The acute hepatic flare in a patient with chronic hepatitis C infection receiving pegylated interferon alpha 2b and ribavirin

The pegylated interferon alpha and ribavirin treatment is well established therapy for hepatitis C virus (HCV) infection.During the treatment alanine aminotransferase (ALT) flare may be observed rarely.A 51-year-old female receiving pegylated interferon and ribavirin therapy for HCV infection, complained nausea, vomitingin seventh week of the therapy, and her ALT level was detected over 20 times above the normal level. Hepatitis B surfaceantigen, anti-nuclear antibody, anti-mitochondrial antibody, anti-double stranded DNA antibody and anti-hepatitisA virus IgM antibody were negative, and thyroid stimulating hormone was normal. HCV RNA level was 424 IU/ml. PEGIFN and ribavirin therapy was interrupted for three weeks, after liver enzyme level was detected less than 100U/L, thetreatment was resumed. The patient was followed up for 2 months, ALT flare was not observed.In conclusion, we present a rare case with ALT flare, while receiving pegylated interferon and ribavirin therapy forchronic HCV infection. J Microbiol Infect Dis 2012; 2(3): 121-123Key words: Pegylated interferon, ribavirin, ALT flare, hepatitis C viru

Antibiotic Susceptibilities of iPseudomonas aeruginosa, Klebsiella pneumoniae/i and iAcinetobacter baumannii/i Strains Isolated from Patients in the Pediatric Intensive Care Unit

Objective:In this study, it was aimed to determine the antibiotic susceptibility of <i>Pseudomonas aeruginosa, Klebsiella pneumoniae</i> and <i>Acinetobacter baumanii</i> bacteria isolated from blood and endotracheal aspirate samples, and to start the appropriate empirical antibiotic treatment.Materials and Methods:The antibiogram results of the patients’ whose blood and endotracheal aspirate samples sent from Erciyes University Faculty of Medicine Pediatric Intensive Care Unit to our hospital between January 1, 2013-August 30, 2017, and <i>Pseudomonas aeruginosa, Klebsiella pneumoniae</i> and <i>Acinetobacter baumannii</i> bacteria reproduction detecting were evaluated retrospectively.Results:One hundred thirty-five samples sent from a total of 111 patients [65 male (63.6%), 56 female (36.4%)] with a median age of 17 months (7-112) were analyzed retrospectively. Of these samples reproduction of <i>Pseudomonas aeruginosa</i> were detected in 68 [blood: 31, endotrakealaspirat (ETA): 37], <i>Acinetobacter baumannii</i> in 42 (blood: 22, ETA: 20), <i>Klebsiella pneumoniae</i> in 25 samples (blood: 18, ETA: 7). Amikacin resistance rate was the lovest antibiotic (23.7%), while cefepime, ceftazidime, meropenem, ciprofloxacin and gentamicin resistance rates were 49.6%, 53.7%, 62.2%, 46.7% and 60%, respectively. Amikacin resistance was determined as 5.9%, 64.3% and 4% for <i>Pseudomonas aeruginosa, Acinetobacter baumannii</i> and <i>Klebsiella pneumoniae</i>, respectively.Conclusion:Our study also suggests that, clinicians should be more careful when deciding to use this drug because of the severe carbapenem resistance for <i>Acinetobacter, Pseudomonas</i> and <i>Klebsiella</i> in Intensive Care Units. It also reveals that amikacin is a good option in empirical treatment

In Vitro Activity of Tigecycline Against Francisella tularensis Subsp holarctica in Comparison with Doxycycline, Ciprofloxacin and Aminoglycosides

Francisella tularensis is the etiological agent of tularemia which is a zoonosis of the northern hemisphere. For decades, streptomycin was considered the drug of choice, despite possible side effects, and vestibular toxicity in particular. Alternatives are tetracylines and chloramphenicol which are bacteriostatic agents that are associated with a considerable risk of relapse. The aim of the present study was to assess the in vitro susceptibility of F.tularensis subsp. holarctica biovar II strains to tigecycline, a member of a new class of glycylcyclines. Fourteen F.tularensis strains isolated from patients in Central Anatolia region of Turkey were examined. Minimum inhibitory concentration (MIC) values of tigecycline, doxycycline, streptomycin, gentamicin, and ciprofloxacin were determined using the E-test method on glucosecysteine blood agar plates. Interpretation of results was made according to CLSI clinical breakpoints. All strains were susceptible to the antibiotics traditionally used to treat tularemia. Tigecycline showed good in vitro activity to all the isolates (MIC range: 0.094-0.38 mg/L). In this study, tigecycline was more active than doxycycline against F.tularensis subsp. holarctica strains, according to MIC50 (0.19 mg/L) and MIC90 (0.25 mg/L) values. Doxycycline (MIC90: 0.38 mg/L) showed good in vitro activity against all the isolates and MIC values interpreted according to the CLSI criteria for potential bioterrorism agents, have shown ranges below the breakpoint for sensitivity determination (S <= 4 mg/L). Ciprofloxacin had the lowest MIC50 and MIC90 values. In case the other antibiotics can not be used or intravenous therapy is required, tigecycline may be an important therapeutic alternative agent. However, confinement of tigecycline in the treatment of multi-drug resistant bacterial infections, its parenteral way of administration and overall cost were considered as the major limitations of tigecycline in tularemia treatment

Risk factors and clinical characteristics of virus Infection after haematopoietic stem cell transplantation

Risk factors and clinical characteristics of virus Infection after haematopoietic stem cell transplantation Gamze Kalın Ünüvar*1, Zeynep Ture Yuce1, Aysegül Ulu Kilic2 1University Of Erciyes Faculty Of Medicine, Kayseri, Turkey, 1University Of Erciyes Faculty Of Medicine, Kayseri, Turkey Background: BK polyomavirus is an important cause of morbidity and mortality in hematological patients after hematopoietic stem cell transplantation (HSCT). It is acquired in childhood and especially becomes latent in urothelial epithelial cells. Reactivation of virus after HSCT can be seen with asymptomatic viruria or hemorrhagic cystitis (HC). The aim of the study was to assess risk factors, clinical characteristics and treatment options of BK virus infection after HSCT. Materials/methods: We retrospectively analyzed information about patients with HSCT and BK virus (BKV) disease between January 2017-August 2019. Data included; underlying hematological disease, transplantation type, associated graft versus host disease (GVHD) and recent use of immunosuppressive agent. Results: In total fifty-eight patients with HSCT were evaluated and BKV disease occurred in 20 (34%). The median age was 40 (range, 20 to 68), 50% were male. The most underlying disease was Acute Myeloid Leukemia (n=11). Five patients had autologous and fifteen patients had allogeneic SCT. The median time to engraftment was 15 days (range, 10 to 20). GVHD was seen eleven patients (40% skin, 15% gastrointestinal GVHD). These patients received systemic glucocorticoid therapy or immunosuppressant agents. The median time elapsed to BK virus disease after HSCT was 60 days (range, 30 to 450). Sixteen patients with BKV disease had high grade (grade 3) HC and four patients had low-grade HC (grade 2). While BK viremia was positive in 17 patients (68%), viruria was positive for all patients. Eight patients (15%) were treated with ciprofloxacin and cidofovir combination, six patients (30%) with cidofovir and three patients (15%) with ciprofloxacin. Three of them (20 patients) was treated by intravesical cidofovir. The complete response to the viruria or viremia was obtained from 11 patients (55%). Conclusions: HC associated with BKV is an emerging clinical problem after HSCT causing prolonged hospitalization and mortality. It can be severe because the treatment options are often ineffective. The main goal of treatment is to reduce the dose of immunosuppressive agents. Close monitoring of BK virus in high-risk patients can be an important method to improve the complication in the early period.</p

Determination of Risk Factors for the Colonization of Vancomycin Resistant Enterecocci in Chronic Hemodialysis Patients

iriş: Hastane ortamında kolonize olan vankomisine dirençli Enterokoklar (VRE) kuru yüzeylerde uzun süre canlı kalabilmeleri nedeniyle sağlık personelinin elleri ve çevreye temas yoluyla kolayca yayılabilir. Çalışmamızda nefroloji kliniğinde takip edilen, kronik hemodiyaliz hastalarında VRE kolonizasyonu gelişmesindeki risk faktörlerinin belirlenmesi amaçlandı.Materyal ve Metod: Bu çalışma hastane İnfeksiyon Kontrol Komitesi sürveyans takip formu ve hastane otomasyon sistemi bilgileri kullanılarak retrospektif olarak yapıldı. Hastaların demografik verileri, komorbiditeleri, immunsüpresyon, antibiyotik kullanım öyküsü ve kullanılan antibiyotikler, VRE kolonizasyonu açısından riskli servislerde yatış öyküsü, servisler arası transfer öyküsü ve VRE kolonizasyonu ya da infeksiyonu olan hasta ile aynı serviste yatış öyküsü varlığı kaydedildi. VRE ile kolonize olan hastalar vaka; aynı dönem içinde takip edilen ve kolonize olmayan hastalar kontrol grubu kabul edildi. Çoklu lojistik regresyon analizinde vaka ve kontrol grubu arasında anlamlı olarak fark bulunan parametreler risk faktörü olarak kabul edildi. Bulgular: Çalışmaya 64 vaka ve 72 kontrol grubu olmak üzere toplam 136 hasta dâhil edildi. Riskli servislerde yatış öyküsü (p= 0.003), servisler arasında transfer öyküsü varlığı (p= 0.001), VRE kolonize ya da infekte hastalarla aynı serviste bulunma (p= 0.006), ve antibi-yotik kullanım öyküsü (p= 0.004) tek değişkenli analizde anlamlı bulundu. Çoklu lojistik regresyon analizi sonucunda ise, servisler arası transfer öyküsü varlığı (β= 3.258 (%95 GA 1.65-9.05) p= 0.002), VRE’li hasta ile aynı dönemde serviste yatış öyküsünün olması (β= 2.80 (%95 GA 1.33-5.87) p= 0.006) ve VRE kolonizasyonu öncesi antibiyotik kullanım öyküsünün varlığı (β= 3.21 (%95 GA 1.45-7.12) p= 0.004) VRE kolonizasyonu için risk faktörü olarak bulundu.Sonuç: Uzun süreli ve gereksiz antibiyotik kullanımı enterokoklarda vankomisine karşı direnç gelişmesine neden olabilir. Bu yüzden antibiyotik kullanımında dikkatli olunmalıdır. VRE’li hasta ile aynı serviste yatma ve servisler arası transfer de VRE kolonizasyonu için risk faktörüdür. İnfeksiyon kontrolü ve gerekli izolasyon önlemlerine uyulması bu riskin azaltılması için önemlidir.Introduction: Vancomycin resistant Enterococci (VRE), can survive on dry surfaces for a long time, easily spread through contact withthe hands of healthcare professionals and the environment. In this study, we aimed to determine the risk factors for the developmentof VRE colonization in chronic hemodialysis patients in the nephrology clinic.Materials and Methods: This study was conducted retrospectively using Hospital Infection Control Committee surveillance follow-upform and hospital automation system. Demographic data, comorbidities, immunosuppression, antibiotic use history, and antibiotics,hospitalization history in risky services, transfer history between services, and presence of a history of hospitalization with the patientwith VRE colonization or infection were recorded. Patients colonized with VRE were accepted as the case and patients who were followedup in the same period and not colonized were accepted as the control group.Results: A total of 136 patients (64 cases and 72 control groups) were included into the study. As a result of multiple logistic regressionanalysis, the presence of transfer history between services (β= 3.258 (95% CI 1.65-9.05) p= 0.002), having a history of hospitalizationin the same period with the patient with VRE (β= 2.80 (95% CI 1.33-5.87) p= 0.006) and presence of a history of antibiotic use beforeVRE colonization (β= 3.21 (95% CI 1.45-7.12) p= 0.004) were found to be the risk factors for VRE colonization.Conclusion: Prolonged and unnecessary use of antibiotics may cause resistance to vancomycin in enterococci. Therefore, caution shouldbe exercised in the use of antibiotics. Hospitalization with VRE patient and transfer between services are also risk factors for VRE colonization. Infection control and compliance with necessary isolation measures are important to reduce this risk.&nbsp;</p