The detection of invasive pulmonary aspergillosis incidence rate with galactomannan and aspergillus pcr methods in icu patients

Bu çalışmanın amacı; YB'deki hastalarda İPA tanısında bronkoalveolar lavaj (BAL) örneklerinde GM antijeni ve aspergillus PZR yöntemlerinin tanı değerinin ve bu yöntemlerle İPA insidansının belirlenmesidir. Gazi Üniversitesi Tıp Fakültesi Hastanesi göğüs hastalıkları yoğun bakım ünitesinde İMV'de takip edilen ve BAL örneği alınan 18 yaşından büyük 44 hastanın verilerinin ileriye yönelik incelenmesiyle yürütülmüştür. Veriler frekans, yüzde, ortalama ve ortanca (en küçük, en büyük) olarak sunulmuştur. Verilerin karşılaştırılmasında Ki-kare, Kruskal-Wallis ve Mann-Whitney U testleri kullanılmıştır. Tanı değerlerinin belirlenmesi için ROC analizi uygulanmıştır. Farklı BAL GM sınır değerleri, kan GM ve BAL aspergillus PZR yöntemi için duyarlılık, özgüllük, PPD, NPD, +LR, -LR ve DOR hesaplanmıştır. YB'de İMV desteği alan 44 hastada İPA insidansı %11,4'tür. YB yatış ve İMV süresinin uzaması, septik şok tanısı ile takip edilmesi, steroid kümülatif dozunun artması İPA gelişimini arttırmaktadır. Geniş spektrumlu antibiyotik tedavisine yanıt alınamayan mevcut durumun diğer etiyolojik etkenlerle açıklanamadığı pnömoni olgularında İPA düşünülmelidir. İnvaziv pulmoner aspergilloz tanısında BAL GM antijen tayini öncelikle tercih edilmelidir. İnvaziv pulmoner aspergilloz tanısında BAL galaktomannan 0,7 sınır değerinin tanı gücü en yüksektir. Serum GM antijeninin nötropenik olmayan YB olgularında tanısal değeri düşüktür. YB hastalarında aspergillus PZR yönteminin İPA tanısındaki duyarlılığı düşük olup BAL GM antijenine tanısal üstünlüğü yoktur.The aim of the study is to determine the diagnostic value of GM antigene and aspergillus PCR method in BAL and to estimate the incidence rate of IPA with these methods in non-neutropenic ICU patients.This study is conducted prospectively with 44 patients older 18 years-old-age whose BAL has been taken in thoracic ICU of Gazi University Faculty of Medicine. ata is presented as frequency, percentage, mean and median (min, max). Chi-square, Kruskal-Wallis nd Mann-Whitney U tests are used. ROC curve is used to determine the diagnostic values. Sensitivity, specifity, PPV, NPV, +LR, -LR nd DOR are calculated for serum GM, BAL aspergillus PCR and different levels of BAL GM. The incidence rate of IPA is 11,4%. The duration of ICU hospitalization and IMV before BAL, septic shock, total doses of steroid are found to be risk factors of IPA. IPA should be taken into account in patients who are non-responsive to treatment with broad spectrum antibiotics. Detection of BAL GM antigene should be preferred for diagnosis of IPA in non-neutropenic ICU patients. The 0,7 cut-off level for BAL GM has the highest diagnostic value. The diagnostic value of serum GM is low in non-neutropenic ICU patients. Aspergillus PCR has lower diagnostic sensitivity and is not superior to BAL GM antigene in IPA

Public Knowledge, Attitudes and Practices Regarding Antibiotic Use and Resistance in Türkiye: A Cross-Sectional Survey

Introduction: Antimicrobial resistance is common due to inappropriate and overuse of antimicrobial agents. This study aimed to evaluate the knowledge, attitudes, and practices of the public about antibiotic use and resistance in Türkiye. Materials and Methods: In this study, a cross-sectional study design was used for a population-based survey. An online survey was conducted from June to September 2021. Results: 937 people (87.5%) responded to the questionnaire. About half of the respondents answered correctly that amoxicillin was an antibiotic and ibuprofen was not an antibiotic. 31.8% of the respondents considered that antibiotics were effective against viruses. Most of the respondents (88.2%) disagreed with the idea that they would not be happy if the physician did not prescribe antibiotics. 63.7% of the respondents declared that they never stopped using antibiotics when they believed they were cured. Conclusion: The study shows that the participants have a good attitude towards antibiotic use and resistance despite the lack of knowledge and practices

Hyponatremia: More than just an electrolyte for COVID-19 patients

AIM: Hyponatremia is the most common electrolyte disturbance among infections, especially with pneumonia. Here, we aimed to analyze the presence of hyponatremia among COVID-19 patients along with its relation to mortality.MATERIALS and METHODS: Patients were divided into two groups COVID-19 negative and positive and also another group with pneumonia and without pneumonia for covid-19 PCR positive patients. The association between hyponatremia and in-hospital mortality from any cause was evaluated with univariate and multivariate cox regression model.RESULTS: A total of 636 patients, a mean age of 50± 18 years, 48 % of the female with a median duration of hospitalization of 5.5 (IQR, 2,11) days were included. Of those 553 (%87) were detected COVID-19 PCR positive and 298 (47%) of those with pneumonia. The median serum sodium concentration was lower in COVID-19 PCR positive patients [134 (IQR, 130,137) mEq/L] compared to negatives [139 (IQR, 136, 140) mEq/L] (p&lt;0.001). The median serum sodium levels were significantly lower in patients with pneumonia [136 (IQR, 133.138) mEq/L] than without pneumonia [139 (IQR, 137, 145) mEq/L] (p&lt;0.001). All deaths occurred in patients with pneumonia [(n=40 (13.4 %)]. Patients with hyponatremia had increased mortality on unadjusted (OR, 3.85, 95%CI: 1.73, 8.53, P&lt;0.001) and adjusted [OR, 3.58, 95%CI: 1.58, 8.1, P=0.002] in Cox proportional hazard modelsCONCLUSION: Hyponatremia at admission is prevalent and an independent risk factor for in-hospital mortality among COVID-19 patients particularly those with pneumonia. It might be an important laboratory clue for both the diagnosis and survive of these patients.</p

Assessment of Risk Factors, Treatment and Hospital Stay in Complicated Urinary Tract Infections in Men Caused by Pseudomonas: A Case-Control Study

Objective: It is known that Pseudomonas has been isolated more frequently in health care-related urinary tract infections (UTIs). It was aimed to determine the risk factors and empiric therapies due to antibiotic resistance in Pseudomonas-related male UTIs, and assess the effect of Pseudomonas isolation on treatment and length of hospital stay. Materials and Methods: The study was conducted between January 2011 and January 2013 with 228 male health care-related complicated UTI patients hospitalized in the Urology and Infectious Diseases Inpatient Clinics at Gazi University Faculty of Medicine. Three hundred UTI attacks in 228 patients were evaluated retrospectively with regard to agents. Results: Pseudomonas was isolated in 37 of 300 complicated UTI attacks in 228 male patients. Nephrolithiasis, recurrent UTI and internal urinary catheterization were determined as the risk factors for Pseudomonas related with health care-related UTI. It was understood that nephrolithiasis increased Pseudomonas isolated UTI risk 3.5 fold and recurrent UTI increased the risk 8.9 fold. The antibiotic resistance of Pseudomonas was higher than other agents. Pseudomonas related UTIs prolonged the duration of hospital stay and antibiotic treatment. Conclusion: In the presence of nephrolithiasis, recurrent UTI and internal urinary catheterization, drugs against Pseudomonas would be appropriate empiric treatment for health care-related complicated UTI. Ciprofloxacin use should be restricted when local antibiotic resistance, which leads empiric treatment, is taken into consideration. Increases in hospital stay and antibiotic treatment duration were thought to be associated with recurrent infection frequency and high antibiotics resistance in Pseudomonas related UTIs