms comprise the majority. Daptomycin is a novel agent in treating infections due to multidrug-resistant gram-positive pathogens. In this multicenter study, the outcomes of the daptomycin treatment were evaluated retrospectively in the treatment of diabetic foot infectious without osteomyelitis. Materials and Methods: Patients with diabetic foot infection without osteomyelitis and who received daptomycin treatment were included into the study. Sociodemographic characteristics of the patients, risk factors for methicillin resistant Staphylococcus aureus (MRSA), antimicrobial treatment, and the data of microbiological and clinical outcomes of the cases were registered in a standard form by eleven centers. Clinical success was defined as a combination of end-of-treatment laboratory parameters, clinical and microbiological responses. Results: A total of 46 patients (30 males, 16 females) were clinically evaluated for the outcome of daptomycin therapy. Mean age was 61.09 ± 11.82 years (31-81) and mean diabetes duration was 13 ± 8.2 years. The number of mild, moderate and severe infections identified according to the infection scoring system of the Infectious Diseases Society of America (IDSA) were 12 (26.1%), 25 (54.3%), and 9 (19.6%) respectively. Duration of daptomycin therapy was 17.5 ± 9.3 days and overall daptomycin success rate was 82.6% (n= 38). Two patients developed side effects. Conclusion: The clinical success rate of this study which assessed the efficacy of daptomycin in diabetic foot infections was 82.6%. Daptomycin can be safely used even in severe cases having had no success with previous antibiotic therapy.

Tularemia is a zoonosis caused by Francisella tularensis. Oropharyngeal tularemia is due to bacteria penetrating the oral mucosa during intake of contaminated water and food and is the common form seen in our country. A case of oropharyngeal tularemia associated with erythema multiforme is reported herein. Physicians should recognize the cutaneous lesions of tularemia and consider tularemia in patients with eruptions having an epidemiological history.

Introduction: This study was planned to determine the rate of surgical site infection and to evaluate related risk factors and the effect on cost following surgical procedures in the Departments of Surgery and Orthopedics and Traumatology. Materials and Methods: Six hundred and twenty nine patients who underwent surgery were enrolled into the study. Incidence rates of clean, clean-contaminated, contaminated, and dirty-infected wounds were 3.2%, 16.4%, 32.7%, and 40.9%, respectively. Results: Older age, wound classification, malignancy, diabetes mellitus, cardiovascular system disease, bleeding from wound, preoperative antibiotic usage, urgent surgery, secondary surgical operation, number and duration of drainage catheters, and shaving with blade prior to operation were risk factors significantly related with the occurrence of surgical site infection. Duration of hospitalization (28.6 ± 20.1 days) was significantly longer in patients with surgical site infection compared to the non-surgical site infection group (11.4 ± 8.1 days) (p< 0.001). The mortality rate was 12.7%, and it was higher in patients with surgical site infection compared to the non-surgical site infection group (1.3%) (p< 0.001). The mean cost was 5038 ± 4237 American dollars and 1305 ± 1249 American dollars for the groups with and without a history of surgical site infection, respectively (p< 0.001). Conclusion: To minimize the incidence of surgical site infection, possible risk factors related with the patient should be considered.

Introduction: Fever of unknown origin is first defined in 1961 as a temperature higher than 38.3°C lasting longer than 3 weeks, with a diagnosis that remains uncertain after 1 week of investigation. In this study, it’s aimed to evaluate etiology of fever of unknown origin cases hospitalized in department of infectious diseases and clinical microbiology. Patients and Methods: Fifty three fever of unknown origin cases hospitalized at our department between January 2002-August 2007 were evaluated retrospectively. Fever of unknown origin was diagnosed according to the criteria described by Petersdorf and Beeson. Patients with a history of immunosuppressive disease and nosocomial fever were excluded. Results: Median days with fever was 15.8 days (20-160 days), median days for diagnosis was 4.8 days (3-120 days). Seventeen (32.1%), 10 (18.9%) and 5 (9.4%) of the 53 cases were diagnosed as infection, collagen vascular disease and malignancy respectively. Eight (15.1%) of all cases were diagnosed as other diseases such as thyroiditis, pheochromocytoma, ulcerative collitis, and familial mediterrenean fever. Origins of the fever was not defined for 13 (24.5%) of the patients. Fever decreased spontaneously in 61.5% of undiagnosed patients at follow up. Invasive procedures were performed at 20.8% of whole cases. Conclusion: As a result infectious diseases are the leading causes of fever of unknown origin. For diagnosis routine tests should be performed first and then if necessary, more complicated or invasive tests may be performed. Endemic, regional infectious diseases should be considered primarily.

Peginterferon alfa (PEG-IFN-α) and ribavirin combination treatment may cause flu like symptoms, hematologic, neuropsychiatric, autoimmune adverse effects. This study aimed to compare adverse effects of two different PEG-IFN molecules used to treat chronic hepatitis C patients. 40 chronic hepatitis C patients followed by our clinic were enrolled to study. Twenty two patients were treated with PEG-IFN-α 2a and ribavirin combination, 18 patients were treated with PEG-IFN-α 2b and ribavirin combination for 48 weeks. Adverse effects were noted during treatment period. Flu like symptoms were the most frequent adverse effects observed in both treatment groups. Treatment was stopped because of adverse effects in 13.6% of PEG-IFNα 2a and ribavirin combination group and 11.1% of PEG-IFN-α 2b and ribavirin combination group. There was no statistically significant difference between frequency of advers effects and discontinuation rate of two therapy modalities. Finally, both of PEG-IFN molecules were found similar about frequency of adverse effects, reducing dose and discontinuation of treatment.

Medical students are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharps injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, their knowledge and compliance on universal precautions. One hundred and fourteen medical students filled out the questionnaire. 31.6% were in 3rd, 22.8% in 4th, 35.1% in 5th, and 10.5% in 6th class. 61.4% of students had history of occupational injuries at least once. Rate of sharps injuries, needlestick injuries and mucosal exposure were 30%, 82.9%, 35.7% respectively. Rate of OEs was higher and statistically significant in 5th, 6th classes compared to 3rd, 4th.The most common way for exposure was recapping the needle. Rate of underreporting was 74.2%. 53.5% of the participants were vaccinated with complete dose of hepatitis B virus vaccine. 28.9% declared they always wore gloves prior to any percutaneus procedures. Medical students should be educated for the risk and encouraged to report OEs for their own safety.

Health care workers (HCWs) are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharp injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, condition of hepatitis B virus immunization, their knowledge and compliance on universal precautions. One hundred and thirty HCWs filled out the questionnaire. One hundred and three (79.2%) of participants determined at least one or more occupational exposure during last one year. Eighteen (17.5%) of participants exposed to accidental exposure during last one year reported these exposures. One hundred and nine (83.8%) of participants had history of hepatitis B virus vaccination. Results showed that only 30 (23.1%) followed universal precautions completely.

Infective endocarditis is a life threatening disease of endocardium of the heart. Viridans streptococci are the most common reported isolates among patients with infective endocarditis. Abiotrophia and Granulicatella species form part of the normal flora of the oral cavity. They are infrequently isolated in patients with infective endocarditis. We report a case of native valve endocarditis attributed to Granulicatella elegans. We isolated G. elegans in two blood samples of the patient. Patient was successfully treated with ceftriaxone and gentamycin.

In this study, the clinical and epidemiologic spectrum of 200 cases of complicated upper urinary tract infection which treated at a university hospital were evaluated, retrospectively. The mean age was 62.9 years and female/male ratio was 118/82. The most common complaints were fever (n= 131) and disuria (n= 71). Bacteriuria was detected in 119 patients and bacteremia was detected in 20 patients. The most common etiologic agent was Escherichia coli (%63). Advanced age, recent antimicrobial usage and diabetes mellitus were found as common complicating factors. Fourty-six patients had urosepsis and 17 patients were died. The rates of susceptibility of E. coli isolated from urine samples were detected as 100% to imipenem, meropenem & fosfomycin, 98% to amicasin, 70% to gentamycin, 73% to ciprofloxacin, to ofloxacin 56%, to nitrofurantoin 93%, to ceftriaxone 88% and to piperacilin-tazobactam 86%. Trimethoprim/sulfamethoxazole and ampicilin demonstrated the fewest susceptibility (46% and 47%, respectively). Consequently, the patients with complicated upper urinary tract infections should be treated in hospital. A third generation cephalosporin or fluoroquinolones may be suitable choices for ampiric treatment of the patients without urosepsis; and a third generation cephalosporin or beta-lactam with beta-lactamase inhibitor combined with aminoglycosides and carbapenemes may be suitable choices for the patients with urosepsis.

In this article, a patient in whom cochlear implant was administered following hearing loss associated with acute bacterial meningitis is presented. The 57-year-old male patient presented due to fever, ear pain and hearing loss for the past three days. On physical examination, the patient was conscious, had a moderate general condition, and fever of 37.7°C. There was total hearing loss and aphasia. Neck stiffness was positive during neurological examination. During non-stained microscopic examination of the cerebrospinal fluid, 1900 cells/mm3 (89% PMNL, 11% lymphocyte) were detected. During gram staining, gram-positive diplococcus was seen. Ceftriaxone was started with the diagnosis of acute bacterial meningitis. On day 2 of the treatment, his fever decreased, but hearing loss and speech and balance disorder continued. On day 4 of the treatment, vancomycin was added due to newly developed fever. Response to fever was achieved on day 2 of the combination treatment. During audiological examination of the patient with ongoing hearing loss, very severe bilateral sensorineural hearing loss was detected. 1 mg/kg prednisolone was started for the patien,t and cochlear implant was planned by the otorhinolaryngology department. Cochlear implant was performed as the patient’s complaint did not regress after one month of prednisolone treatment. Monitoring of the patient is ongoing. In conclusion, hearing loss developing in acute bacterial meningitis should be detected promptly, and rehabilitated as required.

Brucellosis is a zoonosis, and transmitted by direct or indirect exposure. Direct invasion of the central nervous system occurs in fewer than 5% of cases. Neurobrucellosis includes meningitis, encephalitis, myelitisradiculoneuronitis, brain abscess, intra-medullary spinal cord abscess, epidural abscess, granuloma, and demyelinating and meningovascular syndromes. We report a case of meningitis caused by Brucella melitensis in a patient with ventriculoperitoneal shunt.

Urinary system infections are usually bacterial, however, fungal etiology, particularly Candida spp. are encountered in about 10% of these infections. C.albicans is still the most frequently isolated species in candiduria. This study was aimed to identify the risk factors of candiduria and to determine species distribution of Candida which cause candiduria in hospitalized patients. The study was carried out in a total of 93 hospitalized patients (68 female, 25 male; age range: 17-84 yrs, mean age: 59.5 ± 1.7 yrs) of which 50 presented with candiduria (case group) and 43 with bacteriuria (control group), between January 2009 to December 2009. The most frequently isolated species was C.albicans (n= 32; 64%), followed by C.glabrata (n= 13; 26%), C.tropicalis (n= 4; 8%) and C.krusei (n= 1; 2%). All of the isolates except one, were found susceptible to fluconazole and voriconazole by E-test (AB Biodisk, Sweden), however, C.krusei isolate was resistant to fluconazole and susceptible to voriconazole. The mean hospitalization period and the period of stay in intensive care unit (ICU) of the case group (9.56 ± 9.09 and 4.12 ± 7.05 days, respectively) were found statistically significant compared to control group (4.42 ± 3.71 and 0.53 ± 1.78, respectively) (p0.005). Nosocomial origin of infection was higher in control group (n= 45, 90%) than the case group (n= 30, 69.8%), (p= 0.014). The rate of antibiotic use prior to candiduria in the case group was detected significantly higher (n= 43; 86%) than the controls (n= 14; 32.6%) (p= 0.000). The most frequently used antibiotic prior to candiduria/bacteriuria was the quinolone group of agents both in case and control groups (42% and 21%, respectively). The other risk factors for candiduria found to be higher in the case group than the controls were as follows; presence of urinary system intervention (32% and 0, respectively; p= 0.000), catheter use (76% and 46.5%, respectively; p= 0.003) and immunosuppression history (24% and 9.3%, respectively; p= 0.041). However, there was no significant relationship between candiduria and history of surgical intervention, diabetes mellitus and renal failure (p0.05). In conclusion, rate of candiduria might be reduced by judicious antibiotic use, by implementation of guidelines for urinary catheter use, care and maintenance, and shortening the duration of ICU and hospital stay.

Acinetobacter baumannii is a frequent cause of nosocomial infections in most hospitals. Management of infections caused by these strains is difficult, as the strains often display multiple drug resistance, including carbapenem. Tigecycline which is a glycylcycline derivative has antimicrobial activity against many gram-positive and gram-negative organisms. In this study, in vitro activity of tigecycline and carbapenems against clinical isolates of A.baumannii strains were investigated. A total of 100 A.baumannii isolates were collected from hospitalized patients with documented nosocomial infections [pneumonia (n = 39), surgical wound infection (n = 32), bacteremia (n = 16), catheter infection (n = 6), urinary tract infection (n = 5), peritonitis (n = 1), eye infection (n = 1)] between October 2006 and June 2007. Only one isolate per patient was included to the study. Minimum inhibitory concentrations (MIC) of tigecycline were determined by E-test (AB Biodisk, Sweden). Carbapenem resistance of A.baumannii strains were determined by disk diffusion method. All of the 100 A.baumannii isolates (100%) were found susceptible to tigecycline (MIC values ≤ 2 µg/ml; MIC ranges: 0.032-1.5 µg/ml). Imipenem susceptibility test was performed for 95 strains, and 36 (37.9%) were found sensitive, 18 (18.9%) were intermediate sensitive, and 41 (43.2%) were resistant. Meropenem susceptibility test was performed for 87 strains, and 22 (25.3%) were found sensitive, 9 (10.3%) were intermediate sensitive, and 56 (64.4%) were resistant. Since tigecycline is found quite effective on nosocomial A.baumannii isolates, it may be considered as a treatment alternative in infections caused by carbapenem-resistant Acinetobacter spp.