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AIM: In this study it was aimed to analyse the clinical characteristics and outcomes of IE cases in our hospital. BACKGROUND: Despite developments in antibiotics and medicine, infective endocarditis (IE) is associated with significant morbidity and mortality. METHODS: Patients that were followed up for definite IE (diagnosed according to modified Duke criteria) in ourhospital between March 2007 and September 2023 were analyzed retrospectively. Patients were evaluated in terms of demographic features,underlying diseases, risk factors, clinical and laboratory findings, therapy responses, complications, and mortality. RESULTS: There were 230 patients diagnosed with IE [79-52.6% femaie, aged 53.3±16.9 years, ranging 18-92 years] fulfilling the study inclusion criteria. Risk factors, complaints, laboratory findings and complications of patients was shown in Table 1. Blood culture was positive in 175 patients (75,5%). The most common etiologic agents were; S. viridans (26.08%), S. aureus (18.6%) and E. feacalis (10.8%). The antibiotherapy of 40 patients with native valve endocarditis comprised ampicillin/sulbactam and gentamicin (other therapy combinations were vancomycin and gentamicin [n=11], penicillin and gentamicin[n=38]). Nine of 49 patients with prosthetic valve endocarditis were treated with vancomycin, rifampicin and gentamicin while other nine were treated with daptomycin including therapy. In hospital mortality was (20%-46/230). Mortality rates between blood culture positive and negative cases were similar (Chi-square test p=1) while mortality in S. viridans was less than S. aureus or enterococci (Chi-square test p=0.0085, Table 2). CONCLUSIONS: IE is still associated with significant mortality. More interventions are needed to further decrease the complication and mortality rates.

AIM: The aim of this studt to compare the therapy responses of native valve IE patients in whom empirical penicillin +gentamicin, ampicillin/sulbactam + gentamicin, or vancomycin + gentamicin were initiated. BACKGROUND: Despite developments in antibiotics and medicine,infective endocarditis (IE) is associated with significant morbidity and mortality METHODS: Outcomes of patients in whom empirical penicillin + gentamicin (PENG),ampicillin/sulbactam + gentamicin (SAMG), or vancomycin + gentamicin (VANG) were initiated for native valve IE (according tomodified Duke criteria) between March 2007 and November 2023 were evaluated retrospectively. Of note, antistaphylococcal penicillins have never been available in our setting/country. Patients were analyzed in terms of demographic features, clinical and laboratory findings, therapy responses and mortality. Patients were given ampicillin/sulbactam 12 gr + gentamicin 3 mg/kg/daily, penicillin 24 MU+ gentamicin 3 mg/kg/daily, and vancomycin 2 gr/daily + gentamicin 3 mg/kg/daily. We used Chi-square,Fisher Exact and One Way Anova tests for statistical comparison. RESULTS: There were 38, 40 and 11 patients in PENG, SAMG and VANG cohorts,respectively. While S. viridans were significantly more common in PENG cohort, there was no significant difference between the three cohorts in terms of age, gender, fever, presence of vegetation, IE with microbiological evidence, culture-negative IE, S.aureus and Enterococcus spp. successful outcome without antimicrobial modification and end of treatment mortality (Table 1). Conculisons: Despite the relatively low number of cases in both arms, there was no significant difference between the three therapy cohorts in our series. The possible reason may be the relatively few S.aureus in the etiology.

Abstract Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

Among the hospital infections, hospital-acquired central nervous system infections are quite important due to the high mortality. The pathogens that cause hospital-acquired meningitis differ according to the immune system and underlying diseases. The most frequent pathogens are gram-negative bacilli, Staphylococcus aureus, and coagulase-negative staphylococci. There are difficulties in the treatment due to the problem of increasing resistance. Treatment options of the multiple-drug-resistant pathogens are limited. In this paper, the treatment options of the hospital-acquired and methicillin-resistant S. aureus meningitis are reviewed.

Transrectal prostate biopsy (TPB) is a commonly used invasive technique for the diagnosis of prostate cancer. Escherichia coli is a rare cause of adult meningitis. It can cause nosocomial meningitis after invasive procedures. In this paper, we present two cases of E. coli meningitis developing after TPB. The first case was a 65-year-old man who was admitted to the emergency service with fever and unconsciousness two days after TPB. He had neck stiffness, leukocytosis, and high C-reactive protein (CRP) levels. His cerebrospinal fluid (CSF) had turbid appearance, low glucose and high protein levels. More than 1000/mm3 leukocytes were seen on direct microscopy, and gram-negative bacilli were observed. Ceftriaxone 2 g q12h was started. CSF culture yielded E. coli susceptible to ceftriaxone. Concomitant urine and blood cultures were sterile. The second case was a 69-year-old man admitted with fever and unconsciousness six days after TPB. He had neck stiffness, leukocytosis and high CRP levels. His CSF had purulent appearance, low glucose and high protein levels. On microscopy, there were 800 leukocytes/mm3. Ceftriaxone 2 g q12h was started. CSF culture yielded extended spectrum beta-lactamase producer E. coli. Treatment was changed to meropenem 6 mg daily. Both patients were cured with the three-week antibiotic treatment. After TPB, resistant microorganisms can be involved in the etiology of severe bacterial infections; carbapenems can be used until culture results are available.