A surveillance of nosocomial candida infections: epidemiology and influences on mortalty in intensive care units

Introduction: it was aimed to investigate the frequency of Candida infections (CI) in the intensive care units (ICU), to determine typing of candida to evaluate risk factors associated with CI and mortality, and to evaluate influence of CI on mortality. Methods: the prospective cohort study was carried out between Jan 1, 2009 and Dec 31, 2010 in ICUs, and the patients were observed with active surveillance. VITEK 2 Compact System (BioMerieux, France) kits were used for the identification of isolates from various clinical samples. Results: a total of 2362 patients had enrolled for 16135 patients-days into the study. During the study, 63 (27,5%) of patients developed 77 episodes of CI were observed. Of the patients; 54% were male, 46% were female. Duration of hospitalization (OR=1,03, p=0,007), hyperglycemia (OR=17,93, p=0,009), and co- infections (OR=3,98, p=0,001) were identified as independent risk factors for CI. The most common infections were bloodstream (53%). 77 of 135 candida strains was isolated as causative pathogens. C. albicans (63,6%) was the most frequent species. Overall mortality rate was 78%. The rates of mortality attiributable to CI and candidemia were 27%, and 18,3% respectively. Species- specific mortality rates of C.albicans and C.tropicalis were determined as 12%. High APACHE II scores (OR=1,37; p=0,002), and the use of central venous catheter (OR=9,01; p=0,049) were assigned as independent risk factors for mortality. Conclusion: CI is an important problem in our hospital. CI and associated mortalty can be prevented by controlling of risk factors. Updating of epidemiological data is required for successful antifungal treatment

Naiv hepatit C enfeksiyonlu hastaların on-altı yıllık prognozu

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p<0.001, p<0.001, and p=0.005, respectively). In the study group, 19.2% of the patients underwent liver biopsy and 4.1% underwent transient elastography (FibroScan). An increased histological activity index (HAI) score and fibrosis in the second biopsy were observed in one patient, only increased HAI in two patients and increased fibrosis in one patient, as shown on the FibroScan. In the 16 years of the study period, cirrhosis was radiologically detected in only one patient. Conclusion: Even if rapid progression is not observed, close monitoring of the clinical findings related to liver failure and fibrosis with invasive or non-invasive methods may be useful.Amaç: Bu çalışmada ülkemizin çeşitli merkezlerinde takip edilen naiv hepatit C virüs (HCV) ile enfekte hastaların klinik seyrini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma retrospektif olarak 15 merkezin katılımıyla gerçekleştirilmiştir. Çalışmaya 18 yaş üstü, HCV enfeksiyonu olan hastalar dahil edilmiştir. Bulgular: Çalışmada 391 tedavi-naiv HCV enfeksiyonlu hasta yer almıştır. Hastaların takip süresinde son alanine aminotransferase, aspartate transaminase ve total protein değerleri ilk düzeyine göre önemli düzeyde azalmıştır (sırasıyla p<0,001, p<0,001, p=0,005). Çalışma grubunda hastaların %19,2’sine karaciğer biyopsisi, %4,1’ine elastografi (FibroScan) uygulanmıştır. Takip esnasında bir hastada ikinci biyopside histolojik aktivite indeksi (HAI) ve fibroziste artma, iki hastada sadece HAI’da artma, birinde FibroScan ile fibrozis değerinde artma olduğu gözlenmiştir. Bir hastada 16 yıl içinde radyolojik olarak siroz saptanmıştır. Sonuç: Hızlı progresyon gözlenmemekle birlikte hastaların izleminde karaciğer yetmezliği ile ilgili klinik bulguların ve invaziv veya noninvaziv yöntemlerle fibrozisin yakın takibi yararlı olabilir

A surveillance of nosocomial candida infections: epidemiology and influences on mortalty in intensive care units

Abstract Introduction: it was aimed to investigate the frequency of Candida infections (CI) in the intensive care units (ICU), to determine typing o

Treatment of nosocomial candidemia and invasive aspergillosis: current approaches

nvaziv fungal infeksiyonların (İFİ) immunsistemi baskılanmış hastalarda yönetimi çok önemli bir konudur. Candida spp. ve Aspergillus spp. hastane kaynaklı İFİ’in en sık görülen nedenleridir. Her iki mantar infeksiyonunun da mortalite oranları yüksektir. Özgün klinik bulgular göstermedikleri için risk faktörlerinin takibi, şüpheli olgularda uygun örneklerin alınması, en hızlı tanı yöntemlerinin kullanılması ve tedavinin erken başlanması hayati önem taşır. Bu yazıda "Amerika İnfeksiyon Hastalıkları Derneği (IDSA)", "Alman İnfeksiyon Hastalıkları Çalışma Grubu (AGIHO) ve Hematoloji-Onkoloji derneği (DGHO)", "Avrupa Lösemide İnfeksiyonlar Konferansı (ECIL)" ve "Avrupa Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği (ESCMID)" rehberleri ve uzman görüşleri gözden geçirilmiştir. Uygun tedavinin hasta ve merkezin özelliklerine göre belirlenmesi gerekir. Kandidemi tedavisi için nötropenik olmayan hastalarda belirli kriterlere göre kaspofungin, mikafungin, anidulafungin, vorikonazol veya lipozomal amfoterisin B (LAmB) önerilen primer ajanlardır. Nötropenik hastalarda kandidemi tedavisinde kaspofungin, mikafungin, anidulafungin veya LAmB kullanılması uygundur. İnvazif aspergillozisin (İA) primer tedavisinde vorikonazol önerilir. Posakonazol, LAmB veya kaspofungin İA’nın kurtarma tedavisi için antifungal ajanlardır. Ampirik tedavide kandidemi şüphesinde nötropenik olmayan hastalar için flukonazol, kaspofungin, anidulafungin veya mikafungin uygundur. Nötropenik hastalarda İA şüphesinde ampirik tedavi LFAmB, vorikonazol, mikafungin veya kaspofungin ile tavsiye edilir. Kandidiyazis riskindeki hastalar için proflaksi olarak risk faktörlerine göre flukonazol, posakonazol, vorikonazol veya ekinokandinler kullanılabilir. Primer hastalığa göre posakonazol, vorikonazol, itrakonazol, mikafungin veya kaspofungin İA için proflaktik olarak önerilir. Bu derlemenin amacı Kandida ve Aspergillus infeksiyonlarının tedavisinde temel yaklaşımları hatırlatmak, güncel kılavuzları inceleyerek yol haritalarının belirlenmesine yardımcı olmaktır.The management of invasive fungal infections (IFI) in immunosuppressive patients is a very important issue. Candida spp. and Aspergillus spp. are the most frequent causes of nosocomial IFIs. There are higher mortality rates in both of them. Due to there are no specific symptoms of IFIs, evaluating risk factors of those patients, taking appropriate samples in suspected cases, early diagnosis and prompt initiation of antifungal treatment are crucial behaviors for targeting satisfactory outcomes. In this article, we review "The Infectious Diseases Society of America (IDSA)", "The Infectious Diseases Working Party (AGIHO) and The German Society Hematology and Oncology (DGHO)", 'European Conference on Infections in Leukemia’ (ECIL) and "The European Society for Clinical Microbiology and Infectious Diseases (ESCMID)" guidelines and expert opinions. The appropriate treatment needs to be adjusted according to characteristics of patients and health care centers. Caspofungin, micafungin, anidulafungin, voriconazole or liposomal amphotericin B (LAmB) is the primary agents recommended for the treatment of candidemia in nonneutropenic patients according to specific criteria. Caspofungin, micafungin, anidulafungin or LAmB is the convenient agents for the management of neutropenic individuals, as well. Voriconazole is recommended for the treatment of invasive aspergillosis (IA). Besides posaconazole, LAmB or caspofungin is the antifungal agents for salvage treatment of IA. Empirical therapy for suspected candidemia in non-neutropenic patients, fluconazole, caspofungin, anidulafungin or micafungin is proper. Empirical therapy with an LFAmB, voriconazole, micafungin or caspofungin is recommended for suspected IA in neutropenic patients. As prophylaxis, fluconazole, posaconazole, voriconazole or echinocandins can be used for patients at risk of candidiasis according to the risk factors. According to primary disease posaconazole, voriconazole, itraconazole, micafungin or caspofungin is suggested as prophylaxis for IA. The goal of this review is to remind the main approaches for treatment of Candida and Aspergillus infections and to help determine a road map by searching current guidelines

Treatment of nosocomial candidemia and invasive aspergillosis: current approaches

nvaziv fungal infeksiyonların (İFİ) immunsistemi baskılanmış hastalarda yönetimi çok önemli bir konudur. Candida spp. ve Aspergillus spp. hastane kaynaklı İFİ’in en sık görülen nedenleridir. Her iki mantar infeksiyonunun da mortalite oranları yüksektir. Özgün klinik bulgular göstermedikleri için risk faktörlerinin takibi, şüpheli olgularda uygun örneklerin alınması, en hızlı tanı yöntemlerinin kullanılması ve tedavinin erken başlanması hayati önem taşır. Bu yazıda "Amerika İnfeksiyon Hastalıkları Derneği (IDSA)", "Alman İnfeksiyon Hastalıkları Çalışma Grubu (AGIHO) ve Hematoloji-Onkoloji derneği (DGHO)", "Avrupa Lösemide İnfeksiyonlar Konferansı (ECIL)" ve "Avrupa Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği (ESCMID)" rehberleri ve uzman görüşleri gözden geçirilmiştir. Uygun tedavinin hasta ve merkezin özelliklerine göre belirlenmesi gerekir. Kandidemi tedavisi için nötropenik olmayan hastalarda belirli kriterlere göre kaspofungin, mikafungin, anidulafungin, vorikonazol veya lipozomal amfoterisin B (LAmB) önerilen primer ajanlardır. Nötropenik hastalarda kandidemi tedavisinde kaspofungin, mikafungin, anidulafungin veya LAmB kullanılması uygundur. İnvazif aspergillozisin (İA) primer tedavisinde vorikonazol önerilir. Posakonazol, LAmB veya kaspofungin İA’nın kurtarma tedavisi için antifungal ajanlardır. Ampirik tedavide kandidemi şüphesinde nötropenik olmayan hastalar için flukonazol, kaspofungin, anidulafungin veya mikafungin uygundur. Nötropenik hastalarda İA şüphesinde ampirik tedavi LFAmB, vorikonazol, mikafungin veya kaspofungin ile tavsiye edilir. Kandidiyazis riskindeki hastalar için proflaksi olarak risk faktörlerine göre flukonazol, posakonazol, vorikonazol veya ekinokandinler kullanılabilir. Primer hastalığa göre posakonazol, vorikonazol, itrakonazol, mikafungin veya kaspofungin İA için proflaktik olarak önerilir. Bu derlemenin amacı Kandida ve Aspergillus infeksiyonlarının tedavisinde temel yaklaşımları hatırlatmak, güncel kılavuzları inceleyerek yol haritalarının belirlenmesine yardımcı olmaktır.The management of invasive fungal infections (IFI) in immunosuppressive patients is a very important issue. Candida spp. and Aspergillus spp. are the most frequent causes of nosocomial IFIs. There are higher mortality rates in both of them. Due to there are no specific symptoms of IFIs, evaluating risk factors of those patients, taking appropriate samples in suspected cases, early diagnosis and prompt initiation of antifungal treatment are crucial behaviors for targeting satisfactory outcomes. In this article, we review "The Infectious Diseases Society of America (IDSA)", "The Infectious Diseases Working Party (AGIHO) and The German Society Hematology and Oncology (DGHO)", 'European Conference on Infections in Leukemia’ (ECIL) and "The European Society for Clinical Microbiology and Infectious Diseases (ESCMID)" guidelines and expert opinions. The appropriate treatment needs to be adjusted according to characteristics of patients and health care centers. Caspofungin, micafungin, anidulafungin, voriconazole or liposomal amphotericin B (LAmB) is the primary agents recommended for the treatment of candidemia in nonneutropenic patients according to specific criteria. Caspofungin, micafungin, anidulafungin or LAmB is the convenient agents for the management of neutropenic individuals, as well. Voriconazole is recommended for the treatment of invasive aspergillosis (IA). Besides posaconazole, LAmB or caspofungin is the antifungal agents for salvage treatment of IA. Empirical therapy for suspected candidemia in non-neutropenic patients, fluconazole, caspofungin, anidulafungin or micafungin is proper. Empirical therapy with an LFAmB, voriconazole, micafungin or caspofungin is recommended for suspected IA in neutropenic patients. As prophylaxis, fluconazole, posaconazole, voriconazole or echinocandins can be used for patients at risk of candidiasis according to the risk factors. According to primary disease posaconazole, voriconazole, itraconazole, micafungin or caspofungin is suggested as prophylaxis for IA. The goal of this review is to remind the main approaches for treatment of Candida and Aspergillus infections and to help determine a road map by searching current guidelines

