Yumuşak Doku Enfeksiyonları

ÖZET Bakteriyel yumuşak doku enfeksiyonları (BYDE) klinikte sık karşılaşılan enfeksiyöz tablolardan biri olup, etiyolojisinde tanımlanmış lokal ve sistemik birçok risk faktörü söz konusudur. Mikrobiyal invazyona karşı birincil koruma sağlayan deri bariyerinin bozulması neticesinde enfeksiyöz süreç başlamaktadır. BYDE, yüzeyel veya derin, komplike veya komplike olmayan ya da nekrotizan veya nekrotizan olmayan enfeksiyonlar olmak üzere farklı başlıklar altında sınıflandırılabilir. Tedavide komorbiditeler, etiyopatogenez, enfeksiyon lokalizasyonu gibi faktörler göz önünde bulundurularak antibiyoterapinin doğru bir şekilde düzenlenmesi oldukça önemlidir. Klinisyenler için ciddi bir sorun olmaya devam eden nekrotizan BYDE’nin tanı ve tedavisinde ise acil cerrahi girişim altın standarttır.ABS TRACT Bacterial soft tissue infections (BSTI) are among the most common infectious conditions encountered in clinical practice, and there are various local and systemic risk factors defined in their aetiology. As a result of the breakdown of the skin barrier, which provides primary protection against microbial invasion, the infectious process begins. BSTI can be classified under different headings as superficial or deep, complicated or uncomplicated, or necrotizing or non-necrotizing infections. It is essential to adjust the appropriate anti biotherapy by considering comorbidities, etiopathogenesis, and infection localization. Urgent operative intervention is the gold standard for diagnosing and treating necrotizing BSTI, which continues to be a significant challenge for clinicians.</p

Risk factors and clinical characteristics of virus Infection after haematopoietic stem cell transplantation

Risk factors and clinical characteristics of virus Infection after haematopoietic stem cell transplantation Gamze Kalın Ünüvar*1, Zeynep Ture Yuce1, Aysegül Ulu Kilic2 1University Of Erciyes Faculty Of Medicine, Kayseri, Turkey, 1University Of Erciyes Faculty Of Medicine, Kayseri, Turkey Background: BK polyomavirus is an important cause of morbidity and mortality in hematological patients after hematopoietic stem cell transplantation (HSCT). It is acquired in childhood and especially becomes latent in urothelial epithelial cells. Reactivation of virus after HSCT can be seen with asymptomatic viruria or hemorrhagic cystitis (HC). The aim of the study was to assess risk factors, clinical characteristics and treatment options of BK virus infection after HSCT. Materials/methods: We retrospectively analyzed information about patients with HSCT and BK virus (BKV) disease between January 2017-August 2019. Data included; underlying hematological disease, transplantation type, associated graft versus host disease (GVHD) and recent use of immunosuppressive agent. Results: In total fifty-eight patients with HSCT were evaluated and BKV disease occurred in 20 (34%). The median age was 40 (range, 20 to 68), 50% were male. The most underlying disease was Acute Myeloid Leukemia (n=11). Five patients had autologous and fifteen patients had allogeneic SCT. The median time to engraftment was 15 days (range, 10 to 20). GVHD was seen eleven patients (40% skin, 15% gastrointestinal GVHD). These patients received systemic glucocorticoid therapy or immunosuppressant agents. The median time elapsed to BK virus disease after HSCT was 60 days (range, 30 to 450). Sixteen patients with BKV disease had high grade (grade 3) HC and four patients had low-grade HC (grade 2). While BK viremia was positive in 17 patients (68%), viruria was positive for all patients. Eight patients (15%) were treated with ciprofloxacin and cidofovir combination, six patients (30%) with cidofovir and three patients (15%) with ciprofloxacin. Three of them (20 patients) was treated by intravesical cidofovir. The complete response to the viruria or viremia was obtained from 11 patients (55%). Conclusions: HC associated with BKV is an emerging clinical problem after HSCT causing prolonged hospitalization and mortality. It can be severe because the treatment options are often ineffective. The main goal of treatment is to reduce the dose of immunosuppressive agents. Close monitoring of BK virus in high-risk patients can be an important method to improve the complication in the early period.</p

Recent Advances in Colorimetric Tests for the Detection of Infectious Diseases and Antimicrobial Resistance

Abstract:Diagnosisofinfection-causingmicroorganismswithsensitive,rapid,selectiveandeconomicaldiagnostictestsiscriticaltostarttherighttreatment.Withthesetests,thespreadofinfectionscan beprevented.Inadditiontothat,thedetectionofantimicrobialresistancealsomakesasignificant contributiontopublichealth.Inrecentyears,differenttypesofdiagnostictestshavebeendevelopedasalternativestotraditionaldiagnostictestsusedinclinics.Inparticular,colorimetrictests, whichminimizetheneedforaninstrument,haveadvantagesowingtotheircosteffectiveness,rapid responseandnaked-eyedetectionandpracticaluse.Inthisreview,weespeciallyfocusedonpH indicatorsandnanomaterial-basedcolorimetrictestsindetectionofinfection-causingmicroorganisms andantimicrobialresistance.</p

