Five-Years Tigecycline Experience an Analysis of Real-Life Data

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy

Serum TNF-alpha and IL-4 levels in Crimean-Congo Hemorrhagic Fever 134

ABSTRACT Objectives: Crimean-Congo hemorrhagic fever (CCHF) is a tick borne zoonotic infection. Up till now knowledge about pathogenesis of the disease is limited. Cytokine response is quite important during this infection. The aim of this study was to determine the serum tumor necrosis factor-alpha (TNF-α) and the interleukin-4 (IL-4) levels in patients with CCHF and compare with those of healthy controls. Materials and methods: Forty-two adult CCHF patients and 40 healthy subjects were included in this study. The diagnosis of CCHF was based upon anti-CCHF virus IgM positivity (ELISA method), and/or positivity in real time-polymerase chain reaction (RT-PCR) in acute phase serum samples. Serum TNF-α and IL-4 levels were determined by ELISA method. Results: In patients with CCHF the mean serum TNF-α level was significantly higher than the control group (15.01 vs. 7.69 pg/ml; p<0.05) and also the mean serum IL-4 levels were significantly higher than the control group (1.07 vs. 0 pg/ ml; p<0.05). Conclusion: The levels of serum TNF-α and IL-4 in CCHF patients were found higher than healthy controls. These cytokines might play an important role in the pathogenesis of CCHF. Bulgular: KKKA'lı hastalarda ortalama serum TNF-α seviyesi kontrollere göre istatistiksel olarak anlamlı şekilde daha yüksek bulundu (15,01'e karşılık 7,69 pg/ml; p<0,05). Ortalama serum IL-4 düzeyleri de hasta gurubunda kontrollere göre anlamlı oranda yüksek (1,07'ye karşılık 0 pg/ml; p<0,05) idi. Sonuç: KKKA'lı hastalarda serum TNF-α ve IL-4 düzeylerinin yüksek olması bu sitokinlerin hastalık patogenezinde önem-li rol oynayabileceğini göstermektedir

Astım'lı Hastalarda Serum Aktif Oksidasyon Protein Ürünleri (AOPP Düzeyleri)

Aim: This study aims to compare the levels of serum activated oxidation protein products (AOPP) between patients with asthma and healthy controls and to investigate a possible relationship between AOPP levels and disease duration and laboratory results. Material and Method: Total of 54 subjects including 34 asthma patients and 20 healthy controls who were admitted to Kırıkkale Yüksek Ihtisas Hospital Chest Disease Policlinic and Yenimahalle State Hospital Chest Disease Outpa- tient Clinic were included. The levels of serum AOPP were compared between the groups. A statistically significant relationship between AOPP levels and comorbidities (hypertension, diabetes, etc), leukocyte counts, sedimentation rates, C-reactive protein levels, and hemoglobin levels were investigated. Results: There was no statistically significant difference in serum AOPP levels between the patient group and con- trols (75.61 32.22 µM and 73.23 20.87 µM). No statistically significant relationship was observed between serum AOPP levels and duration of asthma, the presence of comorbidities, leukocyte counts, sedimentation rates, C - reac- tive protein, and hemoglobin levels among the patients with asthma and healthy controls. Conclusion: We conclude that further large-scale controlled studies are required to establish the definite role of serum AOPP levels, a novel indicator of oxidative stress, in patients with asthma.Ama

Evaluation of The Seroprevalence of H1N1 IgG Antibodies Between Healthcare Workers and Outpatients

Amaç: Pandemik influenza döneminde sağlık çalışanlarında H1N1 influenza virüsü IgG antikor sıklığının H1N1 döneminde üst solunum yolu semptomları ile müracat eden ve olası pandemik H1N1 enfeksiyonu olan poliklinik hastaları ile karşılaştırılması idi.Gereç ve Yöntemler: Çalışmaya 53 sağlık personeli [ 15 doktor (, 16 hemşire , 22 yardımcı sağlık personeli ile 29 poliklinik hastası olmak üzere influenza A (H1N1) aşısı uygulanmamış 82 kişi dahil edildi. Sağlık çalışanlarında ve poliklinik hastalarında influenzaya yönelik semptomların varlığı sorgulandı. Sağlık personeli ve hasta grubunda H1N1 IgG antikor düzeyleri ELISA yöntemiyle belirlendi. İstatistiksel analizler SPSS programında yapıldı. p<0,05 için sonuçlar istatistiksel olarak anlamlı kabul edildi. Bulgular: Sağlık çalışanlarında ve poliklinik hastalarında H1N1 IgG antikor pozitiflik oranları sırasıyla; %43.3 ve %6.9 idi. H1N1 IgG antikor pozitifliği açısından cinsiyete ve yaş ortalaması açısından anlamlı farklılık saptanmadı ( p değerleri sırasıyla cinsiyet için p: 0.87, yaş ortalaması için p: 0.657) H1N1 IgG antikor pozitifliği açısından sağlık personeli ile poliklinik hastaları arasında istatistiksel olarak anlamlı farklılık vardı ( p< 0.001). Sağlık çalışanlarında H1N1 IgG antikor poizitifliği oranı poliklinik hastalarından daha yüksekti. Sağlık çalışanları kendi arasında karşılaştırıldığında H1N1 IgG antikor pozitifliği açısından farklılık saptandı. Doktorlarda H1N1 IgG antikor pozitifliği oranı, hemşire ve sağlık personelinden daha yüksekti. Sonuç: Sağlık çalışanlarında pandemik influenza döneminde H1N1 ile karşılaşma sıklığı ve antikor pozitifliği oranı, influenza ile uyumlu üst solunum yolu semptomları olan poliklinik hastalarından daha yüksekti. Sağlık çalışanları influenza enfeksiyonu açısından risk grubundadır bu nedenle sağlık çalışanları aşılama konusunda eğitim verilerek teşvik edilmelidir.Aim: The aim of the present study was to compare the seroprevalence of pandemic H1N1 IgG antibodies between health care workers and patients presenting with upper airway symptoms suggestive of H1N1 influenza infection who are admitted to the outpatient clinics during pandemic H1N1 influenza infection.Material and Methods: The present study comprised 82 subjects unvaccinated with influenza A (H1N1) vaccination, including 53 health care workers (33 females, 20 males, 15 doctors; median age: 38 years), 16 nurses (median age: 26.5 years), 22 auxiliary health care workers (median age: 32 years), and 29 outpatients (14 females, 15 males; median age: 38 years). The presence of symptoms suggestive of pandemic influenza infection was questioned in the health care providers and outpatients. Serum H1N1 IgG antibody levels were determined in the health care workers and outpatients using the ELISA method. The statistical analyses were performed using the SPSS software package. ANOVA (analysis of variance) was used to evaluate the significance of difference between the groups, and the Kruskal-Wallis test was used to evaluate the significance of difference in terms of median values. The nominal variables were analyzed using Pearson's chi-square test or Fisher's exact test. A p value of &lt; 0.05 was considered statistically significant. Results: The seroprevalence of H1N1 IgG antibody positivity for health care workers and outpatients were %43.3 and %6.9, respectively. H1N1 IgG antibody seropositivity did not show a significant relation with gender and mean age (p=0.87 and p=0.657, respectively). There was a statistically significant difference between health care workers and outpatients in terms of H1N1 IgG antibody seropositivity (p&lt;0.001). The prevalence of H1N1 IgG antibody seropositivity was significantly higher in health care providers compared to outpatients. The intra-group comparison of health care workers shows a significant difference in terms of H1N1 IgG antibody positivity. The prevalence of H1N1 IgG antibody positivity among the doctors was higher compared to nurses and auxiliary health care workers (p&lt;0.001). Conclusion: Exposure to the H1N1 virus and the prevalence of the H1N1 antibody positivity among health care workers during pandemic influenza infection was higher compared to outpatients presenting with upper airway symptoms suggestive of an influenza infection. Therefore, health care workers who are at risk of acquiring influenza influenza infection encouraged through training about immunization

Acil Servise Başvuran 7423 Olgu Üzerinden Hayvan-İlişkili Yaralanmaların İncelenmesi