Neurobrucellosis; Three Case Reports

Various systematic complications occur in up to 30% of patients with brucellosis however brucellosis may involve central nervous system in only 2-5% of patients. In this study, the clinical and laboratory characteristics and therapeutic approach of three cases of neurobrucellosis (in a case series of 86 brucellosis patients) followed in our clinic between 1990-2004 were evaluated retrospectively. Cranial nerve involvement was present in all of these cases. Diagnosis was made based on the clinical features and pathological cerebrospinal fluid (CSF) findings and presence of the specific brucellosis antibodies in CSF. Rose-Bengal tests and Wright agglutination tests were positive in all cases. Three cases of neurobrucellosis treated with a combination of rifampicin, doxycycline and trimetoprim-sulphametoxazole for a period of six months and they become disease free, completely. As a conclusion, neurobrucellosis should be considered especially in the differential diagnosis of meningitis of undetermined origin where brucellosis is endemic like Turkey and other Mediterranean basin countries

Is there an influence of hepatic steatosis on fibrosis and necroinflammation in young patients with chronic viral hepatitis B?

Objectives: Our aim was to investigate the association of liver fibrosis and necroinflammation with HS in untreated young patients with chronic hepatitis B (CHB)

A surveillance of nosocomial candida infections: epidemiology and influences on mortalty in intensive care units

Introduction: it was aimed to investigate the frequency of Candida infections (CI) in the intensive care units (ICU), to determine typing of candida to evaluate risk factors associated with CI and mortality, and to evaluate influence of CI on mortality. Methods: the prospective cohort study was carried out between Jan 1, 2009 and Dec 31, 2010 in ICUs, and the patients were observed with active surveillance. VITEK 2 Compact System (BioMerieux, France) kits were used for the identification of isolates from various clinical samples. Results: a total of 2362 patients had enrolled for 16135 patients-days into the study. During the study, 63 (27,5%) of patients developed 77 episodes of CI were observed. Of the patients; 54% were male, 46% were female. Duration of hospitalization (OR=1,03, p=0,007), hyperglycemia (OR=17,93, p=0,009), and coinfections (OR=3,98, p=0,001) were identified as independent risk factors for CI. The most common infections were bloodstream (53%). 77 of 135 candida strains was isolated as causative pathogens. C. albicans (63,6%) was the most frequent species. Overall mortality rate was 78%. The rates of mortality attiributable to CI and candidemia were 27%, and 18,3% respectively. Species-specific mortality rates of C. albicans and C. tropicalis were determined as 12%. High APACHE II scores (OR=1,37; p=0,002), and the use of central venous catheter (OR=9,01; p=0,049) were assigned as independent risk factors for mortality. Conclusion: CI is an important problem in our hospital. CI and associated mortalty can be prevented by controlling of risk factors. Updating of epidemiological data is required for successful antifungal treatment

Comparison of neostigmine and sugammadex on postoperative nausea and vomiting in patients undergoing laparascopic cholecystectomy surgery

WOS: 000437950000008Purpose: The aim of this study is to compare the effects of neostigmine and sugammadex on the postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy surgery. Materials and Methods: Sixty patients (ASA I-III) and with a predicted operation time not exceeding 150 minutes were included to the study. Patients were divided into two groups. The first group received neostigmin, the second group received sugammadeks respectively. For anesthesia induction, all patients were applied thiopental (5-7 mg kg-1) and rocuronium (0.5 mg kg-1) intravenously and endotracheal entubation was provided. The lungs were ventilated with N2O (67%) and oxygen mixture (FiO2 33%) and anesthesia was maintained with desflurane. After completion of the surgery, cessation of desflurane and N2O while the last skin sutures were closured and neuromuscular blockade was reversed with atropine and neostigmine or sugammadeks. Extubation time and recovery time, postoperative hemodynamic variables and the other advers effects were recorded. Results: Extubation and recovery times were shorter in group sugammadex than in group neostigmine. Postoperative nausea and vomiting was lower in sugammadex group than neostigmine group at first twenty minutes, but this diffference was not significant. Conclusion: when neostigmine or sugammadex were applied for decurarization after general anesthesia with desflurane there is no superiority between sugammadeks or neostigmine for postoperative nausea and vomiting