Determination of Risk Factors for the Colonization of Vancomycin Resistant Enterecocci in Chronic Hemodialysis Patients

iriş: Hastane ortamında kolonize olan vankomisine dirençli Enterokoklar (VRE) kuru yüzeylerde uzun süre canlı kalabilmeleri nedeniyle sağlık personelinin elleri ve çevreye temas yoluyla kolayca yayılabilir. Çalışmamızda nefroloji kliniğinde takip edilen, kronik hemodiyaliz hastalarında VRE kolonizasyonu gelişmesindeki risk faktörlerinin belirlenmesi amaçlandı.Materyal ve Metod: Bu çalışma hastane İnfeksiyon Kontrol Komitesi sürveyans takip formu ve hastane otomasyon sistemi bilgileri kullanılarak retrospektif olarak yapıldı. Hastaların demografik verileri, komorbiditeleri, immunsüpresyon, antibiyotik kullanım öyküsü ve kullanılan antibiyotikler, VRE kolonizasyonu açısından riskli servislerde yatış öyküsü, servisler arası transfer öyküsü ve VRE kolonizasyonu ya da infeksiyonu olan hasta ile aynı serviste yatış öyküsü varlığı kaydedildi. VRE ile kolonize olan hastalar vaka; aynı dönem içinde takip edilen ve kolonize olmayan hastalar kontrol grubu kabul edildi. Çoklu lojistik regresyon analizinde vaka ve kontrol grubu arasında anlamlı olarak fark bulunan parametreler risk faktörü olarak kabul edildi. Bulgular: Çalışmaya 64 vaka ve 72 kontrol grubu olmak üzere toplam 136 hasta dâhil edildi. Riskli servislerde yatış öyküsü (p= 0.003), servisler arasında transfer öyküsü varlığı (p= 0.001), VRE kolonize ya da infekte hastalarla aynı serviste bulunma (p= 0.006), ve antibi-yotik kullanım öyküsü (p= 0.004) tek değişkenli analizde anlamlı bulundu. Çoklu lojistik regresyon analizi sonucunda ise, servisler arası transfer öyküsü varlığı (β= 3.258 (%95 GA 1.65-9.05) p= 0.002), VRE’li hasta ile aynı dönemde serviste yatış öyküsünün olması (β= 2.80 (%95 GA 1.33-5.87) p= 0.006) ve VRE kolonizasyonu öncesi antibiyotik kullanım öyküsünün varlığı (β= 3.21 (%95 GA 1.45-7.12) p= 0.004) VRE kolonizasyonu için risk faktörü olarak bulundu.Sonuç: Uzun süreli ve gereksiz antibiyotik kullanımı enterokoklarda vankomisine karşı direnç gelişmesine neden olabilir. Bu yüzden antibiyotik kullanımında dikkatli olunmalıdır. VRE’li hasta ile aynı serviste yatma ve servisler arası transfer de VRE kolonizasyonu için risk faktörüdür. İnfeksiyon kontrolü ve gerekli izolasyon önlemlerine uyulması bu riskin azaltılması için önemlidir.Introduction: Vancomycin resistant Enterococci (VRE), can survive on dry surfaces for a long time, easily spread through contact withthe hands of healthcare professionals and the environment. In this study, we aimed to determine the risk factors for the developmentof VRE colonization in chronic hemodialysis patients in the nephrology clinic.Materials and Methods: This study was conducted retrospectively using Hospital Infection Control Committee surveillance follow-upform and hospital automation system. Demographic data, comorbidities, immunosuppression, antibiotic use history, and antibiotics,hospitalization history in risky services, transfer history between services, and presence of a history of hospitalization with the patientwith VRE colonization or infection were recorded. Patients colonized with VRE were accepted as the case and patients who were followedup in the same period and not colonized were accepted as the control group.Results: A total of 136 patients (64 cases and 72 control groups) were included into the study. As a result of multiple logistic regressionanalysis, the presence of transfer history between services (β= 3.258 (95% CI 1.65-9.05) p= 0.002), having a history of hospitalizationin the same period with the patient with VRE (β= 2.80 (95% CI 1.33-5.87) p= 0.006) and presence of a history of antibiotic use beforeVRE colonization (β= 3.21 (95% CI 1.45-7.12) p= 0.004) were found to be the risk factors for VRE colonization.Conclusion: Prolonged and unnecessary use of antibiotics may cause resistance to vancomycin in enterococci. Therefore, caution shouldbe exercised in the use of antibiotics. Hospitalization with VRE patient and transfer between services are also risk factors for VRE colonization. Infection control and compliance with necessary isolation measures are important to reduce this risk.&nbsp;</p