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

Pityriasis Rosea Associated with Pegylated Interferon Alfa and Ribavirin Treatment in a Patient with Chronic Hepatitis C

Background: Pityriasis rosea is an acute inflamatory skin disease that the etiology is unknown but some viral agents like human herpes virus-6 and 7 and drugs are suspected. Case report: A-58-year-old man with chronic hepatitis C was being followed up in our hospital. Pegylated interferon (PEG-IFN) alfa-2b (100 µg per week) and ribavirin (1000 mg/day) was started. In the third month of this treatment, the patient was diagnosed with pityriasis rosea (PR), which was confirmed by skin biopsy. PEG-IFN alfa-2b treatment for chronic hepatitis C was maintained and no therapy was given for PR. The lesions spontaneously improved within 5 weeks. Conclusion: Interferon and ribavirin have several cutaneous side effects. Our case is the first case of PR, emerged in a patient with chronic hepatitis C while receiving PEG-IFN alfa 2b and ribavirin

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

Listeria Meningoencephalitis in Immunocompetent Person Complicated with Hydrocephalus

Listeria monocytogenes is a common cause of central nervous system infection, especially in immunosuppressed patients, infants, and the elderly and in pregnancy; it is uncommon in individuals with immunocompetent status. In this case report, we aimed to present the case of an immunocompetent 45-year-old patient who presented with meningoencephalitis due to Listeria, which was complicated with hydrocephalus

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

Epidemiologic, Clinical and Laboratory Features of Pandemic Influenza (H1N1) 2009 Virus Infection

Introduction: After the definition of the first H1N1 case on 15 April 2009, the first case in our country was reported on 15 May 2009, and the first local case was seen on 18 June 2009. In this study, we evaluated patients hospitalized with a pre-diagnosis of H1N1 virus infection, according to epidemiologic, clinical and laboratory features. Materials and Methods: Cases hospitalized between October 2009 and January 2010 with a pre-diagnosis of pandemic influenza and for whom samples of nasal and oropharyngeal swabs were obtained were included in the study. Epidemiologic and laboratory properties of the cases (for both H1N1 positive and H1N1negative groups) were evaluated, as well as their prognoses and treatment. Results: Between October 2009 and January 2010, 155 patients with pre-diagnoses of H1N1 were hospitalized. Eighty-four H1N1 positive and 71 H1N1 negative patients were evaluated. Cough, fatigue and fever were the most frequently observed symptoms. Obesity, fatigue and diarrhea were more common in the H1N1 negative group. Abnormal chest X-ray, lymphopenia and leukopenia were more common in the H1N1 positive group. The fatality rate was determined as 7.1%. 21.4% of the patients (18/84) required intensive care. Twelve patients were monitored with invasive and 3 with non-invasive mechanical ventilation. None of the patients in the H1N1 negative group required intensive care. In the H1N1 positive group, 69 patients received oseltamivir and 47 patients received oseltamivir and antibiotherapy. Conclusion: The new pandemic influenza virus came under the spotlight because of its fast spread and the complications seen in young patients with no comorbidities, where normally influenza-related complications are not expected. The majority of our cases were young adult patients. Most of the cases hospitalized with H1N1 diagnosis had symptoms similar to pneumonia, low oxygen saturation and deterioration in their general condition. Antiviral treatment initiated during the early phases of the disease was successful. Respiratory support and intensive care play a vital role in the cases in which they are needed. Informing the population about the disease and educating them on its transmission and immunization are very important in preventing its spread

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