Investigation of influenza and respiratory viruses in hospitalised patients with influenza-like illness in an emergency room

Introduction: Influenza-like illness (ILI) surveillance is usually performed using outpatient data, and information on the surveillance of patients hospitalised for ILI, which is critical for the complete assessment of the influenza burden, is lacking. Methodology: In this prospective active surveillance study, patients with community-acquired ILI hospitalised for at least 24 hours in the Emergency Room (ER) of Gazi University Hospital were identified according to the ICD-10 codes at hospital admission through active surveillance of the 2013-2014 and 2014-2015 influenza seasons. The presence of influenza and other respiratory viruses was analysed in the nasopharyngeal or pharyngeal specimens by real-time polymerase chain reaction. Results: 351 patients admitted to emergency room with certain ICD-10 codes were assessed, and 111 patients with ILI were included in the study. We detected 15 influenza and 23 other respiratory viruses in 33 of the 111 patients. More than one virus was detected in 5 patients. No virus was detected in a majority of the patients with ILI. The sensitivity of hospital admission/discharge ICD-10 codes used in the study to detect real influenza cases was low. Patients with influenza were admitted to the hospital more frequently with high fever symptoms compared with patients with influenza virus-negative and other respiratory virus-positive (p < 0.05). Conclusions: This study revealed that non-influenza respiratory viruses were a major contributor to ILI. Patients admitted with fever during the influenza seasons should be evaluated for influenza virus infection, and the use of diagnostic codes in surveillance studies can lead to incorrect results

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

WOS: 000373481300007PubMed: 27026760Objective: 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

Catheter-associated urinary tract infections in intensive care units at a university hospital in Turkey

In this study, urinary catheter utilization rates, the causative agents for catheter-associated urinary tract infection (CAUTI) and their antimicrobial susceptibilities in intensive care units (ICUs) in 2009 were investigated at Gazi university hospital. We aimed to determine the causative agents and risk factors for CAUTIs, and antimicrobial susceptibilities of the pathogens; and also sensitivities of Candida spp. to antifungal agents with Microdilution and E-test. The most common etiological agents of CAUTIs were Candida spp. (34.7%). The most frequently isolated Candida spp. was C.albicans  (52.4%). All C. albicans spp. were sensitive to fluconazole. Microdilution, used as a reference method to determine the sensitivity to antifungal agents, was compared with E test. E test was found to be sufficient to analyze sensitivity to amphotericin B, caspofungin, fluconazole and voriconazole, but inappropriate for itraconazole. E.coli and Klebsiella spp. were found to be causative agents for CAUTI in 20.6% and 9.9% of cases respectively. Pseudomonas spp. and Acinetobacter spp.  were isolated in 14% and 8.2% of the cases, respectively. All E.coli and Klebsiella strains were found sensitive to carbapenems. Carbapenem sensitivity was found in 47.1% and 30% of the cases infected with Pseudomonas and  Acinetobacter  strains, respectively. According to our results, fluconazole therapy seems to be an appropriate choice for the treatment of CAUTIs caused by  C.albicans. Third and fourth generation cephalosporins should not be used for empirical treatment because of the high prevalence of extended spectrum beta-lactamase production among E.coli and Klebsiella isolates.

Molecular investigation of a fungemia outbreak due to Candida parapsilosis in an intensive care unit

We investigated a nosocomial cluster of four Candida parapsilosis fungemia episodes that occurred in a neurological intensive care unit over a two-week period. The four infected patients had received parenteral nutrition through central lines, and all four had catheter-related candidemia. All of the isolates were susceptible to all of the antifungals tested, including amphotericin B, fluconazole, voriconazole, and caspofungin. They had strictly related fingerprints, based on randomly amplified polymorphic DNA analysis. Additional DNA sequencing data revealed that they were same strain. Although no isolate of Candida parapsilosis was recovered from other clinical, surveillance, or environmental samples, nosocomial spread of this yeast ceased, following the reinforcement of infection-control measures. Candida parapsilosis may require an intravascular foreign body to cause fungemia, but this outbreak shows that it can be transmitted nosocomially and can cause epidemics

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

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes