An evaluation of six-year Stenotrophomonas maltophilia infections in a university hospital

Background: Stenotrophomonas maltophilia is a Gram-negative bacillus and opportunistic emergent pathogen causing hospital-acquired infections (HAIs). Due to risk factors such as prolonged intensive care unit stay and invasive procedures, it has become one of the leading causes of HAIs. Objective: The aim of this study was to evaluate the epidemiology of S.maltophilia infections over a six-year period at D\ufczce University Hospital, Turkey. Methods: The incidence, clinical characteristics, antimicrobial susceptibility and outcomes of nosocomial S. maltophilia infections during this period were retrospectively analyzed. Results: During the study period, 67 samples obtained from 61 patients were identified. Pneumonias (82%) were the most common HAIs, followed by bloodstream infections (10.5%), urinary tract infections (3%), skin and soft tissue infections (3%) and surgical site infection (1.5%). Admission to intensive care, hospitalization exceeding 30 days, and previous use of broad-spectrum antibiotics constituted risk factors. Resistance to cotrimoxazole (6%) was lower than that to levofloxacin (18%). Conclusion: The most important risk factors for S.maltophilia infection in patients are previous exposure to antibiotics, prolonged hospitalization and invasive procedures such as mechanic ventilation. Discharging patients as early as possible with the rational use of antibiotics may be effective in reducing S. maltophilia infections and resistance rates

Diagnostic approach of tuberculous lymphadenitis in a multicenter study

Introduction: Tuberculous lymphadenitis (TBLN) is the most common infectious etiology of peripheral lymphadenopathy in adults, in Turkiye. This study aimed to identify the demographic, clinical, and laboratory variables that differentiate TBLN from non-tuberculous lymphadenitis (NTBLN), as well as the etiology of lymphadenopathy in adults. Methodology: Patients who were over 18 years old and were referred to the infectious disease outpatient clinics with complaints of swollen peripheral lymph nodes, and who underwent lymph node biopsy between 1 January 2010 and 1 March 2021, were included in this multicenter, nested case-control study. Results: A total of 812 patients at 17 tertiary teaching and research hospitals in Turkiye were included in the study. TBLN was the most frequent diagnosis (53.69%). The proportion of patients diagnosed with TBLN was higher among females; and among those who had a higher erythrocyte sedimentation rate, positive purified protein derivative test, and positive interferon-gamma release test result (p < 0.05). However, TBLN was less frequent among patients with generalized lymphadenopathy, bilateral lymphadenopathy, axillary lymphadenopathy, inguinal lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, and moderately increased C reactive protein levels (p < 0.05). Conclusions: Identifying the variables that predict TBLN or discriminate TBLN from NTBLN will help clinicians establish optimal clinical strategies for the diagnosis of adult lymphadenopathy

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Evaluation of Knowledge and Attitudes of Dentists about HIV/AIDS and Oral Lesions

WOS: 000487340900007Objective: Human Immunodeficiency Virus (HIV) is a virus that can cause Infectious Immunodeficiency Syndrome (AIDS) when it infects infections by targeting immune system cells and the infection progresses. The aim of this study was to determine the knowledge level of the dentists about the possible transmission of HIV / AIDS, the body fluids of HIV and the oral symptoms of HIV / AIDS, to determine the means of access to information, and to evaluate their attitudes and awareness towards patients. Methods: A questionnaire with 17 items was developed through Survey Monkey system. The link of this questionnaire was sent to dentists through e-mail, SMS, or social networking sites, and they were asked to fill out the questionnaire. 180 dentists filling out the questionnaire were taken as the data collection group. Results: Of the dentists participating in the study, 73% of them were females, and 43% of them were between 31 and 40 ages. Considering the items on oral lesions of HIV / AIDS patients, 39.8% of them responded as oral candidiasis. In questions that measure the level of HIV / AIDS knowledge; 28.4% knew that HIV and AIDS were not the same definition, 99% were infected with unprotected sexual intercourse, blood contact and stab wounds. A significant proportion of dentists; and urine and saliva, cups, towels, as well as common materials used to be infected (20-40%). When the attitudes of the HIV infected patient were evaluated, more than half of there spondents answered without hesitation. When the patients were asked if they were worried about HIV infection, 40% answered yes. They stated that they got their knowledge about HIV / AIDS mostly in the faculty (85%) and written sources (56.1%). 73.3% of the dentists stated that they did not have enough information about HIV / AIDS and oral lesions and they wanted their information to be updated. Conclusions: Although the knowledge level of the dentists in our study was generally acceptable, it was observed that there was misinformation and attitude about the transmission routes of HIV. It is thought that updating the information about the dentists working in the field after graduation is important

Frequency and Antibiotic Susceptibility of Moraxella catarrhalis Isolated from Sputum in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Kronik obstrüktif akciğer hastalığı (KOAH), morbidite ve mortaliteye neden olan progresif , kronik seyirli ve akut alev- lenmelerle seyreden bir hastalıktır. Çalışmamızda KOAH alevlenmelerinde sık görülen etkenlerden olan Moraxella catarrhalisin izolasyon oranı, beta-laktamaz aktivitesi ve antibiyotik duyarlılıkları araştırılmıştır. Çalışmaya, Ekim 2009- Mart 2010 tarihleri arasında Abant İzzet Baysal Üniversitesi Tıp Fakültesi ve İzzet Baysal Devlet Hastanesi Göğüs Hastalıkları ve Tüberküloz Bölümüne başvuran, KOAH alevlenmesi tanısı alan 124 gönüllü hasta alınmıştır. Hastalardan alınan balgam örneklerinde üreyen bakteriler konvansiyonel mikrobiyolojik yöntemler ve API NH test kiti ile tanımlanmıştır. Antibiyotik duyarlılık testleri için agar dilüsyon testi ve E-test yöntemi, beta-laktamaz aktivitesi için nitrosef in testi kullanıl- mıştır. Kültürü yapılan 98 balgam örneğinin 50sinde patojen kabul edilen 51 mikroorganizma üremiştir. Bu bakterilerin % 15i Streptococcus pneumoniae (n:15), % 11.2si Pseudomonas aeruginosa (n:11), % 10.2si Moraxella catarrhalis (n:10), % 6.1i Haemophilus inf luenzae (n:6), % 3ü Escherichia coli (n:3), % 3ü Klebsiellae pneumoniae (n:3) ve, % 3ü Haemophilus parainf luenzae (n:3) olarak bulunmuştur. Bir hastanın balgam kültüründe patojen olarak bilinen iki bakteri (M.catarrhalis ve H.inf luenzae) birlikte üretilmiştir. İzole edilen on M.catarrhalis suşlarının dokuzunda beta-laktamaz testi pozitif olarak sap- tanmıştır. Eritromisin, tetrasiklin, siprof loksasin, sef uroksim ve sef triaksona karşı direnç görülmemiştir. Trimetoprim- sülf a- metoksazol direnci % 10, ampisilin direnci % 90 olarak belirlenmiştir. Elde edilen sonuçlar dünya ve ülkemiz verileri ile uyumlu bulunmuştur.Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease that can lead to morbidity and morta- lity which also can have acute exacerbations. In our study, the isolation rate, beta lactamase activity and antibiotic suscepti- bility of Moraxella catarrhalis, one of the most common agents causing COPD exacerbations, is assessed. A hundred and twenty-f our voluntary COPD patients diagnosed with acute exacerbation who were ref erred to Pulmonary Disease and Tuberculosis Department of Izzet Baysal Research Hospital and Abant Izzet Baysal University Medical Faculty during the time period of October 2009 to March 2010 were included the study. Bacteria isolated f rom sputum cultures were identif ied by conventional microbiological methods and API NH test kit. Agar dilution test and E-test method were used f or antibiotic susceptibility testing and nitrocephin test was used f or testing beta-lactamase production. In 50 of the 98 cultured sputum specimens, 51 pathogenic microorganisms were detected. Fif teen percent % of these bacteria were Streptococcus pneumoniae (n:15), 11.2 % were Pseudomonas aeruginosa (n:11), 10.2 % were Moraxella catarrhalis (n:10), 6.1 % were Haemophilus inf luenzae (n:6), 3 % were Escherichia coli (n:3) 3 % were Klebsiella pneumoniae (n:3) and 3 % were Haemophilus parainf - luenzae (n:3). In one patients sputum culture, two pathogenic bacteria were isolated (M.catarrhalis and H.inf luenzae). Beta- lactamase test was positive in nine of the 10 M.catarrhalis strains. No resistance was detected aganist erythromycin, tetracy- cline, ciprof loxacin, cef uroxime and cef triaxone. Resistance aganist trimethoprim-sulf amethoxazole was 10 % and the resis- tance aganist ampicillin was 90 %. Results obtained were in correlation with the data reported f rom the world and Turkey

Piperasilin Tazobaktama Bag?lı Febril Nötropeni Olgusu

Piperasilin tazobaktam (PTZ), güçlü antipseudomonal etkinliğe sahip olan ve pnömoni, sepsis, intraabdominal enfeksiyonlar ve komplike deri, yumuşak doku enfeksiyonları gibi birçok enfeksiyon hastalığının tedavisinde sıklıkla kullanılan betalaktam grubu bir antibiyotiktir. Uzun süreli PTZ kullanımı ve yüksek doz PTZ kullanımına bag?lı olarak kemik iliği baskılanması sonucu nötropeni, trombositopeni veya pansitopeni gibi yan etkiler gelis?ebilmektedir. Bu etki reversible bir yan etkidir ve bütün beta-laktam grubu antibiyotiklerin kullanımına bağlı görülebilmektedir. Kemik iliği baskılanması sonucu sıklıkla nötropeni görülmektedir ve genellikle trombositopeni tabloya eşlik etmektedir. Bu çalışmada osteomyelit tanısı ile takip edilen ve piperasilin-tazobaktam tedavisinin 21. gününden sonra ateş ve nötropeni gelişen bir olgu sunulmuştur

The comparison of two different direct acting antiviralregimens in treatment of chronic hepatitis C virus

Aim: Chronic hepatitis C virus (HCV) is considered a critical threat to the public health in the world. We compared treatment outcomesof Ombitasvir, Paritaprevir and Ritonavir with Dasabuvir (PrOD) and Ledipasvir (LDV) and Sofosbuvir (SOF) in real world patients with chronic HCV in treatment-naïve and pre-treated patients with chronic HCV.MaterialS and Methods: 91 adult patients enrolled in our study and were divided in two groups. The first group; consisted of 53patients, who orally received a fixed-dose combination tablet comprised of LDV and SOF once daily for 24 weeks. The second group; consisted of 38 patients, who orally received a fixed-dose combination tablet comprised of PrOD twice daily for 12 weeks without regard to fat or calorie content. Results: The results showed that sustained virologic response (SVR) rates were 100% in the both groups analyzed. 76 adverse eventswere occurred in total. 46 of overall adverse events were found on patients in the first group and 30 of those events were found on patients in the second group. Weakness (13.1%), pruritus (5.5%), myalgia (1.1%) nausea (5.5%), dry mouth (1.1%) and insomnia (1.1%) were observed among the patients. Twelve weeks after initiating treatment, virologic suppression was accomplished for all patients in the both groups. Additionally, laboratory analysis concluded that HCV-RNA levels of the overall patients were negative after 48 weeks of the onset of the treatment.Conclusion: The real world comparative analysis of two distinct treatment regimens concluded that administration of PrOD and LDV/ SOF on the patients with chronic HCV has an extremely effective outcome. SVR12 rates of 100% were obtained in both treatment regimens for all treatment naïve and treatment-experienced patients regardless of cirrhosis occurrence and of HCV genotype

Factors Affecting Cervical Lymph Node Suppuration in Oropharyngeal Tularemia Cases

Objective: To determine the factors associated with cervical lymph node suppuration in oropharyngeal tularemia. Study Design: Observational study. Place and Duration of Study: Departments of Infectious Diseases and Clinical Microbiology, Faculties of Medicine, Duzce University and Bolu Abant Izzet Baysal University Turkey, between January 2016 and August 2019. Methodology: Tularemia was diagnosed in clinically compatible cases by micro-agglutination test (>= 1/ 160 titres). Positive cases were divided into two groups according to development of suppurated and discharging lymph nodes. If the cases did not develop suppuration and discharge lymph nodes, they were defined as completely healed. If they did, they were defined as suppurated and drained lymph node group. Demographic and clinical characteristics and acute phase reactants of these groups were compared as to investigate any significant difference between the groups. Results: There were 88 tularemia cases in the current study. Of these, 60 cases were completely healed (68.2%) and 28 cases had suppurated and drained lymph nodes (31.8%). Tonsillopharyngitis was found significantly lower in suppurated and drained lymph node group compared to the completely healed group (p= 0.016). However, late presentation (>14 days) was found significantly more frequent in suppurated and drained lymph node group compared to the completely healed group (p=0.033). Conclusion: In order to prevent suppurative lymphadenitis in oropharyngeal tularemia, it is advisable to start appropriate antimicrobials within 14 days after the appearance of symptoms.WOS:0006304743000152-s2.0-85102224108PubMed: 3364518

Elevated mean platelet volume to platelet ratio predicts advanced fibrosis in chronic hepatitis C

PubMed ID: 31714386OBJECTIVE: Chronic hepatitis C virus (HCV) infection is an important health problem that can cause liver cirrhosis and hepatocellular carcinoma. Recently, novel inflammatory markers from complete blood count have been used as a precursor of many clinical conditions. In this study, we investigated the role of hemogram parameters in predicting advanced liver fibrosis in chronic HCV patients. METHODS: Patients who underwent percutaneous liver biopsy due to chronic HCV infection between 01.01.2011 and 01.08.2019 were included in this study. Liver biopsies were evaluated according to Ishak method. Patients were classified into those with mild fibrosis (F ? 2) and advanced fibrosis (F ? 3). Hemogram parameters of these groups were compared and their efficacy in predicting severe fibrosis was investigated. RESULTS: Of the 81 chronic HCV patients, 38 cases were in the mild fibrosis group and 43 cases were in the severe fibrosis group. Mean platelet volume, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, and red cell distribution width to platelet ratio of the severe fibrosis group were significantly higher than those of the mild fibrosis group (P < 0.05 for all). In the ROC curve analysis, mean platelet volume to platelet ratio showed the biggest area under the curve in the prediction of advanced fibrosis. CONCLUSION: Mean platelet volume to platelet ratio may be an easy and practical biomarker to gain a preliminary insight into advanced fibrosis in chronic HCV patients

Bir Üniversite Hastanesi Enfeksiyon Hastalıkları Polikliniğinde Takip Edilen HIV Pozitif Hastaların Aşılanma Durumu

Amaç: Antiretroviral tedavi (ART) ile insan immün yetmezlik virüsü/edinilmiş bağışıklık yetmezliği sendromu (HIV/AIDS) tanılı hastaların yönetiminde büyük adımlar atılmış ve HIV ölümcül bir hastalıktan kronik bir hastalığa dönüşmüştür. HIV ile yaşayan bireylerde yaşam sürelerinin uzaması ile bazı enfeksiyon hastalıklarının taranmasının ve seronegatif bireylerin aşılanmasının önemi artmıştır. Bu çalışmada polikliniğimizde takip edilen HIV pozitif hastaların kızamık, kızamıkçık, kabakulak, suçiçeği (VZV), hepatit B (HBV), hepatit A (HAV), pnömokok, meningokok, influenza gibi aşı ile önlenebilir hastalıklara karşı bağışıklanma durumlarını değerlendirmeyi amaçladık.Materyal ve Metot: 2013-2021 yılları arasında enfeksiyon hastalıkları polikliniğimizde takipli 79 HIV pozitif hasta retrospektif olarak incelendi.Bulgular: Toplam 79 hastanın 14’ü (%18) kadın, 65’i (%82) erkek olup, yaş ortalaması 41±13,88 (min:20-max:76)’dir. Hastaların seropozitiflik oranları VZV için %99, kızamıkçık ve kabakulak için %97, kızamık için %93, HAV için %80 olarak bulundu. Bakılan HBV tetkikleri sonucu hastaların %43’ünde anti-HBs pozitif, %49’unun HBV açısından seronegatif, %8’inde ise kronik hepatit B infeksiyonu olduğu saptandı. Hastaların %71’ine yıllık influenza, %57’sine pnömokok, %56’sına meningokok aşısı yapıldığı saptandı.Sonuç: HIV/AIDS hasta sayısı ülkemizde her yıl giderek artmaktadır. Bu hastaların aşı ile önlenebilir hastalıklara karşı bağışıklık durumlarının belirlenmesi ve gerekli aşılamaların yapılması önem arz etmektedir.