Impact of antimicrobial drug restrictions on doctors' behaviors

Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics.Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician.Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had 5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05).Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did

FLORA INFEKSIYON HASTALIKLARI VE KLINIK MIKROBIYOLOJI DERGISI

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

Evaluation of patients with zygomycosis

Aim: Zygomycosis is a severe angioinvasive infection caused by Zygomycetes. We retrospectively investigated 16 cases of zygomycosis.Materials and methods: The data of patients, who had been followed between 2004 and 2010 in 8 tertiary-care teaching hospitals, were reviewed. Demographic characteristics, underlying diseases, and clinical signs and symptoms of the patients, as well as diagnostic methods, data obtained by radiological imaging methods, and the therapies, were recorded. Therapeutic approaches, antifungal agents and duration of use, and the characteristics of the cases were identified.Results: The study included 11 female and 5 male subjects. The most common symptoms and clinical signs were fever (n = 9) and retro-orbital pain (n = 7). Rhinocerebral zygomycosis was the most common form. The mean time elapsed for diagnosis was 14.26 +/- 13.96 (range: 2-52) days. Antifungal therapy was given to 15 patients (94%). In addition to antifungal therapy, 12 patients underwent surgical intervention 1 to 4 times. The mean duration of receiving antifungal therapy was 61.4 +/- 58.02 (range: 1-180) days. The median duration of treatment was 62.5 (range: 42-180) days in survivors.Conclusion: Zygomycosis is an infectious disease with high mortality despite antifungal therapy and surgical interventions

Multicenter Analysis of Anidulafungin Use in Invasive Candida Infections

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.C1 [Isikgoz Tasbakan, Meltem; Pullukcu, Husnu; Mermut, Gulsen] Univ Ege, Fac Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.[Eren Kutsoylu, Oya; Alp Cavus, Sema; Avkan Oguz, Vildan; Yapar, Nur] Univ Dokuz Eylul, Fac Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.[Sayin Kutlu, Selda; Kutlu, Murat] Univ Pamukkale, Fac Med, Dept Infect Dis & Clin Microbiol, Denizli, Turkey.[Ozturk, Barcin; Ertugrul, Mustafa Bulent] Adnan Menderes Univ, Fac Med, Dept Infect Dis & Clin Microbiol, Aydin, Turkey.[Kaya, Onur] Univ Suleyman Demirel, Fac Med, Dept Infect Dis & Clin Microbiol, Isparta, Turkey.[Turhan, Ozge] Univ Akdeniz, Fac Med, Dept Infect Dis & Clin Microbiol, Antalya, Turkey.[Senol Akat, Sebnem; Cetin, Cigdem Banu] Univ Celal Bayar, Fac Med, Dept Infect Dis & Clin Microbiol, Manisa, Turkey.[Metin, Dilek Yesim] Univ Ege, Fac Med, Dept Med Microbiol, Izmir, Turkey.[Ozhak, Betil] Univ Akdeniz, Fac Med, Dept Med Microbiol, Antalya, Turkey.[Ergin, Cagri] Univ Pamukkale, Fac Med, Dept Med Microbiol, Denizli, Turkey