Efficacy of Colistin Therapy in Patients with Hematological Malignancies: What if There is Colistin Resistance?

Objective: The objective of this study was to evaluate the clinical efficacy and appropriateness of colistin therapy in patients with hematological malignancies. Methods: Age, gender, type of hematologic malignancy, and potential carbapenem-resistant microorganism risk factors were all noted in this retrospective study. In empirical and agent-specific treatment groups, differences in demographic features, risk factors, treatment responses, and side effects were compared. Results: Sixty-three patients were included, 54% were male, and the median age was 49. In the last three months, the hospitalization rate history was 68%, and four patients had a hospitalization history in the ICU. Carbapenem-resistant K. pneumoniae colonization was present in 22 patients (35%). Gram-negative microorganisms were isolated in 34 patients (54%). The carbapenem, quinolone, and colistin resistance rates were 82%, 76%, and 4% respectively. Clinical and microbiological response rates were 60% and 69%. 7 and 28-day mortality rates were 17% and 35%. There was no significant difference in demographic data and comorbidities in empirical (n=48) and agent-specific (n=15) treatment groups. The rate of carbapenem and glycopeptide treatments before colistin was higher in the empirical treatment group (p = 0.004; p = 0.001). The rate of starting combined antibiotics was higher in the empirical treatment group (p = 0.016). Two of the patients developed renal failure in the first week after treatment. Conclusion: The use of empirical colistin may be unavoidable given the risk considerations. Shortly, colistin-resistant strains may also be a factor affecting treatment success negatively

Teaching the Academic Word List in Foreign Language Speaking Classes

WOS: 00043485270039

An overview: Tularemia and travel medicine

Tularemia is a bacterial zoonotic infection. The disease is endemic in most parts of the world, has been reported through the northern hemisphere between 30 and 71 degrees N latitude. Francisella tularensis causes infection in a wide range of vertebrates (rodents, lagomorphs) and invertebrates (ticks, mosquitoes and other arthropods). Humans can acquire this infection through several routes including; a bite from an infected tick, deerfly or mosquito, contact with an infected animal or its dead body. It can also be spread to human by drinking contaminated water or breathing contaminated dirt or aerosol. Clinical manifestation of this disease varies depending on the biotype, inoculum and port of entry. Infection is potentially life threatening, but can effectively be treated with antibiotics. Travelers visiting rural and agricultural areas in endemic countries may be at greater risk. Appropriate clothing and use of insect repellants is essential to prevent tick borne illness. Travelers also should be aware of food and waterborne disease; avoid consuming potentially contaminated water and uncooked meat. Physicians should be aware of any clinical presentation of tularemia in the patients returning from endemic areas. (C) 2014 Elsevier Ltd. All rights reserved

New threat: 2019 novel Coronavirus infection and infection control perspective in Turkey

Human coronaviruses (HCoV) were first described in the mid-1960s. HCoV is an enveloped RNA virus with a single chain and positive polarity. The name “corona” comes from the crown-like spikes on the surface of the virus. Four major subgroups are known as follows: alpha, beta, gamma and delta. Subtypes of coronaviruses circulating in humans (HCoV-229E, HCoV-OC43, HCoV-NL63 and HKU1-CoV) are mostly viruses that cause colds. Coronaviruses are zoonotic viruses that infect many mammals and birds [1]. There are many coronaviruses that have not been transmitted to humans yet but are detected in animals. Before the virus (most likely a bat virus) gained the ability to infect humans, it jumps an intermediate host as occurred in previous outbreaks. It has been revealed that for emerge of SARS-CoV (Severe acute respiratory syndrome), civet cats played an imported role for transmission of disease to humans, whereas one-humped camels played an intermediate host for MERS-CoV (Middle East Respiratory Syndrome) [2]. SARS-CoV was first defined in February 2003 in Asia (Guandong, China) and has spread to more than two dozen countries in North and South America, Europe and Asia. In about eight months, 8098 people are infected, and 774 people died. Since 2004, to our knowledge, there have been no new cases reported in the world. MERS- CoV also causes a severe respiratory disease with symptoms of fever, cough and shortness of breath. The disease was seen for the first time in September 2012 in Saudi Arabia, and all the patients with MERS- CoV had a history of travel or residence in the Arabian Peninsula and nearby countries. Outside the Arabian Peninsula, the disease was seen in the Republic of Korea in 2015. Again, the outbreak was associated with a traveler returning from the Arabian Peninsula. To date, 2494 people have been infected, and there 858 related deaths were reported related to MERS [2, 3]

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