Rifampicin + ceftriaxone versus vancomycin + ceftriaxone in the treatment of penicillin-and cephalosporin-resistant pneumococcal meningitis in an experimental rabbit model

Abstract This study was planned to compare the efficacy of ceftriaxone + vancomycin with ceftriaxone + rifampicin in a rabbit model of penicillin and cephalosporin-resistant Streptococcus pneumoniae meningitis. Meningitis was induced by intracisternal inoculation of S. pneumoniae. After 18 h of incubation, Group 1 was given saline solution (control group), whilst Groups 2 and 3 were given ceftriaxone + vancomycin and ceftriaxone + rifampicin, respectively. Cerebrospinal fluid bacterial concentrations were measured at 0, 2, 12, 14 and 24 h after therapy was initiated. In the control group, bacterial growth was present at all time points, whereas no growth was observed in either the ceftriaxone + vancomycin group or the ceftriaxone + rifampicin group after 2 h of therapy. Ceftriaxone + rifampicin was found to be as effective as ceftriaxone + vancomycin in the treatment of penicillin-resistant S. pneumoniae meningitis in experimental rabbit model

Pooled analysis of 163 published tuberculous peritonitis cases from Turkey

Background/aim: Tuberculous peritonitis may be difficult to diagnose due to its insidious and variable clinical manifestations as well as characteristics similar to malignancy. In this study, case reports from Turkey over the last 10 years were reviewed systematically using pooled analysis. Materials and methods: Thirty-four suitable articles were found and 163 tuberculous peritonitis cases were included in the study. Results: The mean age was 34.1 years (17–79 years), and 146 (98.6%) of the patients were female and 17 (10.4%) were male. The most common complaints of these patients were abdominal pain (77.4%) and abdominal distention (73.5%). Ascites in the abdomen (75%), fever (42%), abdominal tenderness (33%), and abdominal distention (30.7%) were the most common physical examination findings. The mean adenosine deaminase level was 120.3 IU/L. In the subsets of patients with relevant data, acid-fast bacilli were found in 23.3%, culture was positive in 22.2%, and Mycobacterium tuberculosis polymerase chain reaction was positive in 20%. In abdominal imaging, ascites was reported in 92%. Elevated serum CA-125 was reported in 96.7% of the patients. Of 105 patients with data available following the antituberculous therapy prognosis, four (3.8%) died and the other 101 (96.2%) showed good treatment response. Conclusion: Tuberculous peritonitis should be kept in mind during the differential diagnosis of patients admitted with the triad of ascites, fever, and abdominal distention

Experience of a seasonal influenza epidemic

Amaç: Grip, dünyanın bütün bölgelerinde görülebilen, influenza virüsünün neden olduğu bir akut solunum yolu enfeksiyonudur. İnfluenza ile enfekte olan hastalarda, hastaneye yatışı gerektiren ve ölüme yol açabilen komplikasyonlar gelişebilmektedir. Bu çalışmada 2015-2016 sezonundaki influenza epidemisi sırasında hastaların klinik ve virolojik bulgularının ve ağır hastalık açısından risk faktörlerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: İnfluenza benzeri hastalık tanısıyla, 2015-2016 influenza sezonunda hastanemizde yatırılarak takip edilen 284 hasta retrospektif olarak değerlendirildi. Nazofarengeal sürüntü örnekleri, Halk Sağlığı Laboratuvarında 21 farklı virüs açısından PCR ile test edildi. Bulgular: İnfluenza benzeri hastalık tanısı ile yatırılarak takip edilen 284 hastanın 134'ü (%47.2) erkek, 150'si (%52.8) kadın ve yaş ortalaması 31.4 yıl idi. İnfluenza tanısı 175 (%62) hastada virolojik olarak doğrulandı. İnfluenza virüslerinin 136'sı (%78) H1N1; 30'u (%17) H3N2; dokuzu (%5) ise influenza B virüsü idi. H1N1 saptanan olguların 97'sinde (%71.3); H3N2 saptanan olguların 15'inde (%50); İnfluenza B saptananların dördünde (%44.4) pnömoni ile uyumlu klinik ve/veya radyolojik bulgular mevcuttu. İleri yaştaki (>=65 yaş) hastalarda mortalite istatistiksel olarak anlamlı derecede yüksekti (p=0.007). Sonuç: Birinci basamak sağlık kurumları ile yürütülen sentinel sürveyansın yanında ulusal hastane bazlı sürveyansın yapılıyor olması hem influenza aktivitesinin izlenmesine hem de gerçek hastalık yükünün belirlenmesine katkı sağlayacaktır. Toplanan veriler hastalık kontrol önlemlerinin ve ulusal aşı politikalarının şekillenmesinde önemli rol oynayacaktır.Aim: Influenza is an acute respiratory infection caused by influenza viruses which circulate in all parts of the world. Patients infected with influenza can develop complications that result in hospitalization and death. In this study, it has been aimed to interpret the clinical, virologic findings and risk factors for severe illness of the patients during 20152016 influenza epidemic. Materials and Methods: The hospitalised 284 patients diagnosed with Influenza like illness during 2015-2016 influenza season, were evaluated retrospectively. Nasopharynegeal swab samples were tested for 21 different virus by PCR in Public Health Laboratory. Results: Of the 284 patients hospitalized with the diagnose of Influenza like-illness, 134 (47.2%) were male; 150 (52.8%) were female and the median age was 31.4 years. Clinical influenza diagnose was confirmed virologically in 175 patients. Influenza virus distribution was H1N1 in 136 (78%) patients, H3N2 in 30 patients and Influenza B in 9 (5%) patients. Clinical and/or radiological findings consistent with pneumonia were present in 97 (71.3%) of H1N1 cases, 15 (50%) of H3N2 cases and 4 (44.4%) of Influenza B cases. Mortality was statistically significantly higher in elderly (>=65 years) patients (p=0.007). Conclusion: Beside the sentinel surveillance which is conducted in the first-level health facilities, national hospital based surveillance practices will contribute both to follow-up the influenza activity and to determine the real disease burden. Collected data will play an important role in developing both disease control measures and national vaccination policies

Hydatid Cyst Disease of the Spine: Evaluation of Seven Cases

Introduction: Hydatid cyst is a zoonotic infectious disease, and generally affects the liver and lungs. Spinal involvement is a very rare condition. In this study, we aimed to evaluate patients with spinal hydatid disease. Materials and Methods: Seven patients with spinal hydatid disease treated between 2009 and 2012 were evaluated retrospectively. Demographic characteristics, symptoms and findings, spinal involvement levels, and treatment modalities of the patients were recorded. Results: Four (57%) of the patients were male and 3 (43%) were female. The mean age of the patients was 43 ± 18.2 years. Four (57%) cysts were in the thoracic region, 2 (29%) in the sacral region and 1 (14%) in the lumbar region. Cysts were secondary to spread from other organ systems in four patients due, and were primary in three patients. Conclusion: Hydatid cyst is an infectious disease that may affect various organs. Patients with hydatid cyst in the liver or lung should be checked carefully regarding other system involvement, including the spinal region

Potential Drug–Drug Interactions with Antimicrobials in Hospitalized Patients: A Multicenter Point-Prevalence Study

BACKGROUND: Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug–drug interactions associated with antimicrobials among hospitalized patients. MATERIAL AND METHODS: This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged ³18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex® online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. RESULTS: Potential drug–drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237–3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943–1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035–3.1564) were independent risk factors for developing drug interactions. CONCLUSIONS: Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides

Adana İlinde Kronik Hepatit C’nin Değişen Epidemiyolojisi

Amaç: Bu çalışmada, Adana ilinde zaman içinde ortaya çıkan hepatit C virüsü (HCV) nün epidemiyolojik verileri ve genotip dağılımındaki değişikliklerin gösterilmesi amaçlanmıştır. Gereç ve Yöntemler: Kronik hepatit C tanısıyla, Ocak 1996-Mart 2013 tarihleri arasında takip edilen 369 hastanın verileri retrospektif olarak değerlendirilmiştir. Çalışmada, farklı genotipe sahip hastalar arasındaki cinsiyet, yaş ve bulaş yolu farklılıkları ve yıllara göre bölgemizdeki hastaların yaş ortalaması, cinsiyetleri ve virüs genotiplerindeki değişimler ele alınmıştır. Bulgular: Genotip 1, 289 (%78,3) hastada; genotip 2, 23 (%6,2) hastada; genotip 3, 54 (%14,6) hastada; genotip 4 ise 3 (%0,8) hastada tespit edildi. Yıllara göre genotip dağılımı incelendiğinde; 1996-2008 yılları arasında genotip 2 ve 3’e sahip hastaların oranı %2,7 iken, 2012-2013 yılları arasnda bu oranın %44’e yükseldiği görüldü. Genotip 2 veya 3’e sahip 77 hastanın 69 (%89,6)’sında intravenöz ilaç bağımlılığı vardı. Sonuç: Son yıllarda damar içi ilaç kullanımına bağlı HCV enfeksiyonu bölgemizde artış göstermiştir. Hastaların yaş ortalamasındaki düşüş, erkek cinsiyette daha sık görülür olması ve genotip 2 ve 3 oranlarındaki artış bu nedene bağlanmıştır.Objective: Our study aimed to demonstrate the epidemiological data of hepatitis C virus (HCV) and changes in its genotypic distribution which was observed in Adana in time. Materials and Methods: The data from 369 patients who were on follow up with the diagnosis of chronic hepatitis C between January 1996 and March 2013, were reviewed retrospectively. The differences between the gender, age, and routes of transmission among the HCV patients with different genotypes were reviewed. Changes in the mean age, gender, and virus genotypes of the patients in our region by the years were evaluated. Results: Genotype 1 was identified in 289 (78.3%) patients, genotype 2 in 23 (6.2%) patients, genotype 3 in 54 (14.6%) patients and genotype 4 was identified in 3 (0.8%) patients. When the genotypic distribution over the years was assessed, the rate of the patients with genotype 2 or 3 was 2.7% between 1996 and 2008, this rate was observed to increase to 44% between 2012 and 2013. Sixty nine out of 77 (89.6%) patients with genotype 2 or 3 were intravenous drug addicts. Conclusion: In our region intravenous drug use-related HCV infection was increased in recent years. Decrease in the mean age of the patients, higher probability of occurrence among males and increased rates of genotype 2 and 3 were associated with this reason

Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study

Abstract Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p  0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci

The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

Abstract This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity