Pnömokokal menenjit tedavisinin tamanlanmasını takiben gelişen akut dissemine ensefalomiyelit: Olgu sunumu ve literatür taraması

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory disease of the central nervous system (CNS) and is commonly seen in children. It has seasonal peaks in winter and spring, consistent with its infectious etiologies, and it rarely occurs as a reaction to vaccination. ADEM is less common in adults and progresses with a more severe clinical course. Cases diagnosed with ADEM by CNS demyelination after streptococcal meningitis have rarely been reported in adult patients. In this report, we present a rare case of a 31-year-old female diagnosed with ADEM following pneumococcal meningitis treatment and treated successfully with low-dose methylprednisolone.Akut dissemine ensefalomiyelit (ADEM), merkezi sinir sistemini etkileyen immün sistem ilişkili enflamatuvar bir hastalık olup sıklıkla çocuklarda görülür. Enfeksiyöz etiyolojiler ile ilişkili olması sebebiyle sonbahar ve kış dönemlerinde mevsimsel pik yapmakta olup nadiren aşılara karşı bir reaksiyon olarak da görülmektedir. Akut dissemine ensefalomiyelit erişkinlerde daha nadir görülmekte ve daha ağır bir klinik tabloya sebep olmaktadır. Erişkin hastalarda nadiren streptokoksik menenjit sonrası merkezi sinir sistemi demiyelinizasyonu ile ADEM tanısı konulan olgular bildirilmiştir. Bu yazıda pnömokokal menenjit tedavisini takiben ADEM tanısı alan ve düşük doz metilprednizolon ile başarılı bir şekilde tedavi edilen 31 yaşında bir kadın olgu sunulmuştur

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 (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >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.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 (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >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

Osteomiyeliti Olmayan Diyabetik Ayak İnfeksiyonlarında Daptomisin Tedavisi: Çok Merkezli Çalışma

Daptomycin in the Treatment of Diabetic Foot Infections without Osteomyelitis; A Multicenter StudyGiriş: Diyabetik ayak infeksiyonları polimikrobiyal infeksiyonlar olmasına karşın, bu olgularda gram-pozitif mikroorganizmalar çoğunluğu oluşturmaktadır. Daptomisin, çoklu ilaca dirençli gram-pozitif patojenler için yeni bir ajandır. Bu çok merkezli çalışmada, daptomisin ile tedavi edilen diyabetik ayak infeksiyonu olan olgular retrospektif olarak değerlendirilmiştir.Materyal ve Metod: Diyabetik ayak infeksiyonu olup osteomiyeliti olmayan ve tedavide daptomisin alan hastalar çalışmaya dahil edildi. Sosyodemografik özellikler, metisiline dirençli Staphylococcus aureus (MRSA) için risk faktörleri ve olguların tedavi verileri standart bir formla kaydedildi. Çalışmaya 11 merkez katıldı. Klinik başarı, tedavi sonu laboratuvar parametreleri ile klinik ve mikrobiyolojik yanıtların bir kombinasyonu olarak tanımlandı.Bulgular: Daptomisin tedavisinin sonunda toplam 46 (30 erkek, 16 kadın) hasta klinik olarak değerlendirildi. Ortalama yaş 61.09 ± 11.82 yıl ve ortalama diyabet süresi 13 ± 8.2 yıl idi. "Infectious Diseases Society of America (IDSA)" infeksiyon skorlamasına göre tanımlanan hafif, orta ve şiddetli infeksiyon sayıları sırasıyla 12 (%26.1), 25 (%54.3) ve 9 (%19.6) idi. Daptomisin tedavisinin süresi 17.5 ± 9.3 gün ve genel daptomisin başarı oranı %82.6 (n= 38) idi. İki hastada yan etki gelişti. Sonuç: Diyabetik ayak infeksiyonlarında daptomisin etkinliğini değerlendiren bu çalışmada klinik başarı ortalama %82.6 olarak bulunmuştur. Daptomisinin, daha önceki antibiyotik tedavisi ile başarısız olan ağır olgularda bile güvenli bir şekilde kullanılabileceğini düşünüyoru

Daptomycin in the Treatment of Diabetic Foot Infections without Osteomyelitis; A Multicenter Study

Giriş: Diyabetik ayak infeksiyonları polimikrobiyal infeksiyonlar olmasına karşın, bu olgularda gram-pozitif mikroorganizmalar çoğunluğu oluşturmaktadır. Daptomisin, çoklu ilaca dirençli gram-pozitif patojenler için yeni bir ajandır. Bu çok merkezli çalışmada, daptomisin ile tedavi edilen diyabetik ayak infeksiyonu olan olgular retrospektif olarak değerlendirilmiştir.Materyal ve Metod: Diyabetik ayak infeksiyonu olup osteomiyeliti olmayan ve tedavide daptomisin alan hastalar çalışmaya dahil edildi. Sosyodemografik özellikler, metisiline dirençli Staphylococcus aureus (MRSA) için risk faktörleri ve olguların tedavi verileri standart bir formla kaydedildi. Çalışmaya 11 merkez katıldı. Klinik başarı, tedavi sonu laboratuvar parametreleri ile klinik ve mikrobiyolojik yanıtların bir kombinasyonu olarak tanımlandı.Bulgular: Daptomisin tedavisinin sonunda toplam 46 (30 erkek, 16 kadın) hasta klinik olarak değerlendirildi. Ortalama yaş 61.09 ± 11.82 yıl ve ortalama diyabet süresi 13 ± 8.2 yıl idi. "Infectious Diseases Society of America (IDSA)" infeksiyon skorlamasına göre tanımlanan hafif, orta ve şiddetli infeksiyon sayıları sırasıyla 12 (%26.1), 25 (%54.3) ve 9 (%19.6) idi. Daptomisin tedavisinin süresi 17.5 ± 9.3 gün ve genel daptomisin başarı oranı %82.6 (n= 38) idi. İki hastada yan etki gelişti. Sonuç: Diyabetik ayak infeksiyonlarında daptomisin etkinliğini değerlendiren bu çalışmada klinik başarı ortalama %82.6 olarak bulunmuştur. Daptomisinin, daha önceki antibiyotik tedavisi ile başarısız olan ağır olgularda bile güvenli bir şekilde kullanılabileceğini düşünüyoruzDaptomycin in the Treatment of Diabetic Foot Infections without Osteomyelitis; A Multicenter Stud

Diagnosis, Treatment and Prevention of Diabetic Foot Wounds and Infections: Turkish Consensus Report

Study Group for Diabetic Foot Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist societies and the Ministry of Health to issue a national consensus report on the diagnosis, treatment and prevention of diabetic foot (DF) wounds and diabetic foot infections (DFIs) in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions as to pathogenesis, microbiology, assessment and grading, treatment, prevention and control of diabetic foot were identified. Upon reviewing related literature and international guidelines, these questions were provided with consensus answers. Several of the answers provided in the report are listed below: [1] Although there are many reasons for the development of DF wounds, the main reason is the combined effect of diabetes-related vascular disease and neuropathy. [2] Aerobic Gram- positive cocci are mostly responsible for superficial DFIs in patients with cellulitis and no history of antibiotic use. [3] Pseudomonas aeruginosa is one of the commonly encountered agents when between the toes of the patient are moist. [4] When the other potential reasons are eliminated, DFIs should be considered in presence of at least two of the classical signs of inflammation including redness, warmth, swelling, tenderness, and pain, or purulent discharge in the foot lesion. [5] Infections are classified into mild, moderate, or severe groups according to some criteria such as the depth and width of the wounds, and the presence of systemic findings of infection. [6] PEDIS system should be preferred as a classification system for its high predictive value in diabetes-related foot complications. [7] Culture samples from the DF wound should only be obtained when infection is clinically considered and, where possible, before starting antibiotic treatment. [8] Inflammatory biomarkers such as leukocyte count, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin may be useful in distinguishing between colonization with infection. [9] Magnetic resonance imaging is a sensitive and specific method in patients unresponsive to treatment when osteomyelitis and deep soft tissue abscesses are considered. [10] The gold standard in the diagnosis of osteomyelitis is histopathological examination. [11] To provide wound healing and to save the limb, removal of dead and infected tissue with urgent and aggressive debridement, appropriate antibiotic therapy, metabolic control, and off-loading of pressure, the diagnosis and proper treatment of peripheral arterial disease, and restoration of the foot function are necessary. [12] A lot of different factors playing a role in etiopathogenesis complicate the approach to be developed in this type of lesions, and therefore it requires a team concept. [13] In the empirical treatment, the objective should be treating only the potential agents. Adequate tissue levels, low side effects and patient compliance must be observed; effective drugs should be used in specified doses and duration. [14] Debridement is an essential and integral part of wound treatment and is an important tool allowing the formation of healthy granulation tissue. [15] When the infected tissue cannot be completely cleared with the debridement and in cases when the patient could not cope with the remaining infection load, performing a limb amputation on a safe level of infection would be lifesaving