Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Are Soap, Paper Towel and Alcohol-based Disinfectants Easily Accessible in Intensive Care Units in Turkey?: Results of the Phokai Study

WOS: 000463053800011Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001). Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well

A comparison of two different fluorochrome stains for the detection of acid-fast bacilli in sputum specimens

Aim: The early diagnosis of active tuberculosis still depends on the presence of acid-fast bacilli (AFB) in stained sputum smears. In this study, our aim was to investigate the efficiency and cost-effectiveness of two different fluorochrome stains

Cost Analysis of Ertapenem Therapy for Urinary Tract Infections and Assessment of Its Suitability for Outpatient Parenteral Antibiotic Therapy Programme in Turkey

Introduction: The primary aim of this study was to evaluate whether there was a difference between outpatient parenteral antibiotic therapy (OPAT) and inpatient parenteral antibiotic therapy (IPAT) costs of ertapenem for urinary tract infections (UTI"s) due to extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli, and to discuss suitability of ertapenem for OPAT programme of Turkey for the near future. Materials and Methods: A total of 53 patients hospitalized with the diagnosis of UTI and treated with ertapenem were retrospectively evaluated. The cost of ertapenem treatment as IPAT was actual costs retrieved from the hospital records. The estimated cost of the same antibiotic for the same patients as an OPAT programme was then calculated and the costs were compared. Results: The cost difference between IPAT and OPAT was 12.305 (€ 5783). Outpatient parenteral antibiotic therapy programme would provide an estimated 20% reduction in treatment costs. The estimated number of bed days saved, if the patients had received the treatment as OPAT, was calculated to be 583 days, which constitutes about 5% of the total number of hospitalization days. Conclusion: Applying ertapenem therapy through OPAT programme for UTIs caused by ESBL-producing Gram-negative bacilli will decrease the financial burden of health expenditures and the number of inpatient bed days in Turkey

Toksokariyaza Bağlı Bir Transvers Miyelit Olgusu ve Tanıda Yerel Antikor Üretiminin Önemi

Toxocariasis caused by Toxocara canis or less frequently by T.catis is a common parasitic infection worldwide. Clinical spectrum in humans can vary from asymptomatic infection to serious organ disfunction depending on the load of parasite, migration target of the larva and the infl ammatory response of the host. Transverse myelitis (TM) due to toxocariasis is an uncommon illness identifi ed mainly as case reports in literature. In this report, a case of TM who was diagnosed as neurotoxocariasis by serological fi ndings has been presented. A 44-year-old male patient complained with backache was diagnosed as TM in a medical center in which he has admitted two years ago, and treated with pregabalin and nonsteroidal drugs for six months. Because of the progression of the lesions he readmitted to another center and treated with high dose steroid therapy for three months. After six months of follow up, improvement has been achieved, however, since his symptoms reccurred in the following year he was admitted to our hospital. Magnetic resonance imaging (MRI) examination revealed a TM in a lower segment of spinal cord. He was suffering with weakness and numbness in the left lower extremity. There was no history of rural life or contact with cats or dogs in his anamnesis. Physical examination revealed normal cranial nerve functions, sensory and motor functions. There has been no pathological refl exes, and deep tendon refl exes were also normal. Laboratory fi ndings yielded normal hemogram and biochemical tests, negative PPD and parasitological examination of stool were negative for cysts and ova. Viral hepatitis markers, anti-HIV, toxoplasma-IgM, CMV-IgM, rubella-IgM, EBV-VCA-IgM, VDRL, Brucella tube agglutination, echinococcus antibody, autoantibody tests and neuromyelitis optica test were negative. Examination of CSF showed 20 cells/mm3 (mononuclear cells), 45 mg/dl protein and normal levels of glucose and chlorine. In both serum and CSF samples of the patient Toxocara-IgG antibodies were detected by Western blot (WB) assay. Low molecular weight bands (30-40 kDa) were detected in both of the samples by repeated WB testing. CSF revealed more intense bands suggesting local antibody production. Therefore the patient was diagnosed as neurotoxocariasis, and treated with steroid and mebendazole for six weeks. Clinical improvement was detected in the case and thoracic MRI revealed signifi cant improvement in myelitis signs two months after treatment. In conclusion, toxocariasis should be considered in the differential diagnosis of TM although the involvement of central nervous system is rare and serological testing should be performed properly in the serum and CSF samples for the diagnosisToksokariyaz, dünyada yaygın olarak görülen, Toxocara canis veya daha az oranda T.catis tarafından oluşturulan bir parazit enfeksiyonudur. İnsanlarda klinik spektrum, alınan parazitin miktarına, larvanın göçtüğü bölgeye ve konağın infl amatuvar yanıtına bağlı olarak asemptomatik enfeksiyondan ciddi organ hasarına kadar değişebilir. Toksokariyaza bağlı transvers miyelit (TM) oldukça nadir görülen bir hastalık olup, literatürde çoğunlukla olgu sunumları şeklinde rapor edilmiştir. Bu raporda, transvers miyelit (TM) gelişen ve serolojik olarak nörotoksokariyaz tanısı konulan bir olgu sunulmuştur. Yaklaşık iki yıl önce sırt ağrısı yakınmasıyla başvurduğu bir merkezde TM tanısı konulan 44 yaşındaki erkek hasta, altı ay süreyle pregabalin ve steroid-dışı ilaç tedavisi almış, ancak lezyonlarda ilerleme olunca başka bir merkezde üç ay süreyle yüksek doz kortikosteroid tedavisi uygulanmıştır. Altı aylık takipte iyileşme saptanan olgu, bir yıl sonra yakınmaların tekrarlaması üzerine hastanemize başvurmuştur. Yapılan manyetik rezonans görüntüleme (MRG) tetkikinde, daha alt segmentte TM tanısı konmuştur. Sol alt ekstremitede güçsüzlük ve uyuşma yakınmaları olan olgunun anamnezinde kedi ve köpeklerle temas veya kırsal kesimde yaşama öyküsü yoktur. Fiziksel incelemede, kraniyal sinir muayeneleri, yüzeyel ve derin duyu muayenesi normal olarak saptanmış, motor defi sit ve patolojik refl eks izlenmemiş, derin tendon refl eksleri normoaktif olarak tespit edilmiştir. Laboratuvar tetkiklerinde hemogram ve biyokimyasal testler normal, PPD negatif olup, dışkıda parazit kist ve yumurtası görülmemiştir. Viral hepatit göstergeleri, anti-HIV, toksoplazma-IgM, CMV-IgM, rubella-IgM, EBV-VCA-IgM, VDRL, Brucella tüp aglütinasyonu, ekinokok antikorları, otoantikor testleri ve nöromyelitis optika testleri negatiftir. Alınan BOS örneğinin incelemesinde, lökosit sayısı 20/mm3 olarak belirlenmiş (mononükleer karakterde), protein 45 mg/dl, glukoz ve klor düzeyleri normal bulunmuştur. Hastanın hem serum hem de BOS örneğinde, Western blot (WB) yöntemiyle Toxocara-IgG antikor pozitifl iği saptanmıştır. Tekrarlanan WB testinde her iki örnekte de düşük molekül ağırlıklı (30-40 kDa) bantlar tespit edilmiş ve BOS'da lokal antikor üretimini düşündüren daha yoğun bantlar izlenmiştir. Bunun üzerine olguya nörotoksokariyaz tanısı konularak, kortikosteroid ile birlikte mebendazol tedavisi altı hafta süreyle uygulanmıştır. Klinik yanıt alınan olguda, iki ay sonra yapılan kontrol MRG'de miyelit bulgularında belirgin düzelme saptanmıştır. Sonuç olarak, santral sinir sistemi tutulumunun çok nadir görülmesine karşın, TM'nin ayırıcı tanısında toksokariyaz mutlaka akla gelmeli ve tanı için hem serum hem de BOS'da uygun serolojik testler yapılmalıdı

BRUCELLOSIS: A RETROSPECTIVE EVALUATION OF 523 BRUCELLOSIS CASES FROM WESTERN ANATOLIA, TURKEY

Objective: We investigated epidemiological and clinical features of brucellosis within a period of 16 years in Western Anatolia of Turkey which is a moderately endemic area of the disease. We aimed to clarify our future clinical approach for new cases by observing changes in years