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

Sand fly Fever with Skin Lesions: A Case Series from Turkey

Sand fly fever (SF) is an arthropod-borne viral disease, also known as “Phlebotomus fever”, ‘’mosquito fever’’, three-day fever or “Papatacci fever”. It is transmitted by Phlebotomus papatasi, starts with acute onset of high fever, and lasts for three days. We present first cases in a different district of Turkey with the clinical findings of fever, myalgia-arthralgia, headache, gastrointestinal symptoms such as diarrhoea and nausea-vomiting and skin lesions (in two of them). All the patients were treated symptomatically and discharged with complete cure. These cases are indicating that sand fly fever is more common than we thought. It should be considered in the differential diagnosis in patients presenting with fever, arthralgia-myalgia and skin lesions, especially it is important to be aware of this disease in travellers returning from endemic areas

Bcg Sepsis After Intravesical Bcg Instillation: A Case Report

Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is an effective and frequently used treatment for superficial bladder cancer. Local side effects are frequent, whereas systemic side effects are rare, but more serious. In this paper, it was aimed to present a male patient who developed BCG sepsis after intravesical BCG instillation for bladder carcinoma.Wo

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

WOS: 000458956900002Introduction: Bacteria of the genus Acinetobacter play an important role as causative agents of hospital-acquired infections. 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 (bioMerieux SA, France) system. Resistance to three or more drugs was considered as multidrug resistance. MIC, MIC50, and MIC90 values (mu 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 (<= 4 or 8 mu g/mL). Results: The MIC values of sulbactam against the Acinetobacter isolates ranged widely (between 1 and 256 mu g/mL), and the MIC50 and MIC90 values were determined to be 12 and 96 mu g/mL, respectively. When 8 mu 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 mu 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

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

WOS: 000437086400007Aim: 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

Synergistic effects of sulbactam in multi-drug-resistant Acinetobacter baumannii

Abstract Acinetobacter baumannii is a frequently isolated etiologic agent of nosocomial infections, especially in intensive care units. With the increase in multi-drug resistance of A. baumannii isolates, finding appropriate treatment alternatives for infections caused by these bacteria has become more difficult, and available alternate treatments include the use of older antibiotics such as colistin or a combination of antibiotics. The current study aimed to evaluate the in vitro efficacy of various antibiotic combinations against multi-drug resistant A. baumannii strains. Thirty multi-drug and carbapenem resistant A. baumannii strains isolated at the Ankara Training and Research Hospital between June 2011 and June 2012 were used in the study. Antibiotic susceptibility tests and species-level identification were performed using conventional methods and the VITEK 2 system. The effects of meropenem, ciprofloxacin, amikacin, tigecycline, and colistin alone and in combination with sulbactam against the isolates were studied using Etest (bioMérieux) in Mueller-Hinton agar medium. Fractional inhibitory concentration index (FIC) was used to determine the efficacy of the various combinations. While all combinations showed a predominant indifferent effect, a synergistic effect was also observed in 4 of the 5 combinations. Synergy was demonstrated in 43% of the isolates with the meropenem-sulbactam combination, in 27% of the isolates with tigecycline-sulbactam, and in 17% of the isolates with colistin-sulbactam and amikacin-sulbactam. No synergy was detected with the sulbactam-ciprofloxacin combination and antagonism was detected only in the sulbactam-colistin combination (6.66% of the isolates). Antibiotic combinations can be used as an alternative treatment approach in multi-drug resistant A. baumannii infections

Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused by Pseudomonas aeruginosa

Background. Pseudomonas aeruginosa (P. aeruginosa) is resistant to various antibiotics and can cause serious nosocomial infections with high morbidity and mortality. In this clinical study, we investigated the risk factors in patients who were diagnosed with P. aeruginosa-related nosocomial infection. Methods. A retrospective case control study including patients with P. aeruginosa-related nosocomial infection. Patients who were resistant to any of the six antibiotics (imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, amikacin, and ceftazidime) constituted the study group. Results. One hundred and twenty isolates were isolated. Various risk factors were detected for each antibiotic in the univariate analysis. In the multivariate analysis, previous cefazolin use was found as an independent risk factor for the development of imipenem resistance (OR = 3.33; CI 95% [1.11-10.0]; = 0.03), whereas previous cerebrovascular attack (OR = 3.57; CI 95% [1.31-9.76]; = 0.01) and previous meropenem use (OR = 4.13; CI 95% [1.21-14.07]; = 0.02) were independent factors for the development of meropenem resistance. For the development of resistance to ciprofloxacin, hospitalization in the neurology intensive care unit (OR = 4.24; CI 95% [1.5-11.98]; = 0.006) and mechanical ventilator application (OR = 11.7;]; = 0.004) were independent risk factors. Conclusion. The meticulous application of contact measures can decrease the rate of nosocomial infections