A comparison of the efficacy of piperacillin-tazobactam and cefoperazone-sulbactam therapies in the empirical treatment of patients with febrile neutropenia

WOS: 000385278200002PubMed: 26888338Introduction. Empirical antibiotic therapy in neutropenic patients presenting with fever plays a significant role in reducing mortality related to infection. Empirical therapies with broad-spectrum intravenous bactericidal, anti-pseudomonal antibiotics are accepted treatments for febrile neutropenic patients. The aim of this study was to compare the efficacy of piperacillin-tazobactam (PIP-TAZO) and cefoperozone-sulbactam (CS) therapies in adult patients with haematological malignancies presenting with neutropenic fever in a prospective study design. Methodology. Patients with haematological malignancies (leukaemia, lymphoma, multiple myeloma, and myelodysplastic syndrome) were recruited from June 2010-May 2013. Participants were over 18 years old, with an absolute neutrophil count (ANC) of less than 500/mm(3) following chemotherapy or expected to have an ANC less than 500/mm3 in the first 48 h post-chemotherapy, and with an oral body temperature >= 38.3 degrees C at a single measurement or 38.0 degrees C after 1-h monitoring. Patients were randomised to the two treatment groups. The initial empirical therapy comprised PIP-TAZO (4.5 g/6 h/day, IV) and CS (2 g/8 h/day, IV). Results. The overall success rate was 61% with CS and 49% with PIP-TAZO (p = 0.247). Factors affecting the treatment success included a neutrophil count < 100/mm(3), being in the relapse/refractory stage of malignancy, and the presence of a microbiologically documented infection (p < 0.05). Conclusion. PIP-TAZO and CS monotherapies are equally effective and safe for the empirical treatment of febrile neutropenic patients

HBsAg, Anti-HBs and Anti-HCV Seropositivity Rates among Pregnant Women Attending a University Hospital in Zonguldak

Objective: To explore the HBV and HCV seroprevalence rates among pregnant women attending the Obstetric Outpatient Unit at the Medical Faculty of Zonguldak Bulent Ecevit University and to provide contributory data to the already existing data from the other geographical regions of Turkey. Materials and Methods: HBsAg, anti-HBs and anti-HCV seropositivity rates were retrospectively investigated among a total of 1084 pregnant women attending the Obstetric Outpatient Unit at the Medical Faculty of Zonguldak Bulent Ecevit University between January 2012 and January 2014 Serum assays were performed using a chemiluminescence immunoassay method according the manufacturer's instructions (Cobas e 411 Analyzer, Roche Diagnostics, Mannheim, Germany). Statistical analyses of the study data were performed using SPSS 18.0 software package (SPSS Inc., Chicago IL, USA). Results: The mean age of the 1084 pregnant participants was 29.12 +/- 5.48 years (min: 17, max: 46 y) and the average gestational age was 10.7 +/- 4.64 weeks. HBsAg, anti-HBs, and anti-HCV detection rates were 4% (n= 43), 7.3% (n= 79), and 0.6% (n= 7), respectively. With regard to age groups, HBsAg was positive in 3.1%, 3.7%, 4.4%, and 5.9% of the women who were below 20 years of age, between 21 and 30 years of age, between 31 and 40 years of age, and over 40 years of age, respectively. Conclusion: While similar rates of seroprevalence for HBsAg and anti-HCV were found as compared to the previous reports from Turkey, anti-HBs positivity rates were lower than that in most of the previous reports

Nicolau Syndrome due to diclofenac injection

WOS: 000384950300020PubMed: 2734832

Contribution to Determination of Hepatitis C Virus Genotypes in Black Sea Region: Data from Single High Volume Center in Zonguldak, Turkey

