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

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

A Neurosyphilis Case Presenting with Cognitive Dysfunction, Epileptic Seizures, High Signal Intensity and Significant Atrophy in Left Amygdala/Hippocampal Region

Syphilis is generally a sexually transmitted, chronic, multisystemic disease. Central nervous system involvement occurs in secondary and teritary stages. Neurosyphilis presents itself as meningitis or meningovasculitis in secondary stage, and general paresis or tabes dorsalis in teritary stage. But, in the antibiotic era, instead of classical neurosyphilis forms, atypical forms with merged clinical symptoms started to occur more frequently making the diagnosis difficult. In this article, we present a neurosyphilis case who applied to the clinic with generalized tonic clonic convulsions resulting in trafic accidents. The characteristic of this case is ongoing memory problems due to attentional dysfunction as shown in neuropsychological tests despite penicilin treatment and the presence of a high signal intensity and significant atrophy in his left amygdala/hipocampal area in cranial magnetic resonance imagin

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Yalcin, Ata Nevzat/0000-0002-7243-7354; Dursun, Oguz/0000-0001-5482-3780; Leblebicioglu, Hakan/0000-0002-6033-8543; dursun, oguz/0000-0001-5482-3780; UNAL, SERHAT/0000-0003-1184-4711; Geyik, Mehmet Faruk/0000-0002-0906-0902; Topeli, Arzu/0000-0002-5874-9087WOS: 000316641000020PubMed: 23355330Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey.Foundation to Fight against Nosocomial InfectionsThe authors thank the many health care professionals at each member hospital who assisted with the conduct of surveillance in their hospital, including the surveillance nurses, clinical microbiology laboratory personnel, and the physicians and nurses providing care for the patients during the study; without their cooperation and generous assistance this INICC would not be possible; Mariano Vilar, Debora Lopez Burgardt, Santiago Suarez, Cecilia Cappelini, Denise Brito, Eugenia Manfredi, Luciana Soken, Dario Pizzuto, Yuan Ding, Katie Saunders, and Isaac Kelmeszes who work at INICC headquarters in Buenos Aires, for their hard work and commitment to achieve INICC goals; the INICC country coordinators (Altaf Ahmed, Carlos A. Alvarez Moreno, Anucha Apisarnthanarak, Luis E. Cuellar, Bijie Hu, Hakan Leblebicioglu, Eduardo A. Medeiros, Yatin Mehta, Lul Raka, Namita Jaggi, and Toshihiro Mitsuda); the INICC Advisory Board (Carla J. Alvarado, Gary L. French, Nicholas Graves, William R. Jarvis, Patricia Lynch, Dennis Maki, Russell N. Olmsted, Didier Pittet, Wing Hong Seto, Syed Sattar, and William Rutala), who have so generously supported this unique international infection control network; and specially to Patricia Lynch, who inspired and supported us to follow our dreams despite obstacles. The funding for the activities carried out at INICC head quarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Geyik, Mehmet Faruk/0000-0002-0906-0902; Leblebicioglu, Hakan/0000-0002-6033-8543; Dikmen, Yalim/0000-0002-3122-5099; Unal, Necmettin/0000-0002-9440-7893WOS: 000320023600001PubMed: 23641950Background: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods: We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1-bundle of infection control interventions, 2-education, 3-outcome surveillance, 4-process surveillance, 5-feedback of CLAB rates, and 6-performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results: During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions: The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.Foundation to Fight against Nosocomial InfectionsThe funding for the activities carried out at INICC head quarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections

Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC)

Yalcin, Ata Nevzat/0000-0002-7243-7354; dursun, oguz/0000-0001-5482-3780; Geyik, Mehmet Faruk/0000-0002-0906-0902; Dursun, Oguz/0000-0001-5482-3780; Leblebicioglu, Hakan/0000-0002-6033-8543; Unal, Necmettin/0000-0002-9440-7893WOS: 000325254600011PubMed: 23623158Background: We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey. Methods: A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods. Results: The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001). Conclusion: Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Foundation to Fight against Nosocomial InfectionsFunding for the activities carried out at INICC headquarters were provided by the corresponding author, Victor D. Rosenthal, and the Foundation to Fight against Nosocomial Infections

Switching to tenofovir alafenamide in hbv: nationwide real life data of efficacy and safety from Turkey

.....

Real life efficacy, renal and lipid profile data of tenofovir alafenamide in switched chronic hepatitis B patients

....

Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study

Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients’ data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient’s demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients