Five-Years Tigecycline Experience an Analysis of Real-Life Data

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy

A Case of Enterobacter cloacae Meningitis Secondary to Urinary Tract Infection

Gram-negatif bakterilere bağlı menenjit, genellikle yenidoğanlarda ve yaşlı hastalarda, prostat biyopsisi, beyin cerrahisi gibi girişimlerden sonra veya kafa travmasından sonra gelişebilmektedir. Bu hastalarda akut bakteriyel menenjitin ateş, baş ağrısı ve meninks iritasyonu gibi tipik bulguları görülmeyebilmektedir ve mortalitesi yüksektir. Bu yazıda üriner sistem infeksiyonuna bağlı bakteriyemiye sekonder geliştiği düşünülen bir Gram-negatif bakteri menenjiti olgusu sunulmuştur. Uygun antibiyotik tedavisine rağmen hasta eksitus olmuştur. Özellikle yaşlı ve komorbid hastalığı olan hastalar antibiyotik tedavisine yanıt vermediğinde ve bilinç bozukluğu geliştiğinde santral sinir sistemi infeksiyonu mutlaka akılda tutulmalıdır.Gram-negative bacterial meningitis can usually be seen in neonates and elderly patients, after head trauma or interventions such as prostate biopsy and brain surgery. Typical findings of acute bacterial meningitis such as fever, headache and meningeal irritation signs may not be observed, and mortality rate is high in these patients. In this report, we present a case of Gramnegative bacterial meningitis secondary to bacteremia probably due to urinary tract infection. The patient died despite appropriate antibiotic therapy. Central nervous system infection should be kept in mind especially when elderly patients with comorbid diseases do not respond to antibiotic treatment and changes in mental status develop

Management of Community Acquired Pneumonia Patients and Evaluation of Adherence to the Guidelines

Introduction: The aim of this study was to investigate the risk factors and clinical findings of hospitalized patients with community-acquired pneumonia and evaluate adherence to the guidelines in the routine follow-up. Materials and Methods: Those patients hospitalized between June 2010 and June 2011 with the diagnosis of community-acquired pneumonia were included. Patient files were investigated. CURB-65 and Pneumonia Severity Index (PSI) scores were calculated. Results: Totally, 70 patients were included. The highest risk factor was smoking (36%), the most frequent symptom was fever (83%) and the most frequent physical finding was fine crackles (59%). Regarding the pulmonary involvement, 76% was unilateral and 94% showed consolidation. CURB-65 scores were as follows: 41 (58.6%) patients < 2 and 29 (41.4%) patients ≥ 2. PSI scores by group were as follows: 7 (10%) patients in group V, 35 (50%) in group IV, 10 (14.3%) in group III, 15 (21.4%) in group II, and 1 (4.3%) in group I. Mean hospitalization duration was six days (1-15 days). Most of the blood cultures (95%) were negative. Legionella antigen, Mycoplasma IgM and Chlamydophila IgM were positive in 3%, 7% and 9%, respectively. The most frequently used antibiotic in the empirical therapy was ceftriaxone-clarithromycin combination therapy (37%), followed by moxifloxacin (26%) and levofloxacin (17%). Conclusion: CURB-65 and PSI scores are not included routinely in the clinical decision for hospitalization criteria. The benefit of the serological tests in the empirical therapy decision is limited. Although the isolation rate of the etiologic agents is low, the empirical treatment and the duration of treatment of pneumonia patients in our clinic generally seem to be adherent to the guidelines

Nosocomial Infection and Mortality in a Neurology-Neurosurgery Intensive Care Unit

Introduction: Increased mortality has been reported among intensive care unit (ICU) patients with nosocomial infection. Few previous studies have evaluated the relationship between nosocomial infection and mortality in neurology-neurosurgery ICU. The aim of this study was to evaluate effect of ICU-acquired infection and other factors on mortality in a neurology-neurosurgery ICU. Patients and Methods: The study was conducted in Ankara Training and Research Hospital, which is 600-bed tertiary level hospital. The patients treated for more than 48 hours in 14-bed neurology-neurosurgery ICU were enrolled to the study during the study period from 15 May 2006 to 1 November 2006. The patients were followed until death or 2 days after discharge by prospective daily surveillance. Risk factors were recorded and analysed for ICU-mortality. Results: Fifty-four ICU-acquired infections occurred in 44 (31%) of 142 patients during 1190 patient days. The overall rate of ICU-acquired infection was 38.3/100 patients and 45.4/1000 patient-days. Seventyseven of 142 patients included to the study has died (54.2%). In logistic regression analysis a low Glasgow coma scale score, being a neurology patient, infection on admission, ICU-acquired infection remained as independent risk factors for ICU-mortality. Conclusion: Investigation of the factors affecting mortality will guide for preventive measures for specific patient group like neurology and neurosurgery

Evaluation of the Surgeons’ Approach to HIV Infection

Introduction: The number of persons diagnosed as HIV positive is increasing rapidly in Turkey. Although the overall prevalence of the disease is still low, the increase of newly diagnosed persons emerges an important concern dealing with the awareness of the clinicians, and especially the surgeons. The aim of the study is to evaluate the approach of surgeons to HIV infection in the hospital. Materials and Methods: A 12-item self-administered anonymous questionnaire about the HIV infection with true and false options was developed. The questionnaire also included the specialty, age, duration of occupation and position of the surgeons. The questions were targeted to learn the knowledge and attitude about transmission route, occupational risk of acquiring HIV infection, prophylaxis for prevention, reluctance for operation and current drug therapy. The questionnaires were voluntarily filled by surgeons in November 2017. The descriptive statistics of the study were calculated as numbers and percentages. Yates’ corrected chi-square and Fisher’s exact tests were used in comparative analysis. Mann-Whitney U test and Spearman correlation test was used for comparison of continuous variables and correlation, respectively. Results: The total number of filled questionnaires was 90. In 90 of them, the demographic fields were filled. Among 90 surgeons, 37% (33/90) were assistant doctors between the ages of 25-31 years, and the duration of occupation was between 1-6 years. The remaining was older than 31 years of age and the duration of occupation as surgeon was 5-40 years. Specialties were urology, orthopedics, plastic surgery, obstetrics and gynecology, ophthalmic surgery, ear-nose-throat surgery, cardiovascular, general surgery, and neurosurgery. The results generally denote that the surgeons are aware of the occupational risk of HIV infection. Current knowledge about transmission risk evaluation, existence of prevention prophylaxis, advance in HIV treatment and prolonged life expectancy were less than expected. Correspondingly, half of the surgeons were reluctant to touch the patients. For each question, there was no statistically important difference between the answers of the surgeons according to position (residency doctor or specialist) (p> 0.05). There was also no statistically important difference between the answers of the surgeons according to age and duration of occupation (p> 0.05). Any significant correlation was not detected when age and duration of occupation were evaluated according to the total number of true answers (p= 0.802, r= -0.028 and p= 0.831, r= 0.023 respectively) Conclusion: The survey revealed the need for a meeting to be held with the surgeons of our hospital regarding the current status of the disease in the near future

Evaluation of Nosocomial Infections in Neurology-Neurosurgery Intensive Care Unit

Introduction: Intensive care unit (ICU)-acquired infections increase morbidity, mortality and treatment cost. In this study, we aim to evaluate epidemiological features of ICU-acquired infections in patients followed in neurology-neurosurgery ICU. Patients and Methods: The study was conducted in Ankara Training and Research Hospital between 1 July 2005 and 31 December 2006. The patients hospitalized in neurology-neurosurgery ICU more than 48 hours were followed prospectively. The data were collected from patients’ cards and forms used by infection control committee for surveillance purposes. Centers for Disease Control and Prevention (CDC) definitions were used for diagnosis of nosocomial infections. Results: In the 18 months period, 1066 patients followed in the neurology-neurosurgery ICU were included in the study. Three hundred and twenty five ICU-acquired infections were detected in 206 (19.3%) patients in 5564 patient days. Infection rate was 30.5 per 100 patients and 58.4 per 1000 patient days. The most frequent site-specific infection was urinary-tract infection (44.3%). This was followed by primary blood stream infection (22.1%) and lower respiratory tract infection (20.6%). Incidence densities of device-associated infections per 1000 device-days were as follows: 26.48 central-line associated blood-stream infections, 18.26 urinary-catheter associated urinary tract infections and 40.14 ventilator-associated pneumonias. Three hundred and fifty seven microorganisms were isolated in 325 ICU-acquired infections. The most frequent microorganisms responsible for ICU-acquired infections were Escherichia coli (16.2%), Acinetobacter spp. (20.4%) and Enterococcus spp. (18.5%). Methicillin resistance rate of Staphylococcus aureus was (20/30) 66.7%. Penicillin resistance rate of Enterococcus spp. was 33.8%. Gram-negative enteric pathogens were found to have extendedspectrum beta-lactamases at a rate of 29%. Conclusion: The distribution of the site-spesific infections, responsible microorganisms and antimicrobial susceptibility may be different for each ICU. Infection control precautions can be planned and appropriate ampiric therapy can be administered according to these data

Evaluation of Epidemiological, Clinical and Laboratory Characteristics of Patients with Spondylodiscitis

Introduction: Spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebrae and is hematogenous in origin in most cases. The aim of this study was to evaluate the epidemiological, clinical and laboratory characteristics of patients with spondylodiscitis followed in the infectious diseases and clinical microbiology clinic. Materials and Methods: Findings of the patients were evaluated retrospectively. Diagnosis of spondylodiscitis was made based on clinical findings, microbiological and serological test results, radiological findings, and histopathological evaluation. Results: Among 22 patients included in the study, 16 were male (72.7%) and 6 were female (27.3%), and their mean age was 54 ± 16.3 years. The most common symptoms were backache, difficulty in walking, leg pain, and sweating (in 100%, 40.9%, 27.3%, and 22.7%, respectively). C-reactive protein (CRP) and sedimentation rate were found high in 63.6% and 77.3% of the patients, respectively. In 8 (36.4%) patients, brucella agglutination test was positive. All the blood cultures were negative. Biopsy culture was performed in seven patients, and Escherichia coli and Bacillus pumilus were isolated in one patient each. In one patient, acido-resistant bacilli (ARB) was found positive in biopsy material, but tuberculosis culture remained negative. Magnetic resonance imaging findings were compatible with spondylodiscitis in all patients, and in two patients, findings appeared to be tuberculosis. Twelve patients (54.5%) were diagnosed as pyogenic spondylodiscitis, 8 (36.4%) as brucellar spondylodiscitis and 2 (9.1%) as tuberculous spondylodiscitis. Conclusion: Spondylodiscitis must be kept in mind in patients with vertebral pain and high CRP and sedimentation rate even in the absence of fever. Most of our patients were pyogenic spondylodiscitis, but brucellar and tuberculous spondylodiscitis patients were diagnosed as well. We suggest that tuberculosis and brucellosis should be remembered among the causes of spondylodiscitis, especially in endemic regions

Determination of Susceptibility Rates of Nosocomial Acinetobacter baumannii Isolates to Sulbactam by E-test Method

Introduction: Bacteria of the genus Acinetobacter play an important role as causative agents of hospital-acquired infections. Multidrugresistant Acinetobacter infections have increasingly been observed worldwide. In parallel with the increasing rate of infections, therapeutic options are becoming limited. Although the susceptibility rates are not exactly known, sulbactam alone or sulbactam with ampicillin play a part in combination therapies against Acinetobacter infections. This study aimed to determine the minimum inhibitory concentrations (MICs) of sulbactam against multidrug-resistant Acinetobacter baumannii strains using the E-test method and to deduce the susceptibility rates based on literature data. Materials and Methods: The study included 100 multidrug-resistant A. baumannii strains isolated from clinical samples obtained from patients hospitalized in intensive care units of the Ministry of Health Ankara Training and Research Hospital between June 15, 2011 and June 15, 2013. Antibiotic susceptibility testing and strain identification were performed using conventional methods and the VITEK 2 (bioMérieux SA, France) system. Resistance to three or more drugs was considered as multidrug resistance. MIC, MIC50, and MIC90 values (µg/mL) of sulbactam against the 100 isolates were determined using the E test method. Since the breakpoint MIC of sulbactam against Acinetobacter had not been established, the susceptibility rates were estimated based on the MIC values reported in the literature (≤ 4 or 8 µg/mL). Results: The MIC values of sulbactam against the Acinetobacter isolates ranged widely (between 1 and 256 µg/mL), and the MIC50 and MIC90 values were determined to be 12 and 96 µg/mL, respectively. When 8 µg/mL was considered as the susceptibility breakpoint, 44% of the isolates were found to be susceptible; however, the rate was only 21% when 4 µg/mL was considered as the breakpoint. Conclusion: Based on its MIC values determined in our study, sulbactam appeared to be a promising agent for the treatment of infections caused by multidrug-resistant A. baumannii isolates. Nonetheless, more studies are needed, especially on its clinical effectiveness