Amaç: Hayvan-ilişkili yaralanmalar tüm dünyada olduğu gibi ülkemizde de önemli bir halk sağlığı sorunudur. Bu yaralanmalarda ciddi enfeksiyonlar gibi komplikasyonlar oluşabilmektedir. Çalışmamızda hayvan-ilişkili yaralanmalar nedeni ile acil servise başvuran hastalarda sosyo demografik özellikleri, kuduz riskli temas niteliklerini ve profilaksi yaklaşımlarını, temas sonrası profilaksinin uygunluğunu incelemeyi amaçladık. Yöntem: Bu çalışma 2010-2011 yılları süresince Ankara Eğitim ve Araştırma Hastanesi acil servisine hayvan-ilişkili yaralanma nedeni ile başvuran 7423 hastanın dosya kayıtlarının retrospektif olarak değerlendirilmesiyle yapılmıştır. Çalışmada elde edilen veriler SPSS 11.5 paket programında değerlendirilmiştir. Bulgular: Çalışmaya 7423 hasta alındı. Hastaların %66.4'ü erkek, ortalama yaşları 3118'dir. Hayvan-ilişkili yaralanmaların bahar ve yaz aylarında arttığı, bireylerin %80.8'inin ısırılma yolu ile temasa uğradığı belirlendi. Hastaların %69.8'inde etken köpekler, %27.5'inde kediler, %0.2'sinde ise vahşi hayvanlardı. Hastaların %51.6'sı üst ekstremite, %39.7'si alt ekstremite, %4.6'sı baş ve boyun, %2.4'ü göğüs ve %1.7'si sırt bölgesinden yaralanmıştı. En çok izlenen yaralanma tipi laserasyondu. Hastaların %43.6'sına 211 kuduz aşısı şeması uygulandığı, %7.1'ine 211 kuduz aşısı ve immunglobülin uygulandığı, %12.9'una 5 doz aşı şeması uygulandığı belirlendi. Hastaların %34.4'ünün ise kuduz profilaksisi uygulanmadan 10 gün izleme alındığı tespit edildi. Sonuç: Hayvan-ilişkili yaralanmalara en sık köpekler neden olmaktadır. Mekanizma köpekler için daha çok ısırma, kediler için tırmalamadır. Sıklıkla ekstremite bölgelerinde yaralanmaların oluştuğu, çocukluk yaş grubunda ise baş boyun bölgesindeki yaralanmaların diğer yaşlara göre yüksek olduğu görülmüştür. Hayvanın sahipli ve aşılı olması veya lezyonun mevcu t olup olmamasına göre kuduz profilaksisi uygulamasının değişiklikler gösterdiği belirlenmiştir.Objective: Animal-related injuries are major issues of public health in all over the world and in our country as well. These animal-related injuries may result in serious complications like infections. In our s tudy we aimed to investigate the sociodemographic characteristics, the features of contact related to animal bites or exposure to rabies risk, prophylactic treatment strategies and appropriateness of post-exposure prophylaxis in patients with animal-related injuries. Method: This study was retrospectively designed by collecting data of the patients with animal related and bite wound injuries admitted to the emergency department of Ankara Training and Research Hospital during the years of 2010 and 2011. The data was analysed by using SPSS 11.5 software programme. Results: The study was consisted of 7423 patients. Animal related injuries were mostly seen in male patients (66.4%) and the mean age of the patients was 31±18. These injuries were mostly during spring and summer. In 80.8% of the patients the injuries were due to animal bites. Of the 7423 patients; 69.8% were injured by dogs, 27.5% by cats and 0.2% by wild animals. The location of the bite wounds were in the upper extremities in 51.6%, lower extremit ies in 39.7%, head and neck in 4.6%, chest in 2.4% and back in 1.7% of the patients. Lacerations were the most common type of injury. Of the patients 43.6% received 211 rabies vaccination schedule, 7.1% received 211 rabies vaccination schedule and immunoglobulin, 12.9% received 5 dosage vaccination schedule. Of the patients 34.4% followed up for 10 days without any rabies prophylaxis. Conclusions: According to the results of our study; most of the animal related injuries are caused by dogs. Dogs mostly cause bite injuries whereas cats cause scatch injuries. Wounds are located generally in the extremities. Head and neck injuries are more common in pediatric group compared with other age groups. Rabies prophylaxis application strategies were changed if the dogs were owned or not and according to the existence of the lesion

Growing Oxa-23 Type Strains Among Carbapenem-Resistant Acinetobacter Baumannii And Tigecycline As An Alternate Combination Therapy

Background/aim: The increasing prevalence and global spread of difficult-to-treat carbapenem-resistant Acinetobacter baumannii has become a serious problem. The aim of this study is to investigate the resistance patterns and tigecycline sensitivity of carbapenem-resistant A. baumannii strains. Materials and methods: Acinetobacter strains that were carbapenem-resistant and collected mainly from intensive care units were included into this study. The antibiotic sensitivity/resistance of the strains to other antibiotics and tigecycline were noted. Presence of blaOXA-23, blaOXA-48, blaOXA-58, and NDM-1 was investigated by PCR. Results: In total, 44 carbapenem-resistant A. baumannii strains were detected. In addition, 57% (25/44) showed resistance to netilmicin and 2% (1/43) to tigecycline. All of the strains were susceptible to colistin. blaOXA-58 was found only in one (2%) strain while blaOXA-23 was found in 14 (32%) strains. All strains were negative for blaOXA-48 and NDM-1. Conclusion: blaOXA-23 was the main resistance pattern in carbapenem-resistant A. baumannii strains. blaOXA-58 was present only in one strain and no blaOXA-48 was found. Tigecycline susceptibility is high and it can be a treatment option for a possible combination therapy of carbapenem-resistant A. baumannii, especially for those for whom colistin is contraindicated because of its toxicity.WoSScopu

A Case of Enterobacter cloacae Meningitis Secondary to Urinary Tract Infection

Gram-negatif bakterilere bağlı menenjit, genellikle yenidoğanlarda ve yaşlı hastalarda, prostat biyopsisi, beyin cerrahisi gibi girişimlerden sonra veya kafa travmasından sonra gelişebilmektedir. Bu hastalarda akut bakteriyel menenjitin ateş, baş ağrısı ve meninks iritasyonu gibi tipik bulguları görülmeyebilmektedir ve mortalitesi yüksektir. Bu yazıda üriner sistem infeksiyonuna bağlı bakteriyemiye sekonder geliştiği düşünülen bir Gram-negatif bakteri menenjiti olgusu sunulmuştur. Uygun antibiyotik tedavisine rağmen hasta eksitus olmuştur. Özellikle yaşlı ve komorbid hastalığı olan hastalar antibiyotik tedavisine yanıt vermediğinde ve bilinç bozukluğu geliştiğinde santral sinir sistemi infeksiyonu mutlaka akılda tutulmalıdır.Gram-negative bacterial meningitis can usually be seen in neonates and elderly patients, after head trauma or interventions such as prostate biopsy and brain surgery. Typical findings of acute bacterial meningitis such as fever, headache and meningeal irritation signs may not be observed, and mortality rate is high in these patients. In this report, we present a case of Gramnegative bacterial meningitis secondary to bacteremia probably due to urinary tract infection. The patient died despite appropriate antibiotic therapy. Central nervous system infection should be kept in mind especially when elderly patients with comorbid diseases do not respond to antibiotic treatment and changes in mental status develop

Evaluation of the Surgeons’ Approach to HIV Infection

Introduction: The number of persons diagnosed as HIV positive is increasing rapidly in Turkey. Although the overall prevalence of the disease is still low, the increase of newly diagnosed persons emerges an important concern dealing with the awareness of the clinicians, and especially the surgeons. The aim of the study is to evaluate the approach of surgeons to HIV infection in the hospital. Materials and Methods: A 12-item self-administered anonymous questionnaire about the HIV infection with true and false options was developed. The questionnaire also included the specialty, age, duration of occupation and position of the surgeons. The questions were targeted to learn the knowledge and attitude about transmission route, occupational risk of acquiring HIV infection, prophylaxis for prevention, reluctance for operation and current drug therapy. The questionnaires were voluntarily filled by surgeons in November 2017. The descriptive statistics of the study were calculated as numbers and percentages. Yates’ corrected chi-square and Fisher’s exact tests were used in comparative analysis. Mann-Whitney U test and Spearman correlation test was used for comparison of continuous variables and correlation, respectively. Results: The total number of filled questionnaires was 90. In 90 of them, the demographic fields were filled. Among 90 surgeons, 37% (33/90) were assistant doctors between the ages of 25-31 years, and the duration of occupation was between 1-6 years. The remaining was older than 31 years of age and the duration of occupation as surgeon was 5-40 years. Specialties were urology, orthopedics, plastic surgery, obstetrics and gynecology, ophthalmic surgery, ear-nose-throat surgery, cardiovascular, general surgery, and neurosurgery. The results generally denote that the surgeons are aware of the occupational risk of HIV infection. Current knowledge about transmission risk evaluation, existence of prevention prophylaxis, advance in HIV treatment and prolonged life expectancy were less than expected. Correspondingly, half of the surgeons were reluctant to touch the patients. For each question, there was no statistically important difference between the answers of the surgeons according to position (residency doctor or specialist) (p> 0.05). There was also no statistically important difference between the answers of the surgeons according to age and duration of occupation (p> 0.05). Any significant correlation was not detected when age and duration of occupation were evaluated according to the total number of true answers (p= 0.802, r= -0.028 and p= 0.831, r= 0.023 respectively) Conclusion: The survey revealed the need for a meeting to be held with the surgeons of our hospital regarding the current status of the disease in the near future