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This study aimed to evaluate the influencing variables for outcomes in patients with septic shock having culture-proven carbapenem-resistant Gram-negative pathogens. It included 120 patients (mean age 64.29 ± 1.35 years and 58.3% female). The mean Sequential Organ Failure Assessment score during septic shock diagnosis was found to be 11.22 ± 0.43 and 9 ± 0.79 among the patients with mortality and among the survivors, respectively (P = 0.017). The logistic regression analysis showed that empirical treatment as mono Gram-negative bacteria-oriented antibiotic therapy (P = 0.016, odds ratio (OR) = 17.730, 95% confidence interval (CI): 1.728-182.691), Charlson Comorbidity Index2 (P = 0.032, OR = 7.312, 95% CI: 5.7-18.3), and systemic inflammatory response syndrome score 3 or 4 during septic shock diagnosis (P = 0.014, OR = 5.675, 95% CI: 1.424-22.619) were found as independent risk factors for day 30 mortality. Despite early diagnosis and effective management of patients with septic shock, the mortality rates are quite high in CRGNP-infected patients.

Amaç: Bu çalışmanın amacı, 2014 ve 2018 yılları arasında yoğun bakım ünitelerinde (YBÜ) sağlık çalışanlarının el hijyeni uyum oranını saptamaktır.Gereç ve Yöntem: Bu araştırma yedi YBÜ’de (Çocuk Sağlığı ve Hastalıkları, Yenidoğan, İç Hastalıkları, Anestezi ve Reanimasyon, Göğüs Hastalıkları, Nöroloji ve Kalp Damar Cerrahisi) çalışan doktor, hemşire ve yardımcı sağlık personelinin el hijyeni uyumunu değerlendiren prospektif, gözlemsel bir çalışmadır. El hijyeni uyumu enfeksiyon kontrol hemşireleri tarafından Dünya Sağlık Örgütü (DSÖ) beş endikasyonuna göre Ocak 2014 ile Aralık 2018 arasında haberli gözlem şeklinde yapılmıştır. Ayrıca, yüksek ve düşük el hijyeni uyumluluğuna sahip bireylere kişisel geri bildirimler verilmiştir.Bulgular: Toplam 24153 el hijyeni fırsat gözlemi (2014: 5695, 2015: 5307, 2016: 4563, 2017: 4821, 2018: 3767) yapıldı. Çalışmamızda 2014'ün ilk döneminde el hijyeni uyum oranı %25,6 idi. Tüm çalışanların el hijyeni uyum oranı sırasıyla; 2014: %32,0, 2015: %55,7, 2016: %61,0, 2017: %55,6 ve 2018: %68,1 olmuştur. Mesleklere göre; el hijyeni uyum oranları hemşirelerde %37 ile %70, yardımcı sağlık personelinde %20 ile %51, doktorlarda %28 ile %49 arasındaydı.Sonuç: Hastanemizde el hijyeni kurallarına uyum, sürekli çabalarla nispeten zayıf seviyelerden ortalama seviyelere yükselmiştir. El hijyeni uyum oranlarını %70'lerin üstüne çıkarmak için daha fazla destekleyici çalışmaya ihtiyaç vardır., Aim: The aim of this study was to determine the hand hygiene (HH) compliance of the health workers in the intensive care units (ICUs) between the years 2014 and 2018. Materials and Methods: A prospective, observational study assessed the hospital care HH compliance among doctors and nurses and auxiliary staff in seven ICUs (Pediatrics, Neonatal, Internal Medicine, Anesthesia and Reanimation, Chest Diseases, Neurology and Cardiovascular Surgery) of our setting.Unblinded observations were conducted by infection control nurses between January 2014 and December 2018 according to the five indications based on World Health Organization (WHO) guidelines. Practical HH training was continued during the HH observations of employees at ICUs in our hospital. In addition, personal feedback was given to individuals with high and low HH compliance.Results: A total of 24153 HH opportunity (2014: 5695, 2015: 5307, 2016: 4563, 2017: 4821, 2018: 3767) observations were made. In the first period of 2014, the rate of HH compliance was 25.6%. The HH compliance rates of all employees were as follows: 2014: 34%, 2015: 55.7%, 2016: 61.0%, 2017: 55.6% and 2018: 68.1%. According to occupations; HH compliance rates were found to range between 37% and 70% in nurses, 20% and 51% in auxiliary healthcare personnel, 28% and 49% in doctors.Conclusion: In our hospital compliance with HH rules increased from relatively poor levels to relatively average levels via continuous efforts. Further supportive studies are needed to increase HH compliance rates above 70%.

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant Enterobacteriaceae urinary tract infections (UTIs) in the terms of demographic findings, antibiotic sensitivity patterns and clinical features along with the treatment options. This study was performed at a tertiary-care educational university hospital. Adult (>18 years old) patients diagnosed with culture proven UTI due to carbapenem-resistant Klebsiella pneumoniae (between December 2016 to December 2017) were included in the study. Antimicrobial susceptibility testing of the isolates was performed with the VITEK 2 system (bioMerieux). Resistance to imipenem, ertapenem, and meropenem was tested by E-test (bioMerieux). the results were interpreted according to the EUCAST criteria. A total number of 100 patients (34% female, mean age 61.69 +/- 1.65 years) were included in this study. One month all-cause mortality rate was 19%. Microbiologic eradication rate was 88.7% while it was significantly higher in combination therapy (65/70 vs. 14/19, p = 0.019) and carbapenem long-lasting (4 h) infusion subgroups (54/56 vs. 2/56, p = 0.005). Relapse and reinfection rates were 61.7 and 29.7%, respectively. Logistic regression analysis for mortality risk factors resulted as history of ertapenem usage (OR: 4.74, 95% CI: 0.678-33.201, p = 0.117), lack of microbiologic eradication (OR: 21.7, 95% CI: 1.906-247.375, p = 0.013) and ICU stay (OR: 54.8, 95% CI: 4.145-726.324, p = 0.002). Combination, carbapenem long-lasting infusion and double carbapenem therapies seem to result in higher microbiologic eradication rates and thus may effect the mortality rates of these group of patients. Randomized-controlled studies should be performed in this critical patient group to confirm these results.

Objectives Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. Patients and methods In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. Results A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). Conclusion Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Objectives: the aim of this study was to compare the antibacterial activity of ceftaroline versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in an experimental rabbit meningitis model. Methods: the antibacterial activity of ceftaroline was compared with vancomycin in the treatment of meningitis induced by MRSA strain ATCC 43300 in an experimental rabbit meningitis model. Quantitative cerebrospinal fluid (CSF) cultures were performed at the beginning of antibiotic treatment and 24 h and 73 h after the first antibiotic dose. Furthermore, in vitro time-kill data were investigated at 0, 2, 4, 6, 8, 12 and 24 h in sterile human serum. Results: the difference between the control group versus both treatment groups was significant when comparing the decrease in colony counts in CSF both at 24 h and 73 h after the first antibiotic dose (P < 0.05). At the end of the experiment, there was a significant difference in survival between both the ceftaroline-treated group and the vancomycin-treated group versus the control group, but not between the two treatment groups. Conclusion: These results suggest that the antibacterial activity of both ceftaroline and vancomycin are similar in the treatment of MRSA meningitis in an experimental rabbit meningitis model. (C) 2020 the Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy., Ege University (Izmir, Turkey)Ege University, This study was funded by Ege University (Izmir, Turkey).

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant

Background Herein we aimed to evaluate osteomyelitis cases in our setting. Methods We evaluated the hospital records of patients with osteomyelitis between January 2013 and December 2020 retrospectively. Osteomyelitis was confirmed by direct radiography or magnetic resonance imaging or pathology. Demographic features, risk factors, clinical/laboratory findings, treatment response and mortality rates were evaluated. Clinical response was defined as (resolution of clinical signs including fever and purulent discharge and other symptoms) and/or negative culture at the end of antimicrobial therapy. Results Patients were 33 female, aged 29–85 years (mean 59±12.6). Fourty nine of the patients were diabetic foot infection, 30 were spondylodiscitis, eight were primary, seven were post-traumatic, and five were post-surgical osteomyelitis. Overall 62 patients had diabetes mellitus and 16 patients had chronic renal failure. Peripheral arterial disease, neuropathy, diabetic retinopathy and venous insufficiency rate in the DM subgroup is shown in table. Fever was present in 24.2% of the cohort. İncreasing of CRP was in 95,9%, erythrocyte sedimentation rate in 83,9%, and leukocytosis in 37.3%. The radiological findings of osteomyelitis were detected via magnetic resonance imaging in 73 patients. Etiology in biopsy cultures were elucidated in 59.5% and the most common pathogen was S. aureus (30%) Table1. The most common empirical treatment regimens were tigecycline in 27 patients, ampicillin/sulbactam in 19 patients and ceftriaxone+teicoplanin in 12 cases. Duration of treatment was 36,2±17.3 days (range 6-104 days). Overall, clinical response was obtained in 91.9%. Fifty patients were performed surgical procedure + antibacterial treatment, clinical response was 96% (p:0.091). Surgical debridement could be performed in 22 patients, clinical response was obtained in all (p:0.193). Thirteen patients developed recurrence within one year. Sixty-seven patients received oral consecutive treatment after discharge. In hospital mortality rate was 2/99 (2,02%). Conclusion Despite surgical debridement and/or developed antimicrobial treatment, approximately 1/5 of osteomyelitis cases required further treatment Further interventions seem to be needed to reach better outcomes. Disclosures All Authors: No reported disclosures

WOS: 000419586300002, The aim of this study was to screen the patients with solid organ malignancy for HBV (Hepatitis B virus) infection before the start of chemotherapy and follow up in the oncology department of our setting. All cases admitted to oncology department for chemotherapy were screened prospectively for HBV infection and reactivation between March 2013-September 2014. A total of 225 patients were included in the study and divided into 3 groups; Group I: having recovered past HBV infection: 43 patients (19.1%), Group II: isolated Anti-HBcAg total positive: 20 patients (8.9%) and Group III: chronic HBV infection with 10 patients (4.4%). HBV reactivation developed in one (5.9%) of 17 patients in group II, and two (28.6%) of seven patients in group III while under lamivudine prophylaxis. Neither hepatitis flare by HBV reactivation nor HBV-related death were observed in our study. In the moderate endemicity areas like Turkey for HBV infection, all patients must be screened for HBV before starting of chemotherapy.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

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

PubMedID: 30498901 Purpose: In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). Methods: Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status. Results: Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, Conclusions: These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Introduction: Brucellosis is a systemic infection involving many organs and tissues which may present with very different clinical manifestations. In this study, it was aimed to review the cases with the diagnosis of brucellar spondylodiscitis followed up in our center. Materyal and Methods: Cases with the diagnosis of brucellar spondylodiscitis followed up in our clinic from July 2007 to February 2016 were reviewed. Brucellosis diagnosis was established via microbiological culture confirmation and/or agglutination test positivity with a titer of 1/160 or higher. The diagnosis of spondylodiscitis was made with magnetic resonance imaging method. The data were collected by retrospective chart review. Results: During the study period, 94 cases of brucellosis were followed (36 females, 58 males, mean age:47.7 ± 15.5 years). Spondylodiscitis was detected in 16 (17%) patients. The mean age of this group was 58.4 ± 11.1 and it was detected to be significantly higher than patients without spondylodiscitis (mean age 45.5 ± 15.4 years) (p= 0.001). The most frequently involved vertebrae were the lower thoracic and lower lumbar vertebras. Age (p< 0.0001), fever (p= 0.037), backache (p< 0.0001) and weakness-fatigue (p= 0.012) were found statically significant factors for spondylodiscitis. At the end of logistic regression, age higher than 54.5 years was found to be an independent risk factor of the brucellar spondylodiscitis (OR= 9.12; %95 CI= 2.03-41.01; p= 0.004). Conclusion: Brucellosis should be screened in cases with lower thoracic and lower lumbar spondylodiscitis. Age is higher in patients with brucellar spondylodiscitis than others and age > 54.5 years is an independent risk factor for brcsellar spondylodiscitis.

PubMedID: 29960893 Objectives: In this study we retrospectively reviewed A. baumannii meningitis cases treated with tigecycline including regimens and evaluated the efficacy of tigecycline in the therapy. Patients and Methods: Study was performed in seven tertiary-care educational hospitals from five cities of Turkey and one center from France. We extracted data and outcomes of all adult (aged >18) patients with culture proven A. baumannii meningitis treated with tigecycline including antibiotic therapy until April 2016. Results: A total of 23 patients (15 male and eight female) fulfilled our inclusion criteria. All Acinetobacter strains were carbapenem-resistant and susceptible to tigecycline. Six cases received tigecycline monotherapy while 17 received tigecycline including combination therapy (10 with colistin, 4 with netilmicin, 3 with amikacin, 4 with meropenem). Seven of 23 cases (30%) died during the tigecycline including therapy (1 in monotherapy, 4 in colistin, 2 in netilmicin, 1 amikacin, one case received tigecycline + netilmicin followed by tigecycline + colistin). Hence, overall end of treatment (EOT) success was 70%. However, since further 27% died due to additional nosocomial infections, overall clinical success (relieved symptoms at the EOT and one-month post-therapy survival without any relapse or reinfection) decreased to 43%. Conclusion: We conclude that tigecycline may be an alternative in the salvage treatment of nosocomial multidrug-resistant Acinetobacter spp. meningitis. Acinetobacter spp. Meningitis. © 2018 Elsevier B.V.

We presented a sepsis outbreak caused by Serratia marcescens from contaminated propofol to raise awareness. Three patients had sepsis syndrome after chest surgery. Isolation of S marcescens from patients' respiratory and blood samples alerted us to a possible outbreak. Four syringes filled with propofol and 1 saline solution yielded S marcescens. Nine of 10 isolates from samples of patients and environment genotyped by pulsed-field gel electrophoresis were the same. Disobeying aseptic injection rules of propofol is still causing outbreaks. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

WOS: 000219732100013, Introduction: Hydatid disease is a zoonotic infection caused by the cestode Echinococcus spp. It is transmitted by ingestion of infectious cestode eggs, especially through dog feces. The two organs most commonly affected are the liver and the lung. In this paper, a series of 15 cases with symptomatic hydatid cysts hospitalized in our clinic and evaluated via consultations are presented. Materials and Methods: Patients, who were treated with hydatid disease between April 2006 and June 2015, were included in the study. Demographic characteristics, symptoms (fever, abdominal pain, pruritus, weakness, icterus, cough, sputum, nausea-vomiting), signs (hepatomegaly, splenomegaly), radiological-laboratory findings, complications, involvements of other body parts and treatment modalities were evaluated retrospectively. Results: Ten (66.7%) of the patients were female. The mean age of the patients was 52.3 +/- 18.3 year. Twelve (80%) patients had at least one cystic lesion in the liver. Four cases were complicated with a lung cyst, three with spondylodiscitis, three with splenic cyst, two with renal cyst, two with amoebic liver abscess, one with intraabdominal dissemination and one case was complicated with anaphylactic shock. Seven patients (46.7%) had leukocytosis and three (20%) had eosinophilia. All patients received treatment with albendazole p.o 2x400 mg tablets. The mean duration of treatment was 27.4 +/- 18.5 weeks. Conclusion: Hydatid cyst is an infectious disease that may cause severe organ involvement. Patients with hydatid cyst in any part of the body should be checked carefully for other system involvement, including the liver, abdominal and/ or retroperitoneal organs.

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products., Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016)., Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p, Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.

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Background CRE are globally important pathogens associated with significant morbidity and mortality. The problem of carrying CRE may continue to create a problem in discharged cases in the community. Saccharomyces boulardii sachet therapy (SBST) is reported to cause decolonization in several MDR bacteria carriers. Herein, it is aimed to present the decolonizing rates of rectal CRE colonized cases after SBST treatment. Methods The study period was August 2018–March 2019. Inclusion criteria were: (i) age >18, (ii) receiving Saccharomyces boulardii 250 mg sachets q12h for 7 days, (iii) being proven CRE carrier on rectal swab culture (RSC) up to 5 days period before SBST. The first repeated RSC was performed 3–5 days after the end of SBST. Data were retrieved from the hospital electronic database. Cases with three consecutive weekly performed negative RSC were considered to be decolonized. RSC were processed according to CDC protocol; briefly, the swab was inoculated into 10 mL of trypticase soy broth (bioMérieux Inc., Marcy-l’Étoile, France) with the addition of one 10-μg ertapenem disk (Oxoid, Altrincham, UK) and incubated at 35°C for 18–20 h. The next day, after vortexing, 100 μL of the inoculum was subcultured (8) onto chromID CARBA agar plates (bioMérieux) and incubated at 35°C for 18–20 h. Suspected CRE colonies on chromID CARBA (blue/green to blue/gray in color) were identified by the VITEK MS system (bioMérieux). Susceptibility testing of the isolates was performed with the VITEK 2 system (bioMérieux). Isolates were tested for their resistance phenotypes to imipenem, ertapenem, and meropenem by E-test (bioMérieux). The results were interpreted according to the EUCAST criteria. Results Fifteen cases [2 women, mean age 60.6 ± 18.3 (min. 18–max. 83)] fulfilled the inclusion criteria. All had a history of carbapenem usage. Five cases (33%) had three consequent negative RSC after SBST and were considered to be decolonized. Twelve cases were receiving concomitant antibiotic during SBST (10 carbapenem based regimens). Three cases who received no concomitant antibiotic were decolonized. Conclusion SBST may be a promising tool for decolonizing CRE carriers. These data need to be validated in larger cohorts preferably via randomized-controlled trials. Disclosures All authors: No reported disclosures.

WOS: 000419992100006, Introduction: Transrectal prostate biopsy (TPB) is currently a commonly used invasive procedure for the diagnosis of prostatic diseases. Due to increasing infectious complications after TPBs in our institute, it was decided to change antimicrobial prophylaxis regimens and pre-intervention measures. The aim of this study was to evaluate the effects of shorter antimicrobial prophylaxis, intestinal cleansing and single use sterile gels on infections developing after TPBs in our tertiary-care educational hospital. Materials and Methods: Infections developing in the last six months after TPB were evaluated retrospectively by using records of microbiology, radiology and urology departments. Sterilization and disinfection, antimicrobial prophylaxis regimens, intestinal decontamination procedures and routine biopsy procedures were reevaluated in cooperation with the corresponding clinics. Afterwards, it was decided to implement three changes in the TPB practice: 1) Shortening the antimicrobial prophylaxis, 2) Intestinal cleansing one day before the intervention by using enema, and 3) Using sterile gel (single patient use only) during biopsy. Patients were diagnosed as clinical or microbiologically confirmed healthcare-associated infection according to the 'Centers for Disease Control and Prevention' criteria. The preintervention period was 2007 July-December and the intervention period was 2008 January-July. Results: Overall infection/infectious complication rate (10.5% vs. 3.8%; p=0.007), overall clinically defined infection rate (4.8% vs. 1.1%; p=0.028) and overall microbiologically defined infection rate (5.8% vs. 2.7%; p=0.002) decreased significantly in the post intervention period. Conclusions: Our findings suggest that shorter antimicrobial prophylaxis regimens, using sterile gels and intestinal cleansing may be useful in the control of infections developing after TPB.

Amaç: Antibiyotikler, artan bakteriyel direnç, yüksek maliyetler ve yeni antibiyotik keşiflerinin azalması gibi nedenlerden dolayı dikkatli kullanılması gereken ilaçların başında gelmektedir. Akılcı antibiyotik kullanımı (AAK), uygun antibiyotik, uygun süre ve dozda, en düşük maliyet ile bilinir. Diş hekimleri, diş ve dişeti enfeksiyonları, endokardit profilaksisi gibi durumlarla sık karşılaşmakta ve bu nedenle antibiyotikleri sıkça kullanmaktadırlar. Bu çalışmada bir eğitim diş hastanesinde görev yapan hekimlerin AKK’ye etki eden durumlar irdelendi. Gereç ve Yöntem: Çoktan seçmeli sorulardan oluşan anket gözetim altında cevaplama yöntemi ile uygulandı. Sonuçlar sıklık ve yüzdeler hesaplanarak analiz edildi. Bulgular: Çalışmaya dahil olan 114 diş hekiminin 73’ü (%64) kadındı. Reçete yazarken verilecek antibiyotiğe uygun anamnez alma noktasında kendisini “çok iyi” , “iyi” ve “orta” şeklinde tanımlayanların oranı sırasıyla, % 54.1, % 22.3 ve % 11.5 olarak bulundu. Meslekte 15 yılı aşkın süredir çalışan diş hekimleri diğerlerine oranla daha az mezuniyet sonrası eğitim aldıkları, daha az AAK konusunda eğitim aldıkları fark edildi ve 15 yılı aşkı n süredir çalışan diş hekimleri, antibiyotik bilgi kaynağı olarak meslektaşlarını daha yüksek oranda kullandıkları görüldü. Sonuç: İlaç sanayinin bilgilendirmeleri yerine; tanı ve tedavi kılavuzları ve kitapları gibi bilimsel kaynaklar ile mezuniyet sonrası AAK eğitimlerine yönelmenin gerektiği görülmüştür., Aim: Antibiotics should be used with caution because of the increase in bacterial resistance, high treatment costs and decrease of the new antibiotic discovery. Rational use of antibiotics is referred as appropriate antibiotic choice, appropriate döşe and duration and the lowest cost. Dentists are frequently confronted with situations like endocarditis prophylaxis, tooth and gum infections, and therefore they often use antibiotics. In this study; the factors affecting rational antibiotic use of dentists working in educational dental hospital w ere investigated. Materials and Methods: The questionnaire consists of multiple choice questions was performed by answering under surveillance method. Results were analyzed with calculating of frequencies and percentages. Results: Out of 114 dentists included in the study, 73 (64% )were women. In terms of taking anamnesis for appropriate antibiotic prescription, dentists considered himself/herself as very good, good and moderate were 54.1 % , 22.3% and 11.5%, respectively. It was found that the dentists working more than fifteen years attended less post-graduation educations and courses about rational antibiotic use, and they often took information about antibiotics from their colleagues. Conclusion: It was observed that scientific resources such as diagnosis and treatment manuals or books, and post- graduation educations in rational antibiotic use are necessary instead of pharmaceutical industry informations.

The aim of this study is to evaluate tigecycline for diabetic foot infections (DFIs).In this prospective observational study, the investigators included patients who had consultation with the Diabetic Foot Council of Ege University Faculty of Medicine (Izmir, Turkey) between March 2013 and July 2015 and who used tigecycline during their treatment. Treatment success was assessed by design-specific criteria for each evaluation.The study included 105 cases. Of those, 37 (35.2%) were women (mean [± standard deviation] age, 61.9 ± 11.9 years). The success rate of tigecycline treatment was 93.3% in mild infections, 56.2% in moderate, 57.7% in severe, and 61.9% in all cases. The authors found a 9-fold decrease (P = .046) in the success of tigecycline treatment among those who developed moderate or severe DFIs and a 6.4-fold decrease (P.0001) among those who had arterial stenosis. For 33 (71.7%) of 46 (43.8%) patients who experienced a side effect, tigecycline treatment was continued as it could be tolerated.If tigecycline is to be the treatment choice, extra attention must be paid to patients with arterial stenosis, severe DFIs, and side effects. The common disadvantage is the high side effect rate, especially nausea. However, it is generally not necessary to discontinue the medication in cases with nausea. Therefore, tigecycline may be used as a choice of therapy in mild DFIs.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

INSERM U914 ‘Emerging Resistance to Antibiotics’, Le KremlinBicetre, France; Department of Infectious Diseases and Clinical Microbiology, Ege University Medical Faculty, Izmir, Turkey; Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland; Department of Medical Microbiology, Ege University Medical Faculty, Izmir, Turkey; Intensive Care and Reanimation Unit, Ege University Medical Faculty, Izmir, Turkey

WOS: 000408336600025, PubMed ID: 29156865, Background/aim: Staphylococcus aureus is an important nosocomial pathogen and a successful antimicrobial-resistance developer. In this study we retrospectively evaluated the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related S. aureus strains between 2001 and 2013. Materials and methods: Any patient in whom S. aureus was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72 h after hospital admission) was considered to have MCNB. Results: The methicillin-resistant S. aureus (MRSA) rate in 2001 was 73.8% whereas it was 36.2% in 2013. When the 2001-2003 and 2011-2013 periods were compared, resistance to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin decreased significantly (P < 0.05). When we evaluated the total S. aureus, MRSA, and methicillin-sensitive S. aureus (MSSA) bacteremia rates per 1000 days and 1000 patients, there was an increase in the 2004-2005 period, which was followed by a slight decrease until 2013 (P < 0.05). There was a plateau in MCNB-related S. aureus rates between 2008 and 2011. Conclusion: There was a decrease in overall S. aureus and MRSA bacteremia incidence as well as MRSA rates except for a plateau between 2008 and 2011. This steady decrease in the resistance rates is most probably due to the 2003 budget application and application of antimicrobial stewardship.

WOS: 000395632600004, PubMed ID: 28263502, Background/aim: Healthcare-associated meningitis (HCAM) is a relatively rare entity with significant morbidity and mortality. The aim of this study was to systematically review the Turkish medical literature for acute nosocomial meningitis. Materials and methods: One national (ULAKBIM) and two international (www. scopus. com and www. pubmed. com) databases were searched. In addition, abstracts of four national congresses held between 2004 and 2013 were searched for reports for HCAM meningitis. Results: Data for 899 HCAM meningitis episodes were obtained from 24 reports. In terms of clinical findings, 177 of 216 (81.9%) had fever (> 38 degrees C), 55 of 64 (85.9%) had high CRP levels, 105 of 132 had leukocytosis (> 10,000/mm3), and 241 of 759 had shunt infection. Cerebrospinal fluid culture yielded a pathogen in 689 of 872 nosocomial meningitis episodes. The most common pathogen was Acinetobacter spp. (30.7%), followed by coagulase-negative staphylococci (21.2%) and Staphylococcus aureus (19%). Carbapenem resistance was reported in 18 of 48 (37.5%) Acinetobacter spp. Overall mortality was 160/593 (27%). Pathogen-specific mortality was 55.5% (30/54) for A. baumannii whereas it was 18.9% (7/37) for S. aureus and 2/17 (11,7%) for MRSA. Conclusion: Nosocomial meningitis is still a serious and highly fatal disease. More preventive measures should be sought to further decrease HCAM meningitis and the mortality/morbidity related to it.

Varisella Zoster Virüsü (VZV) havayolu, damlacık ve lezyonlardan direkt temas ile bulaşabilmektedir. Bu yazıda bir aile büyüğündeki zona zoster infeksiyonu sonrası suçiçeği gelişen 45 yaşındaki bir erkek olgu sunulmuştur. Zona zoster infeksiyonu nedeniyle hastaneye yatırılan ve asiklovir tedavisi almakta olan hastanın tedavisinin devam ettiği sırada 45 yaşındaki damadında veziküler döküntüler gelişmiştir. Olgunun serolojik testlerinde Varisella Zoster IgM pozitif olarak sonuçlanmıştır. Zona zosterden suçiçeği bulaşını değerlendiren çeşitli çalışmalar bulunmaktadır. Bu çalışmalarda yaş, aşılanma durumu, lezyonun yeri, lezyonun büyüklüğü gibi faktörlerin bulaş riski açısından anlamlı olmadığı bulunmuştur. Bu nedenle zona zoster sonrası sekonder suçiçeği vakalarının gelişebileceği unutulmamalı ve bulaşı engellemek açısından dikkatli olunmalıdır., Varicella Zoster Virüs (VZV) can be transmitted by air, respiratory droplets and direct contamination through lesions. In this paper, a 45 year old male patient was presented who had diagnosed with chickenpox disease aftera zona zoster infection in a family elder. While a patient was hospitalized and was under acyclovir treatment, vesicular lesions developed in her 45 year-old son-in-law. Serological testing of the casegave positive VZV IgM results. There is some studiese valuate chickenpox transmission from zona zoster. Factors such as age, vaccination status, location of the lesion and, size of the lesion were not found to be significant risk factors during studies conducted for transmission of chickenpox from varicella zoster. There fore, it should be keep in mind tha tchickenpox disease can occur secondary to zona zoster and precautions should be carried out in order to prevent transmission.

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study., Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH., Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was, Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing.

Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years-old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white matter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.