WOS: 000341223900019PubMed: 25052121We've read with great interest the article entitled "Determination of hepatitis C virus genotypes among hepatitis C patients in Eastern Black Sea Region, Turkey" by Buruk et al. published in Mikrobiyol Bul 2013; 47(4): 650-7. In that study, the authors described the determination and distribution of hepatitis C virus (HCV) genotypes in Eastern Black Sea Region comprehensively. According to the current information, the determination of HCV genotypes is the most important factor for the management of therapy and virus-related complications, such as chirrhosis and hepatocellular carcinoma. The distribution of HCV genotypes varies geographically throughout the world. Therefore every country and even each region within the country should know the distribution of HCV genotypes to determine the appropriate treatment strategy. Herein we would like to contribute the data about distribution of HCV genotypes in whole Black Sea Region by presenting our current results obtained from Zonguldak province, where maximum number of chronic hepatit C patients have already been identified in Eastern Black Sea Region. A total of 53 chronic hepatitis C patients (26 female, 27 male; mean age: 57.1 +/- 14.3, age range: 21-82 years) who were admitted to Zonguldak Ataturk State Hospital between January 2012-December 2013 were evaluated. Genotype analysis was performed by RealTime HCV Genotype II (Abbott Molecular, ABD) system. Genotype-1 was found to be the most frequently detected type with a rate of 96.2% (51/53). The prevalences of genotype-2 (1/53) and genotype-4 (1/53) were same, with a rate of 1.9%, in our study. Subtyping of genotype-1 strains yielded 52.9% (27/51) genotype-1b, 3.9% genotype-1a (2/51) and 47% untypeable genotype-1 (24/51). The present study was the second study from the Western Black Sea Region in our country, regarding HCV genotypes. In conclusion, considering entire Black Sea Region, genotype-1 is the most common genotype (96.2%), and 1b (52.9%) is the most common subtype, in parallel to the data reported from the other regions of Turkey

Plasmodium falciparum Malaria of Foreign-Origin in Kocaeli Province: Assessment of 16 Cases

WOS: 000389267200008Objective: This paper intends to underline that malaria should be borne in mind in the differential diagnosis of patients with history of visiting endemic regions and of malaria prophylaxis for those intending to travel to these regions. Methods: 16 cases of P. falciparum malaria that were followed in the clinic between 2009 and 2015 were included in our study. Diagnosis was based on plasmodia seen under light microscope in thick and thin smears prepared from peripheral blood samples obtained from febrile patients and stained with Giemsa method. Results: Out of 16 patients, one was female and 15 were males. 14 of these patients, whose average age was 32 years, did not receive prophylaxis. Complaints of all patients were fever with chills, rigor, weakness, and anorexia; other accompanying complaints were headache, nausea, abdominal pain, diarrhea, cough and sore throat. Body temperatures over 38 degrees C were detected in all patients. 11 patients were treated with artemether-lumefantrin and 5 patients treated with combination of quinine and doxycycline. Ertapenem was added in the treatment of a patient due to Serratia marcescens isolation in his blood culture obtained during his febrile period. Acute hepatitis A as a co-infection was detected in a patient and he was followed with symptomatic treatment. Somnolence, bleeding, bilateral pleural effusion and pulmonary infiltrates were observed in two patients diagnosed as severe malaria. Conclusions: Malaria chemoprophylaxis for the people intending to travel endemic regions is crucial

Management of Chronic Hepatitis B Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases convened a meeting to develop a consensus report on management of chronic hepatitis B virus (HBV) infection, a global public health problem, affecting more than 400 million people worldwide. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented at the end of each section such as epidemiology and natural history of HBV infection, economic burden of chronic hepatitis B (CHB), diagnosis of acute hepatitis B (AHB) and CHB, differentiation of AHB from acute exacerbation of CHB, treatment of CHB, evaluation of response to treatment and longterm outcomes in HBeAg-positive and negative patients, antiviral resistance and its follow-up, and prevention of HBV infection. Examples of some selected recommendations are as follows: [1] The selection of a highly potent drug such as entecavir or tenofovir with a high genetic barrier to resistance as a first line therapy provides the best approach of achieving the goals of long-term treatment. [2] Antiviral drugs with a low genetic barrier to resistance such as lamivudine or telbivudine should not be among the first choices. [3] Pegylated interferon a should be used in selected patient groups. [4] Analysis of HBV drug resistance gene mutation should be a part of managing clinical treatment

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study

Objective: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study

OBJECTIVE: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. MATERIALS AND METHODS: A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the “Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013” guideline. RESULTS: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. CONCLUSION: Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP

Protease Inhibitors Drug Resistance Mutations in Turkish Patients with Chronic Hepatitis C

Background: Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. Materials and methods: 178 antiviral-naïve patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. Results: In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. Conclusion: We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment