The distribution of hepatitis c virus genotypes in patients with chronic hepatitis c ınfection

Amaç: Hepatit C virüsü (HCV), kronik hepatit, siroz ve hepatosellüler karsinoma yol açarak dünya çapında önemli bir sağlık sorunu olmaktadır. Dizi analizi çalışmaları ile HCV’nin 7 genotipi ve 100’den fazla alt tipi olduğu ortaya konmuştur. HCV genotip 1’in genotip 2 ve 3’e göre daha ciddi hastalık yaptığı ve tedaviye kalıcı yanıtın daha az olduğu bilinmektedir. Bu çalışmada, kronik hepatit C hastalarında genotip dağılımının belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, Ağustos 2007-Aralık 2010 tarihleri arasında Adnan Menderes Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı Laboratuvarında, anti-HCV ve HCV-RNA pozitif olarak saptanan toplam 50 kronik hepatit C’li hasta dahil edildi. Hasta örneklerinde anti-HCV ticari mikropartikül Enzyme-Linked immunosorbent assay test kiti ile (Murex anti-HCV, UK), otomatize sistemde (Grifols Triturus, İspanya) araştırıldı. HCV-RNA düzeyleri, real-time polimeraz zincir reaksiyonu yöntemi ile iki ayrı sistem (Rotor-Gene 6000, Corbett Research, Amerika ve Cobas Tagman, Roche Diagnostic, Amerika) kullanılarak çalışıldı. HCV genotip tayini, virüs genomundaki 5’UTR bölgesinin amplifikasyon ürünlerinin ters hibridizasyonu temeline dayanan ticari HCV-TS test kiti (AB analytica, İtalya) ile yapıldı. Bulgular: Çalışmaya alınan toplam 50 hastanın 27’si (%54) kadın, 23’ü (%46) erkek olup yaş ortalaması 59,92±13,02’dir. Hastalarda HCV genotipleri, 36’sında (%72) genotip 1b, dokuzunda (%18) genotip 1a, birinde (%2) genotip 2b, birinde (%2) genotip 3 ve üç (%6) hastada ise genotip 1a ve 1b olarak belirlenmiştir. HCV genotipleri arasında HCV-RNA düzeyleri ve anti-HCV indeks değerleri bakımından istatistiksel olarak anlamlı bir fark saptanmamıştır (p>0,05). Sonuç: Hastanemizde izlenen kronik HCV olgularında genotip 1b, ülkemizdeki önceki veriler ile uyumlu olarak en yüksek oranda saptanmıştır.Objective: Hepatitis C virus (HCV) infection represents a major public health problem worldwide. HCV can cause chronic hepatitis infection which may ultimately result in cirrhosis and hepatocellular carcinoma. Seven major genotypes and more than 100 subtypes of HCV are shown by sequence analysis. Genotype 1 is associated with more severity of liver disease than genotypes 2 and 3 and sustained response to treatment is known to be less. In this study, we aimed to determine the HCV genotype distribution in chronic hepatitis C patients. Materials and Methods: A total of 50 patients with chronic HCV infection who attended the Microbiology Laboratory at Adnan Menderes University Hospital between August 2007 and December 2010 found to be positive for anti-HCV and HCV-RNA were included in the study. Anti-HCV testing was performed using microparticle Enzyme-Linked immunosorbent assay test kit (Murex Anti-HCV version 4, UK) with autoanalyser (Grifols Triturus, Spain). The quantification of serum HCV-RNA was carried out by a realtime polymerase chain reaction method with two different systems (Cobas TaqMan HCV, Roche Diagnostics, Germany and Rotor- Gene 6000,Corbett Research, USA). HCV genotype analysis was performed by using a kit (HCV-TS; AB Analitica, Italy ) based on the reverse hybridization of 5’-untranslated region and amplified products with genotype-specific probes. Results: The mean age of the 50 chronic hepatitis C patients [27 (54%) female, and 23 (46%) male] was 57.1±14.3 years. Genotype 1b was found in 36 (72%) subjects, genotype 1a in nine (18%), genotype 2b in one (2%), genotype 3 in one (2%), and genotype 1a/1b was found in three (6%) patients. No statistically significant difference was detected in HCV-RNA quantities and anti-HCV index between HCV genotypes (p>0.05). Conclusion: Compatible with the previous data obtained in Turkey, genotype 1b was found to be the most common HCV genotype in patients with chronic hepatitis C followed in our hospital

Multicenter Analysis of Anidulafungin Use in Invasive Candida Infections

Giriş: Tüm dünyada fungal infeksiyonlar önemli bir sorun olup değişen hasta profili ile birlikte sıklığı artmıştır. Özellikle kandida halen en sık karşılaşılan fungal etken olup son yıllarda albikans dışı kandidaların önemi artmıştır. Bu çalışmada, invaziv kandida infeksiyonu nedeniyle tedavi edilen hastaların gerçek yaşam verileriyle anidulafunginin etkinliğinin ve yan etkilerinin retrospektif olarak değerlendirilmesi amaçlanmıştır. İkincil amaç hastaların risk faktörlerinin değerlendirilmesidir. Materyal ve Metod: Yedi üniversite hastanesinde 1 Ocak 2012-31 Aralık 2014 tarihleri arasında invaziv fungal infeksiyon tanısı ile 48 saatten daha uzun süre anidulafungin tedavisi alan hastaların verileri retrospektif olarak değerlendirildi. Veriler oluşturulan formlara kaydedildi. Bulgular: Çalışmaya yedi merkezden toplam 257 hasta dahil edilmiştir. Hastaların 144 (%56)’ü erkek, yaş ortalaması 58.6 ± 19.5 yıldı. Hastaların 137 (%53.3)’si dahili bölümlerde [100 (%72.9)’ü yoğun bakım], 120 (%46.7)’si cerrahi bölümlerde [103 (%85.3)’ü yoğun bakım] idi. Hastalarda tanımlanmış risk faktörü olarak son bir ayda antibiyotik kullanımı, üriner kateterizasyon ve santral venöz kateter varlığı saptanmıştır. Santral venöz kateter 210 (%82.7) hastada vardı. Santral venöz kateteri olan hastaların 120 (%57.1)‘sinde kan kültürü pozitifti. Kateteri çekilen 86 hastanın 41 (%47.6)’inin, çekilmeyen 124 hastanın 80 (%64.5)’inin mortalite ile sonuçlandığı görülmüştür. Kan kültüründe üreyen etkenlerin %47.7’si Candida albicans , %23.7’si Candida parapsilosis, %12.2’si Candida tropicalis idi. Anidulafungin tedavisi boyunca bir hastada anafilaksi, bir hastada cilt erüpsiyonu, bir hastada ise trombositopeni yan etkisi görülmüştür. Sonuç: Çalışmamızda kateter kaynaklı kandidemi olgularında kateterin çıkarılmasının gerekliliği vurgulanmaktadır. Ayrıca anidulafunginin etkin ve yan etkilerinin az olduğu izlenmekle birlikte diğer ekinokandinlerle karşılaştırmalı prospektif çalışmalara ihtiyaç duyulmaktadır.Introduction: Fungal infections are vital problems worldwide and their incidence have increased along with changing patient profile. Particularly candida species is still the most commonfungal agent, and the significance of non-albicans candida species have gained importance in recent years. in the present study, it was aimed to evaluate retrospectively the risk factors and distribution of candida species in patients with invasive candida infections, who were treated with anidulafungin. Materials and Methods: in the first three years (1 January 2012 to 31 December 2014) when anidulafungin came out in our country, we retrospectively evaluated the data of the patients with invasive candida infections who were treated by anidulafungin for more than 48 hours in seven university hospitals. Data were recorded to the case report forms. Results: Two hundreds and fifty-seven patients were included into the study. Fifty-six percent of the patients were male and mean age was 58.57 ± 19.5 years. Two hundreds and three patients (79%) were hospitalized in intensive care units, 37 (14.3%) in internal medicine services, and 17 (0.07%) in surgery services. As previously described, we detected antibiotic usage in the last month (%96.9), presence of urinary catheter (90.3%) and presence of central venous catheter (82.1%) as risk factors for invasive candida infections. More than half of the patients (57.1%) with central venous catheter had candidemia. Sixty-six (47.7%) of the blood isolates were Candida albicans, 33 (23.7%) were Candida parapsilosis, 17 (12.2%) were Candida tropicalis and 13 (9.4%) were Candida glabrata. During follow up, 64.5% of 124 patients whose catheters couldn’t be taken off and 47.6% of 86 patients whose catheters could be taken off died. During anidulafungin treatment, one anaphylaxis, one skin eruption and one thrombocytopenia were seen as side effects. Conclusion: in our study, we found that removal of central venous catheter of the patients with candidemia was a positive effect on mortality. We suggest that patients with candidemia, insisting on catheter removal besides antifungal treatment is necessary. We observed that anidulafungin is an effective and safe choice in invasive candida infections

Antifungal Prophylaxis in Solid Organ Transplant Recipients

Solid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed

Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units : a prospective observational cohort study

Objectives To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. Methods The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. Results Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55–78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14–1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58–3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12–3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25–6.95) and not achieving source control (aHR 2.02, 95% CI 1.15–3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06–0.90) and source control (aHR 0.46, 95% CI 0.28–0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17–1.43) and age (aHR 1.05, 95% CI 1.03–1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20–0.87) was associated with survival. Conclusions Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.</p