Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis

The objective of this study was to describe factors associated with bloodstream infections (BSIs) with non-albicans Candida species (NAC), compared with Candida albicans BSIs, and antifungal susceptibility patterns in adult intensive care unit (ICU) patients with chronic renal failure undergoing hemodialysis. To the best of our knowledge, this is the first study to report the potential factors for NAC candidemia in ICU patients with end-stage renal disease on chronic hemodialysis. Methods: This prospective, observational, multicenter study was conducted in the two centers of Baskent University between January 2007 and July 2010. All adult patients excluding patients with neutropenia, malignancy, glucocorticoid treatment or AIDS, were included. Results: Sixty cases (58.8%) of candidemia were due to C. albicans and 42 (41.2%) to NAC. Multivariate regression analysis revealed that the presence of a central venous catheter was the only risk factor independently associated with BSI due to NAC (p=0.046, odds ratio: 5.90, 95% confidence interval: 1.032–33.717). Mortality was more frequent in those with NAC than C. albicans BSIs (64.3% vs. 55%), but the difference was not significant (p=0.067). Except for two Candida glabrata strains, which were dose–dependently fluconazole susceptible, all Candida species were susceptible to fluconazole, caspofungin, voriconazole and amphotericin B. Conclusion: Central venous catheterization was the only factor significantly associated with BSI due to NAC in ICU patients with end-stage renal disease

Noninvasive Models to Predict Liver Fibrosis in Patients with Chronic Hepatitis B: A Study from Turkey

WOS: 000429311600004Background: Manynoninvasive methods, including aspartateaminotransaminase (AST)/alanineaminotransaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, thesemethodsare developed for patients with chronic hepatitisC(CHC) andproduce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 +/- 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was >= 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvave models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future

Management of Chronic Hepatitis C 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 C virus (HCV) infection, a global public health problem, affecting nearly 170 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 HCV infection, economic burden of chronic hepatitis C (CHC), diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals, endpoints, stopping rules and pre-therapeutic assessment of CHC therapy, indications for treatment, treatment of CHC, monitoring and managing treatment safety and side effects, measures to improve treatment adherence, posttreatment follow-up of patients who achieve a sustained virological response, contraindications to therapy, retreatment of non-sustained virological responders, follow-up of untreated patients and of patients with treatment failure, and prevention of HCV infection. Examples of some selected recommendations are as follows: [1] It should be kept in mind that approximately 75-85% of people who become infected will develop chronic HCV infection, up to 20% of them develop cirrhosis within 20 years, and the average annual risk of hepatocellular carcinoma among them is 1-4%. [2] In addition to the HCV RNA quantification, the HCV genotype should be assessed to provide relevant information with respect to treatment duration and different response rates prior to treatment initiation. [3] If predicted response rate is not appropriate to any of the existing regimens, the patient should be kept waited until alternative therapeutic options become available