A Case of Brucellosis Presenting with Multiple Hypodense Splenic Lesions and Bilateral Pleural Effusions

Brucellosis is a zoonotic infectious disease, which mainly present with lymphoreticular system invovement. However any organ system can be attacked by the microorganism. In this paper we present a 52-year-old female patient who was admitted to the Infectious Diseases Department with complaints of fatigue, arthralgias, fever, and weight loss. In the medical examination and radiological analysis bilateral pleural effusions and hepatosplenomegaly were detected. Serum transaminase levels were two times higher than the upper limits of normal. Abdominal ultrasound revealed sludge in the gallbladder and multiple hypodense splenic lesions (the largest was 1 cm in diameter). Brucella melitensis was isolated from the blood culture of the patient. Rifampicin (600 mg/day) and doxycycline (200 mg/day) therapy was started. Follow-up chest radiography and ultrasonography revealed the absence of pleural effusion. Splenic lesions and hepatosplenomegaly were totally regressed. The patient has been followed for 3 months after 6 week antibiotic regimen without recurrence. Brucellosis was expected to be the cause of all pathological signs

The Turkish Clinical Microbiology and Infectious Diseases Society (KLİMİK) Evidence-Based Guideline for the Diagnosis and Treatment of Brucellosis, 2023

Bruselloz, dünyada ve ülkemizde çok yaygın olarak görülmesine rağmen hastalığın tanı ve tedavisini yönlendirmede kullanılabilecek kanıta dayalı bir rehber bulunmamaktadır. Bu rehber, brusellozun tanı ve tedavisi ile ilgilenen farklı uzmanlık alanlarından hekimlere kanıta dayalı öneriler sunmak üzere Türk Klinik Mikrobiyoloji ve İnfeksiyon Has- talıkları Derneği tarafından hazırlanmıştır. Rehberin hazırlanmasında, ABD İnfeksiyon Hastalıkları Derneği (IDSA)’nin Klinik Uygulama Rehberi Geliştirme Kı- lavuzu önerileri esas alınmıştır. Rehberi hazırlayan grup üyeleri tarafından, bruselloz tanı ve tedavisinde önemli olduğu düşünülen 20 soru belirlenmiş ve PICO [hasta/popülasyon (P), müdahale/indikator (I), karşılaştırma/kontrol (C), sonuç (O)] formatında oluşturulan bu sorulara yanıt verebilecek yayınlar, ULAKBİM TR Dizin, PubMed ve Cochrane veritabanlarından, tarih kısıtlaması olmadan taranmıştır. Her bir PICO sorusu ve her bir ayrı sonlanım için kanıtların derecelendirilmesinde ve önerilerin gücünün belirlenmesinde “Grading of Recommendations, Assessment, Develop- ment and Evaluation (GRADE) Working Group” yöntemi kullanılmıştır. PICO sorularına yanıt oluşturabilecek şekilde karşılaştırmalı klinik araştırmaların olması halinde bunların meta-analizleri, olmaması halindeyse olgu sunumları ve olgu serilerinden elde edilen verilerle “individual participant data” (IPD) meta-analizleri yapılmıştır. Önerilerin yeni çalışmaların sonuçları doğrultusunda belli aralıklarla güncellenmesi planlanmaktadır.Although brucellosis is very common in the world and Türkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of Amer- ica (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommen- dations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Me- ta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies

The Effects of Different Drugs on Slime Production 150

ABSTRACT Objectives: Higher rate of slime production has been found in pathogen bacteria strains. Accordingly, the factors that contribute to higher slime production rate increase the infection risk, while the factors that reduce the slime production rate will reduce the infection risk. The effect of some drugs that are administered through catheters in intensive care units on slime production with coagulase negative Staphylococci was investigated. Materials and methods: In this study, the effect of four different preparations containing Glyceryl trinitrate (Perlinganit®), Dexmedetomidine (Precedex®), Esmolol (Brevibloc®), and Propofol (Propofol®) on slime production of 24 Staphylococcus epidermidis strains isolated from blood cultures of patients, and reference strain were investigated. Slime production was determined using 'the quantitative microdilution plaque test' described by Christensen. Results: Under controlled medium, eight strains formed slimes, and in the media containing esmolol, glyceryl trinitrate, dexmedetomidine, and propofol slimes were positive for five, 21, 15, and 18 strains, respectively. The rate of slime production in glyceryl trinitrate, dexmedetomidine, and propofol containing media were higher than that of the controls. Conclusions: In the light of the results of this study, it is concluded that the drugs and/or additives increase the rate of slime production. The effects of the preparations administered through catheters on slime production should be investigated, and these effects should be kept in mind during their use. Bulgular: Kontrol kuyucuklarında 8 bakteri slime oluşturdu. Esmolol içeren besi yerinde 5, Glyceryl trinitrate'lı besiyerinde 21, dexmedetomidine olan besiyerinde 15, propofol'lü besiyerinde 18 bakteri slime pozitif bulundu. Glyceryl trinitrate, dexmedetomidine ve propofolün slime pozitifliğini kontrole göre anlamlı ölçüde arttırdığı saptandı. Sonuç: Bu çalışmanın sonuçlarının ışığında; ilaç ve/ veya katkı maddelerinin slime üretimine etkili olabileceği sonucuna varıldı. Kateter yoluyla uygulanan preparatların etkileri araştırılmalı ve kullanımları sırasında bu etkilerinin olabileceği akılda tutulmalıdır. Anahtar kelimeler: Slime üretimi; koagülaz negatif Stafilokok, parenteral ilaç J S Göçmen et al. The Effects of Different Drugs on Slime Productio

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Training in infectious diseases across Europe in 2021 - a survey on training delivery, content and assessment

Objectives: To define the status of infectious diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery and evaluation of postgraduate training in ID in different countries.Methods: Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses.Results: In responses received from 33/35 (94.3%) countries, ID is recognized as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in eight, but it is not recognized in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million inhabitants. Median length of training is 5 years (interquartile range 4.0–6.0 years) with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75.8% (25/33) and assessed by final examinations in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries.Conclusions: There are substantial gaps in modernization of ID training in many countries to match current European training requirements. Joint training with clinical microbiology (CM) and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.peer-reviewe

The Antibiotic Usage Before and After a Nationwide Antibiotic Restriction Policy at a University Hospital

There is a growing concern on wisely use of antimicrobial agents. Some nationwide restrictions on antibiotic usage have been settled via a regulation released by Turkish government in February 2003. We conducted a study to assess the impact of this nationwide antibiotic restriction policy (NARP) at a university hospital. All hospitalized patients were visited on 18th February 2003 (before the regulation) and on 15th September 2003 (after the regulation). For each patient receiving antibiotic treatment, demographic data, diagnosis, results from microbiological specimens, details of antibiotic administration, indication for treatment or prophylaxis, dosage, dose frequency and administration route were recorded on individual forms. The appropriateness of antimicrobial treatments were assessed by two infectious disease specialists and infectious disease proffessors according to the local and international guidelines. On the first prevalence day and on the second prevalence day 20.8% of patients were receiving antimicrobial treatment. Before and after NARP, 36% and 29% of antimicrobial treatments were judged inappropriate, respectively (p= 0.131). There was not any difference between surgical and medical wards. The rate of antibiotic usage without any clinical indication was significantly decreased after NARP (p= 0.03). After NARP, 42% of the empirical treatments was begun after infectious disease consultation, while it was 14% (p< 0.001) before NARP. Fourty-four percent and 36% of antimicrobial regimens used for surgical prophylaxis was inappropriate before and after NARP, respectively (p= 0.39). The daily cost of inappropriate antibiotic usage was 2661 and 2187 dollars in February and September, respectively (p= 0.77). We conclude that, NARP has a good but unsatisfactory impact on antibiotic usage and cost. Other interventions should be implemented for an optimal outcome

Antibiotic overconsumption and resistance in Turkey

WOS: 000468097700002PubMed ID: 30844434The latest report of the OECD Health Policy Studies stated that in2015 the highest rates of antimicrobial resistance (around 35% inTurkey, Korea and Greece) were seven times higher than the lowestrates among its member countries. As the OECD country with thehighest rate of resistance (38.8%), despite a 15-year hospital anti-biotic restriction programme, Turkey is in urgent need of revisingits policies and drawing an effective action plan to reverse thecurrent trend. In this commentary we review previous measurestaken to tackle antimicrobial overuse and resistance in Turkey and discuss their effectiveness