The Effect of Antibiotic Resistance and Inappropriate Empirical Antibiotic Therapy on 3-Day and 28-Day Mortality in Bacteremic Patients in the Intensive Care Unit: 5-Year Retrospective Analysis

Aim: The aim of this study was to examine the effects of antibiotic resistance, empirical antibiotic therapy, and comorbid diseases on 3-day and 28-day mortality in patients with bloodstream infections. Material and Methods: Files of the patients with positive blood cultures results, between January 1st, 2015, and January 1st, 2020 were analyzed retrospectively. The primary outcome was 3-day mortality and the secondary outcome was 28-day mortality. Results: A total of 515 patients, 208 (40.4%) female and 307 (59.6%) male, were included in the study. The median age of the patients was 73 (range, 18-95) years. Vancomycin resistance was detected in 8 (3.4%) of 233 gram-positive bacteria. Third-generation cephalosporin, meropenem, and colistin resistance rates of the 282 gram-negative bacteria were found to be 72.7% (n=205), 53.2% (n=150), and 9.9% (n=28), respectively. The 3-day and 28-day mortality rates were 14.4% (n=74) and 64.3% (n=331), respectively. Charlson comorbidity index score (CCIS) (p=0.001) and acute physiology and chronic health evaluation (APACHE) II score (p=0.019) were found to be risk factors for 3-day mortality. Risk factors for 28-day mortality were; age (p<0.001), CCIS (p<0.001), APACHE II score (p=0.001), chronic obstructive pulmonary disease (p=0.007), hospital-acquired infection (p=0.033), and inappropriate antibiotic therapy (p<0.001). Conclusion: There was no association between antibiotic resistance and mortality, but inappropriate antibiotic treatment was found to increase the risk of 28-day mortality. In addition, since high CCIS and APACHE II scores increase the risk of both 3-day and 28-day mortality, we think that considering these scoring systems will reduce the risk of mortality

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

The Effect of Sex-Specific Genetic Factors on the Host Immune Response to COVID-19: A Pilot Study

Objective: The aim of this study was to investigate the impact of sex-specific genetic factors in the pathogenesis and prog-nosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-induced macrophage activation syndrome (MAS), independent of age and comorbidity presence.Materials and Methods: Patients aged 18-50 years who had been diagnosed with coronavirus 2019 (COVID-19), the disease caused by the SARS-CoV2 virus, were enrolled in a prospective, case-control, multi-center study. Genetic alterations and messenger RNA (m-RNA) expression levels of the TLR7, TLR8, ACE2, CD40L, CXCR3, and TASL genes were determined using DNA sequencing analysis, and gene expression was determined using quantitative reverse transcriptase polymerase chain reaction testing. PolyPhen-2 (Polymorphism Phenotyping v2; Adzhubei et al., 2010) and SNAP2 (Rostlab, Munich, Germany) genetic analysis tools were used to define the pathogenic effects of detected mutations by sequencing the selected genes in hotspot regions.Results: The study group consisted of 80 patients diagnosed with COVID-19 and was divided into groups based on sex and MAS status. Twenty-nine mutations were detected in 6 genes. Among the alterations, 15 were identified in this study for the first time and 9 were pathogenic. Pathogenic missense mutations in the TLR7, TLR8, ACE2, and TASL genes were detected in the MAS (+) group. In males, decreased TLR7, TLR8, and CXCR3 expression was statistically significant in the MAS (+) group (p&lt;0.050). CXCR3 expression was lower in the female and male MAS (+) groups compared with the MAS (-) groups (p&lt;0.050).Conclusion: In the absence of major risk factors for COVID-19, the TLR7/8, ACE2, and CXCR3 variants and decreased m-RNA expression levels associated with genetic susceptibility may be independent prognostic risk factors for COVID-19.</p

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

Childhood interstitial lung disease in Turkey: first data from the national registry

Abstract: The childhood interstitial lung diseases (chILD) Turkey registry (chILD-TR) was established in November 2021 to increase awareness of disease, and in collaboration with the centers to improve the diagnostic and treatment standards. Here, the first results of the chILD registry system were presented. In this prospective cohort study, data were collected using a data‐entry software system. The demographic characteristics, clinical, laboratory, radiologic findings, diagnoses, and treatment characteristics of the patients were evaluated. Clinical characteristics were compared between two main chILD groups ((A) diffuse parenchymal lung diseases (DPLD) disorders manifesting primarily in infancy [group1] and (B) DPLD disorders occurring at all ages [group 2]). There were 416 patients registered from 19 centers. Forty-six patients were excluded due to missing information. The median age of diagnosis of the patients was 6.05 (1.3–11.6) years. Across the study population (n = 370), 81 (21.8%) were in group 1, and 289 (78.1%) were in group 2. The median weight z-score was significantly lower in group 1 (− 2.0 [− 3.36 to − 0.81]) than in group 2 (− 0.80 [− 1.7 to 0.20]) (p < 0.001). When we compared the groups according to chest CT findings, ground-glass opacities were significantly more common in group 1, and nodular opacities, bronchiectasis, mosaic perfusion, and mediastinal lymphadenopathy were significantly more common in group 2. Out of the overall study population, 67.8% were undergoing some form of treatment. The use of oral steroids was significantly higher in group 2 than in group 1 (40.6% vs. 23.3%, respectively; p = 0.040). Conclusion: This study showed that national registry allowed to obtain information about the frequency, types, and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. What is Known: • Childhood interstitial lung diseases comprise many diverse entities which are challenging to diagnose and manage. What is New: • This study showed that national registry allowed to obtain information about the frequency, types and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. Also, our findings reveal that nutrition should be considered in all patients with chILD, especially in A-DPLD disorders manifesting primarily in infancy

The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

Abstract This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity