Five-Years Tigecycline Experience an Analysis of Real-Life Data

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy

Immunopathogenesis of Hepatitis B Infections

Hepatitis B virus (HBV) infections are among the major health problems and leading causes of cirrhosis and hepatocellular carcinoma worldwide. Despite therapeutic advancements, chronic HBV infection is not a curable disease yet. The clinical outcome of hepatitis B infections depend upon the age at infection, level of HBV replication, and immune status of the host. While clinical course of the diseases ranges from subclinical hepatitis to anicteric hepatitis, icteric hepatitis, and fulminant hepatitis in acute hepatitis, manifestations range from an asymptomatic inactive state to chronic hepatitis, cirrhosis, and hepatocellular carcinoma in the chronic phase. Hepatitis B virus replicates in the hepatocyte non-cytopathically and most of the clinical syndromes associated with this infection due to immune response. Activation of the immune responses against viral infections is associated with both liver damage and virus elimination. Even though cellular immune response, especially the virus-specific effector CD8+ T cells, are central, several other components of the immune system components contribute to hepatitis B pathogenesis. In patients with chronic hepatitis B, both innate and adaptive immune responses are weak and T cell response is exhausted. Further understanding of the mechanisms of immunopathology would be beneficial in the development of new effective therapeutic strategie

Ebola Virus Disease

Ebola virus disease is a severe, acute zoonotic viral syndrome with a high fatality rate in human and nonhuman primates. A virus belonging to genus Ebolavirus, a member of Filoviridae family is responsible for the disease. Animal to human transmission may occur through hunting and raw consumption of the reservoir species or close contact with infected non-human primates, and then, the virus spreads in between human population. Human to human transmission occurs mainly via direct contact with the blood or bodily secretions of the infected people. Since its fi rst discovery in 1976, outbreaks have been intermittantly reported from Central Africa. The ongoing epidemic has begun in the western part of Africa in Guinea at the end of 2013, and then, spread to Liberia and Sierra Leone and affected many countries. The current epidemic is the largest outbreak with regards to the number of human cases and fatalities and affected areas. Currently, there is no vaccine or special treatment approved for human use. The present review aimed to overview the various aspects of Ebola virus disease

The Possibility of Pericarditis Due to Brucellosis and Tuberculosis Co-infection: A Case Report

Brucellosis and tuberculosis are endemic disease in Turkey. Hence the clinical and laboratory findings are frequently similar, pericarditis caused by brucellosis and tuberculosis may be confused. In this case, pericarditis due to brucellosis and tuberculosis co-infection has been reported. This report emphasizes the co-infection possibility of brucellosis and tuberculosis in endemic countries

The attitude towards tetanus and determination of clostridium tetani antibody levels in health service staff

Bu çalışma, hastalık ve korunma yolları konusunda bilinçli olduğu ve bunun gereklerini yerine getirdiği varsayılan sağlık çalışanları arasında tetanoza yaklaşımı ve koruyucu antikor düzeylerini belirlemek amacıyla yapılmıştır. Çalışmaya 53 doktor, 60 hemşire 31 sağlık teknisyeni, ve 30 yardımcı sağlık personeli alınmıştır. Çalışmaya katılanlara bir anket uygulandıktan serum antitoksin düzeyleri ELISA ile ölçülmüştür. Tetanozdan korunma yöntemi olarak en fazla (%55) yara temizliği ve aşılama yanıtı verilmiştir. Çalışmaya alınanların %58'inin son 10 yıl içinde tetanoz aşılarını yaptırdıkları ve bu grubun daha çok doktor ve hemşirelerden oluştuğu saptanmıştır. Kadınlarda aşı olma oranının daha yüksek olduğu, tüm gruplarda yaş ilerledikçe aşı olma oranının azaldığı görülmüştür. Çalışmaya alınanların % 53'ünde tetanoz antitoksin düzeyi 1 IU/ml ve üzerinde, %21'inde ise 0.1 IU/ml'den daha düşük bulunmuştur. Yaş ilerledikçe antitoksin fitresinin düştüğü saptanmıştır. Doktor ve hemşire grubunda tetanoz antikor titre ortalamasının diğerlerinden anlamlı olarak yüksek olduğu bulunmuştur. Sonuç olarak, hastalık konusunda daha bilinçli olmanın daha düzenli aşılamayı ve daha yüksek antitoksin düzeyi ile birlikte daha iyi korunmayı sağladığı, ancak erişkin aşılanmasına daha fazla önem verilmesi gerektiğini göstermektedir.The aim of this study was to determine the approach to tetanus prevention and also the tetanus antibody levels in health care workers. The study group consisted of 174 people: 53 doctors, 60 nurses, 31 laboratory technicians and 30 health employees. Tetanus antibody levels were determined by ELISA after a questionaire was filled by the health care workers. In terms of tetanus protection methods; with 55% wound care + vaccination was the highest choice of response. When the vaccination times were examined, 58% of the participants, mostly doctors and nurses, reported that they had been vaccinated in the last ten years. The rate of vaccination in women was found higher (89%) than in men (73%), and with increasing age, the rate of being vaccinated decreased. Antibody liters were less than 0.1 IU/ml in 21% of the study group. The antibody titer levels were found to decline with age. Antibody liter levels were higher in doctors and nurses than in other groups of health personnel. In conclusion, this study showed that education is an important factor for protection against tetanus. However, declining antibody titers with age emphasizes the importance of adult vaccination

In Vitro Activity of Fosfomycin Trometamol Against Extended-Spectrum Beta-Lactamase Producing Escherichia coli Strains Isolated from Community-Acquired Urinary Tract Infections

Introduction: Escherichia coli is the most common microorganism in community acquired UTIs. Treating infections caused by extended-spectrum beta-lactamase (ESBL) producing E. coli strains is problematic. In recent years, in our country and the world, susceptibility of E. coli strains to commonly used antibiotics in the treatment of UTIs has decreased. The aim of this study was to investigate the in vitro activity of fosfomycin in ESBL positive E. coli strainst isolated from community-acquired UTIs. Materials and Methods: The study included E. coli positive urine samples taken from outpatients in the Department of Infectious Disease and Clinical Microbiology at Ankara Training and Research Hospital between June 2012 and January 2013. Antibiotic susceptibilities of the isolates were determined by Kirby-Bauer disc diffusion method and ESBL production was confirmed by double-disc diffusion method according to the recommendations of CLSI (Clinical and Laboratory Standards Institute). Minimum inhibitor concentration (MIC) values for fosfomycin were detected by E-test method. Results: Thirty-five of the 80 E. coli strains (43.7%) producing ESBL was included into the study. However, ESBL-non producing isolates weren’t resistant to fosfomycin but ESBL-producing isolates were 8.6% resistant to fosfomycin (determined by Kirby-Bauer disc diffusion method according to CLSI recommendations). Regarding fosfomycin MIC breakpoints defined by CLSI, 100% of ESBL-producing and non-producing isolates were found susceptible to fosfomycin, indicating no significant difference between the two groups (p= 0.457). Conclusion: It isconcluded that fosfomycin isan appropriate alternative antibiotic in the treatment of community-acquired UTIs because of its high susceptibility rates

Determination of Susceptibility Rates of Nosocomial Acinetobacter baumannii Isolates to Sulbactam by E-test Method

Hastane infeksiyonlarına yol açan etkenler arasında Acinetobacter cinsi bakteriler önemli bir yer tutmaktadır. Çoklu ilaç dirençli Acinetobacter infeksiyonları dünyada artan oranlarda görülmektedir. Bu nedenle, terapötik seçenekler sınırlı hale gelmektedir. Duyarlılık oranları net olarak bilinmese de, tek başına sulbaktam veya sulbaktam-ampisilin, Acinetobacter infeksiyonlarının tedavisinde kombinasyonlarda yer almaktadır. Bu çalışmada, çoğul dirençli Acinetobacter baumannii kökenlerinde, sulbaktamın minimum inhibitör konsantrasyonu (MİK) değerleri E-test yöntemi ile incelenmiştir. Materyal ve Metod: Çalışmaya, 15 Haziran 2011-15 Haziran 2013 tarihleri arasında, Sağlık Bakanlığı Ankara Eğitim ve Araştırma Hastanesinde yatan hastalardan alınan klinik örneklerden izole edilen, karbapenem direncini de barındıran çoklu ilaca dirençli 100 A. baumannii kökeni alındı. Antibiyotik duyarlılıkları ve tür düzeyinde tanımlaması konvansiyonel yöntemler ve VITEK 2 (bioMérieux SA, Fransa) sistemi ile yapılmıştır. Üç veya daha fazla ilaç grubuna karşı direnç saptanması çoğul ilaç direnci olarak kabul edildi. Yüz izolat çalışma gününe kadar -80ºC'de gliserollü "brain heart" besiyerinde (Oxoid, UK) saklandı. Kontrol kökeni olarak Escherichia coli ATCC (American Type Culture Collection) 25922 kullanıldı. Sulbaktamın 100 izolata karşı E-test yöntemi ile saptanan MİK değerleri (µg/mL), MİK50 ve MİK90 değerleri (µg/mL) kaydedildi. Tek başına sulbaktamın Acinetobacter'e karşı belirlenmiş bir duyarlılık sınırı olmadığı için, duyarlılık oranları, literatürde rapor edilen MİK sınır değerleri dikkate alınarak hesaplanmıştır (<= 4 µg/mL ve <= 8 µg/mL). Bulgular: Acinetobacter izolatlarına karşı sulbaktam MİK değerleri geniş bir aralıkta dağılmıştı (1 µg/mL ile 256 µg/mL arasında); MİK50 ve MİK90 değerleri ise sırasıyla 12 µg/mL ve 96 µg/mL saptandı. Duyarlılık sınırı 8 µg/mL kabul edildiğinde, izolatların %44'ü duyarlı saptanmışken, sınır 4 µg/mL kabul edildiğinde bu oran %21 ile sınırlı kaldı. Sonuç: Çalışmamızdaki sulbaktam MİK değerleri göz önüne alındığında, çoklu ilaca dirençli A. baumannii tedavisinde sulbaktam umut verici bir ajan olarak görülmektedir. Ancak, özellikle klinik etkinlik konusunda farklı çalışmalara ihtiyaç vardır.Bacteria of the genus Acinetobacter play an important role as causative agents of hospital-acquired infections. Especially in recent years, multidrug-resistant Acinetobacter infections have increasingly been observed worldwide. In parallel with the increasing rate of infections, therapeutic options are becoming limited. Although the susceptibility rates are not exactly known, sulbactam alone or sulbactam with ampicillin play a part in combination therapies against Acinetobacter infections. This study aimed to determine the minimum inhibitory concentrations (MICs) of sulbactam against multidrug-resistant Acinetobacter baumannii strains using the E-test method and to deduce the susceptibility rates based on literature data.Materials and Methods: The study included 100 multidrug-resistant A. baumannii strains isolated from clinical samples obtained from patients hospitalized in intensive care units of the Ministry of Health Ankara Training and Research Hospital between June 15, 2011 and June 15, 2013. Antibiotic susceptibility testing and strain identification were performed using conventional methods and the VITEK 2 (bioM&eacute;rieux SA, France) system. Resistance to three or more drugs was considered as multidrug resistance. MIC, MICMIC values (&micro;g/mL) of sulbactam against the 100 isolates were determined using the E test method. Since the breakpoint MIC of sulbactam against Acinetobacter had not been established, the susceptibility rates were estimated based on the MIC values reported in the literature (&lt;= 4 or 8 &micro;g/mL).Results: The MIC values of sulbactam against the Acinetobacter isolates ranged widely (between 1 and 256 &micro;g/mL), and the MICand MIC values were determined to be 12 and 96 &micro;g/mL, respectively. When 8 &micro;g/mL was considered as the susceptibility breakpoint, 44% of the isolates were found to be susceptible; however, the rate was only 21% when 4 &micro;g/mL was considered as the breakpoint.Conclusion: Based on its MIC values determined in our study, sulbactam appeared to be a promising agent for the treatment of infections caused by multidrug-resistant A. baumannii isolates. Nonetheless, more studies are needed, especially on its clinical effectiveness

Lung Abscess in Crimean-Congo Hemorrhagic Fever: A Case Report

Crimean-Congo hemorrhagic fever is a viral zoonotic infection that affects multiple organs and systems, and causes various complications and death. Here, we present a case of a Crimean-Congo hemmorrhagic fever with pulmonary abscess complication, which has not been previously reported