Nocardiosis Cases with Internal Organ and Brain Involvement in Turkey

Nocardia have a worldwide distribution in the environment. Nocardia enter the human body via inhalation and cause infection most commonly in the lungs, brain and skin tissue. Nocardiosis is seen especially in immunocompromised patients as an opportunistic infection. The aim of this study was to review nocardial cases with internal organ involvement reported from Turkey. The data of the cases, obtained from both the national and international journals, have been analyzed including underlying disease, infected organ, choice of treatment, prognosis and isolated strains. It was observed that nocardial cases have been increasingly reported and a total of 27 cases of nocardiosis have been reported for the last 27 years. The most frequently isolated strain has been found as Nocardia asteroides and the most frequently affected organ has been found as the lungs. Kidney transplantation was the primary predisposing factor for nocardiosis. As a conclusion, in Turkey, nocardiosis should always be kept in mind especially in immunocompromised patients and at least 2 antibiotics should be given for the treatment

The Role of Procalcitonin in Diagnosis of Different Bacterial Infections

It is reported that procalcitonin (PCT), the precursor of calcitonin is elevated in patients with severe bacterial infections. In this study our aim is to determine the value of PCT in different bacterial infections and sepsis as a marker of infection. Six brusellosis, 8 systemic salmonellosis, 9 bacterial meningitis, 11 sepsis, total 33 patients and 20 healthy adults as control group were included in the study. PCT value was measured and compared by diagnostic value of C-reactive protein (CRP). PCT determination was performed by immunoluminometric assay (Brahms Diagnostica Lumitest, PCT, Berlin). A significant difference was found between all patients and control group for both tests. There were significant differences between PCT concentrations in sepsis and other bacterial infections but no difference was found for CRP. PCT levels increased in patients with bacterial infections like CRP but PCT was a more valuable marker than CRP for indicating the severity of infection

The Use of Daptomycin and Quinolones Combination in Staphylococcus aureus Bacteremia: An In Vitro Synergistic Study

Introduction: Daptomycin, a novel lipopeptide antibiotic, has been introduced recently to clinical use in our country. It is approved for the treatment of complicated skin and soft tissue infections caused by gram-positive microorganisms, Staphylococcus aureus bacteremia, and right-sided endocarditis due to methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA). Its interaction with other therapeutic agents is not well studied. Although there are several studies about the combination of daptomycin with other groups of antibiotics, particularly with beta-lactams, to the best of our knowledge, there has been no study regarding daptomycin and quinolones combination therapy. In this respect, the interactions between daptomycin and quinolones (levofloxacin, ciprofloxacin) were studied in vitro. Materials and Methods: The study was held in Gazi University School of Medicine, Infectious Diseases and Clinic Microbiology Laboratory, between July 2006 and December 2009. In vitro susceptibilities and synergistic activities of daptomycin, levofloxacin and ciprofloxacin were investigated using E-test method in 20 MSSA and 20 MRSA consecutive isolates, which were identified as a cause of nosocomial bloodstream infection. Results: Only one isolate from each patient was included in the study. Fractional inhibitory concentration (FIC) index values were calculated and classified as synergistic (FIC 4). All isolates were susceptible to daptomycin. Although there was no resistance to levofloxacin and ciprofloxacin in MSSA strains, 85% resistance was determined in MRSA strains to both antibiotics. According to FIC index values, neither synergistic nor antagonistic activity between daptomycin-levofloxacin or daptomycin-ciprofloxacin was observed. Conclusion: Although there is no synergistic activity between daptomycin and quinolones against S. aureus isolates, no antagonistic activity was detected either. Even though there are no data about the clinical use of these combinations, it is thought that these drugs can be used in combination for the treatment of selected cases

Peripheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections

Background/aim: The aim of this study was to investigate the microbiological profile and resistance rates of diabetic foot infections (DFIs) and to determine the effect of peripheral arterial disease (PAD) on the microbiology, clinical condition, and treatment outcomes. Materials and methods: Characteristics, laboratory and imaging data, and the treatment modalities of patients admitted to our hospital with a diagnosis of DFI (PEDIS classification 3-4) during 2005-2016 were analyzed according to the presence of PAD. Results: Of 112 patients who were included in this study, 86 (76.8\%) had PAD. Patients with PAD were older and had higher amputation rates (P < 0.05). A microbiological profile of patients revealed a predominance of gram-positive bacteria (57.1\%). Staphylococcus aureus and Streptococcus spp. were the most frequently encountered bacteria. Incidence of Pseudomonas spp. infection was higher in the PAD group (P < 0.05). Of all patients, 24.1\% had multidrug-resistant (MDR) microorganisms in their wound cultures. Presence of MDR bacteria in patients with PAD was 4.9-fold higher than that in patients without PAD (P < 0.05). Conclusion: This retrospective study indicates that PAD has a significant role, especially in elderly patients with DFIs. Patients should be promptly evaluated and treated for PAD to prevent infections with resistant microorganisms and limb loss

Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study

Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean +/- standard deviation. Results It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83\% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use. Conclusions In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses