Incidence, risk factors and mortality of nosocomial pneumonia in Intensive Care Units: A prospective study

To determine the frequency, risk factors and mortality of nosocomial pneumonia a prospective study was conducted in the intensive care units. In the study period, 2402 patients were included. The nosocomial pneumonia was defined according to the Centers for Disease Control Criteria. Overall, 163 (6.8%) of the patients developed nosocomial pneumonia and 75.5% (n = 123) of all patients with nosocomial pneumonia were ventilator-associated pneumonia. 163 patients who were admitted to the intensive care unit during the same period but had no bacteriologic or histologic evidence of pneumonia were used as a control group. The APACHE II score, coma, hypoalbuminemia, mechanical ventilation, tracheotomy, presence of nasogastric tube were found as independent risk factors. Crude and attributable mortality were 65% and 52.6%, respectively. The mortality rate was five times greater in the cases (OR: 5.2; CI 95%: 3.2–8.3). The mean length of stay in the intensive care unit and hospital in the cases were longer than controls (p < 0.0001). Patients requiring mechanical ventilation have a high frequency of nosocomial pneumonia

A rare agent of spondylodiscitis in adult patient: Salmonella enteritidis

Salmonella infections are a public health problem in Turkey,as all over the world. Salmonella spp. can causevery different infections such as gastroenteritis, typhoidparatyphoidfever, bacteremia, local metastatic infectionsand chronic carriage. Salmonella spondylodiscitis occursrarely in the adult population. In this case report, we havepresented a 66 years old female patient followed with thediagnosis of rheumatoid arthritis and treated with prednisolone.The patient had a new diagnosis of Salmonellaenteritidis and we aimed to discuss similar cases by theculture of lumbar empyema culture ampiciline, cefotaxime,trimethoprim/sulfamethoxazole, ciprofloxacin was revealedthe presence of resistant S.enteritidis. The patienthas received ciprofloxacin 2x200 mg per day for 3 weeksas intravenous. And patient was discharged with advice ofusing ciprofloxacin as per oral long three months

Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647]

Background: The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis

A Case of Brain Abscess Caused by Nocardia farcinica

Nocardia enfeksiyonları sağlıklı bireylerde nadiren karşımıza çıkmakta olup immün sistemi herhangi bir nedenle baskılanmış kişilerde fırsatçı enfeksiyonlara neden olurlar. Santral sinir sistemi tutulumu genellikle akciğer enfeksiyonuna sekonder gelişir ve en sık serebral apse şeklinde görülür. Özellikle immün sistemi baskılanmış hastalarda görülmesi, apse sayısının birden fazla olması tanının geç konulması ve tedavinin gecikmesi mortalite oranını artırmaktadır. Ayrıca Nocardia türleri arasında antibiyotik duyarlılıkları açısından önemli farklılıklar olduğu için, etken olarak izole edildiklerinde ampirik başlanan antibiyotik tedavisinin duyarlılık paternleri belirlenmeden devam ettirilmesi de tedavi başarısızlıklarına neden olmaktadır. Bu yazıda bir yıldır sistemik lupus eritematozus nedeniyle immünsupresif tedavi alan ve iki ay önce akciğer tüberkülozu nedeniyle antitüberküloz tedavisi alan bir hastada N. farcinica’nın etken olduğu, cerrahi ve uzun süreli ko-trimoksazol tedavisi ile tam iyileşen çok odaklı beyin apsesi olgusu sunulmuştur.Nocardia infections are rarely encountered in healthy individuals causing opportunistic infections in people that for any reason have suppressed immune system. Central nervous system involvement usually develops secondary to lung infection and often appears in the form of cerebral abscess. The fact that it especially appears in immunocompromised patients, have more than one abscess,late diagnosis and delayed treatment increases the mortality rate. Furthermore, there are significant differences in susceptibilities to antibiotics between Nocardia species so, when they are isolated as a factor, maintaining without determining susceptibility patterns of started empirical antibiotic therapy leads to treatment failure. In this article we present a case of multifocal brain abscess.of a patient who takes immunosuppressive treatment from one year because of the systemic lupus erythematosus and two months before started anti-tuberculosis treatment because the pulmonary tuberculosis and is fully recovered by surgery and long-term co-trimoxazole treatment due to N. farcinica

A micro-elimination approach to addressing hepatitis C in Turkey

Background: In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. Methods: Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015–2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. Results: At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10–25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45–70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80–85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. Conclusions: To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs

Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report

This consensus report includes expert opinions and recommendations regarding the screening, and if necessary, the follow-up, prophylaxis, and treatment of hepatitis B before the treatment in patients who will undergo immunosuppressive therapy due to the risk of hepatitis B reactivation emergency. To increase awareness regarding the risk of hepatitis B reactivation in immunosuppressive patients, academicians from several university health research and training centers across Turkey came together and discussed the importance of the subject, current status, and issues in accordance with the current literature data and presented solutions

Sepsis and Meningitis due to Listeria Monocytogenes

Purpose: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. Patients and Methods: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. Results: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. Conclusion: Listeriosis as an uncommon infection in our region and that immunesuppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-bome illnesses