The Antibiotic Usage in a University Hospital and Necessity of an Antibiotic Policy

To determine the problems with inappropriate prescribing of antibiotics in hospitalized patients, a crosssectional study was carried out in Atatürk University, Medical School Hospital, the largest hospital in Eastern Anatolian Region of Turkey. Patients hospitalized between 03 May 2001 and 10 May 2001 were included in the study. Appropriateness of antibiotic use was evaluated using published recommendations for antibiotic prescription. Statistical analysis was made by chi-square test. A total of 717 patients were evaluated. Of the patients, 378 (52.7%) were receiving one or more antibiotics. Empirical use was more frequent (45.5%) than prophylactic (40.5%) and specific (based on culture result, 14.0%) use. Inappropriate use was found to be 44.4%, and it was 68.6%, 30.2% and 20.8% in prophylactic, empirical and specific administrations, respectively. The main problem in medical wards was unnecessary use of antibiotics while it was improper timing or duration of surgical prophylaxis in surgical wards. Appropriate usage rate of ampicillin-sulbactam, the most commonly used antibiotic, was 38.9%. This study emphasized a high proportion of misuse of antibiotics in the hospital. Our results are striking in respect of display of the need of antibiotic management policy in hospitals

Antrax: Evaluation of 68 Cases

Sixty-eight anthrax cases admitted to our clinic, from June 1986 to June 1996, were evaluated in respect to clinical findings, therapy methods and prognosis. Patients were 15-63 years old, 31 of them were female and 37 were male. It was understood that from August to October, in three months, there was an increase in anthrax cases. A history of direct contact with animals was obtained in 46 (68%) cases. Incubation period of our cases was 1-9 (average : 3.8) days. The whole cases were cutaneous anthrax; 41 of them were malignant pustule, and 27 were malignant edema. Bacillus anthracis was seen on Gram stain smears in 20 cases (29%). Vesicular fluid culture was positive in 12 cases. Both the culture and Gram stain smear was positive in 9 of these cases. Procain penicillin was used for 7 days in the treatment of patients with malignant pustula. For the therapy of malignant edema patients penicillin G was started and then continued with procain penicillin with the addition of prednisolon for 10 days. The average time of hospitalization was 9.5 days and the mortality rate was 1.5%

Fever of Unknown Origin After Cervical Spine Injury: Case Report

In cases with upper thoracal and cervical spine injury, it is difficult to distinguish fever based on autonomic dysfunction from that with infectious causes. Fever can be associated with autonomic dysfunction by eliminating all possible causes, primarily infectious and noninfectious diseases. We present a case with fever of unknown origin after cervical spine injury to call attention to autonomic dysfunction in the etiology of fever in such cases

Adherence to Nucleoside/Nucleotide Analogue Treatment in Patients with Chronic Hepatitis B

Background: Adherence to medication is an important aspect of preventing drug resistance and treatment failure in patients receiving nucleos(t)ide analogues for chronic hepatitis B. Aims: To assess adherence to nucleoside/nucleotide analogues in chronic hepatitis B treatment and to determine factors associated with non-adherence. Study Design: Cross-sectional study. Methods: The study enrolled 85 chronic hepatitis B patients who had been receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was completed by patients themselves, and adherence was evaluated based on patients’ self-reporting. The use of at least 95% of the drugs in the previous month was considered as adequate adherence. Results: Adherence was adequate in 82.4% of patients. Female gender (p=0.003), unemployment (p=0.041) and lower monthly family income (p=0.001) were related to lower adherence. Better adherence was significantly linked to adequate basic knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than 12 months (p<0.001), previous use of other medications for chronic hepatitis B (p=0.014) and regular follow-up by the same physician (p<0.001). Conclusion: Counselling patients about their disease state and the consequences of non-adherence is an important intervention for enhancing adherence. Naïve patients should be followed up more frequently to reinforce adherenc

Sharp Instrument Injuries and Exposure to Blood and Bodily Fluids of Health Care Workers in a Tertiary Care Facility#

Introduction: Exposure of health-care workers (HCWs) to blood and bodily fluids of the patients due to needle sticks or sharp instrument injuries is a potential risk in daily practice. In this study,the epidemiological aspects of these injuries in a tertiary referral hospital were aimed to be determined. Materials and Methods: The needle stick and sharp instrument injuriesHCWs were exposed to were evaluated retrospectively between January 2011 and July 2013 in Ankara Ataturk Training and Research Hospital. Data were obtained from records of the department of HCW. Results: A total of two hundred and seventy HCWs (172 female, 98 male) were included in the study. Considering their occupations, the HCWs who were exposed to injury or blood/bodily fluidswere as follows: nurses (54.8%), cleaning staff (28.8%) and physicians (16.4%). The most common exposure was detected in surgical departments and operation room (23.7% and 11.5%), followed by medical departments (21.8%) and intensive care units (21.4%) The most common devicescausing exposure were needle sticks (73.8%) and intravascular catheters (6.7%). Eighty percent of HCWs reported wearing protective equipment at the time of exposure. The most common reasons of exposure were reported as carelessness (64.8%), haste (14.4%) and full needle stick/sharp device box (8.1%). The vaccination program for Hepatitis B had been completed for 87.8 % of HCWs. Conclusion: The HCWs working in surgical departments and operation rooms possess a high risk for injury, possibly due to higher work load and high rate of urgent interventions. Although the HBV vaccination rate was quiet respectable, one sixth of the HCWs had no immunization against HBV. It seems that the need for more training in respect to the requirement of vaccination program is clear

The Distribution of Hepatitis C Virus (HCV) Genotypes in 59 HCV Infected Patients: A Multicenter Study

Eighty anti-HCV positive serum samples were collected at university centers in Malatya, Erzurum, Samsun and Konya. HCV-RNA sequences were detected in 59 (73.3%) of these samples by reverse transcriptase-polymerase chain reaction (RT-PCR) using primers from the 5’ non-coding region. HCV-RNA positive samples were subsequently genotyped using type-specific primers from the core region of the virus. Type II (I b) infection was detected in 41 samples (69.5%), while a mix type I (I a) and II (I b) infection were found in another 3 samples (5.1%). The remaining 15 samples (25.4%) could have not been typed. These results together with the results of previous studies suggest the predominance of genotype II infection in Turkish patients which is known to have poorer prognosis and lower responce to interferon treatment