Invasive Pulmonary Aspergillosis in a Patient with Acute Lymphoblastic Leukemia

Fungal infections are common and life-threatening among immunosupressive patients.Invasive pulmonar aspergilloz (IPA) generally occurs when Aspergillus inhaled, but rarelywith the hematogen spread of dermal or gastrointestinal Aspergillus. We present here, IPA ina 58 year-old male patient with acute lymphoblastic leukemia (ALL). He was admitted to ourclinic with fatigue, weakness, pansitopenia, and with petechia. Supportive treatment,vincristine and prednisone was initiated. Chest roentgenogram was normal. Dyspnea andfever (39.5’C) were seen after 1 month of therapy. Thorax high resolution computerizedtomography was obtained and cavitary lesion was seen in the left upper-anterior segment oflung. Sputum and blood culture were negative. In spite of the empiric use of Meropenem 3gr/d, Vancomycin 2 gr/d and fluconazole 200 mg/d, fever was not turned to normal andclinical symptoms were not healed. On the fifth days of therapy amphotericin-B was initiatedand the other antibiotics were stopped after 3 days. General symptoms were healed on the 8thdays. Radiologic findings were improved partially after 20 days. The patient clinically is welland remains in remission and radiologic findings were turn to near normal after 10 monthsof treatment. We aimed to emphasis about treatment of empirical Amphotericin-B incritically ill patient with ALL

Impact of an educational meeting on knowledge and awareness of general practitioners on upper respiratory tract infections

Objectives: This study aimed to evaluate knowledge ofprimary care physicians regarding the use of antibioticsfor the upper respiratory tract infections (URTIs) and thespecific outcomes of a health educational meeting in twocities using a self -administered questionnaire.Materials and methods: A standard questionnaire wasfilled by the participants before and after the meeting. Thequestionnaire had seven questions about definition, epidemiology,diagnosis and treatment of URTIs. The knowledgeand approaches of practitioners concern about diagnosisand antibiotic use in URTIs were evaluated. Theproportion of overall satisfied answers before and afterthe meeting was compared.Results: Totally 110 primary care physicians joined intothe study. Before the educational meeting, more than30% of participants stated that the at least 50% of thecausative agents of the URTIs are bacteria. Eighty-eightpercent declared that anaerobes or Neisseria are not theplausible causative agents in URTIs. Only 14% of them indicatedthat procaine penicillin is the primary agent for thetreatment of Streptococcus pyogenes. On the other hand,95% of survey participants considered that penicillin isthe first choice for URTI with Beta-hemolytic Streptococcus.After the educational meeting, most of participants’knowledge showed a significant improvement in knowledge.There were a significantly more correct answers toall questions after the educational meeting compared tobefore the meeting. (27.7% of doctors before vs.92.7%after, p<0.001).Conclusion: As a conclusion, attending the educationalmeetings helps primary care physicians’ to increase theirknowledge and it provides to gain a standard approach intheir professional life

The efficacy of dexamethasone treatment in massive enteric bleeding in typhoid fever

Geyik, Mehmet Faruk/0000-0002-0906-0902WOS: 000263789900025PubMed: 19211432

Risk Factors for Multi-Drug-Resistant Pseudomonas aeruginosa Infections in a University Hospital-A Case Control Study

WOS: 000375099700002Purpose: This study aims to determine the risk factors associated with multi-drug-resistant Pseudomonas aeruginosa (MDR-Pa) infections. Methods: A case control study was conducted at the Dicle University Hospital which is 1150-bed tertiary care teaching hospital in Diyarbakir, Turkey. The study cases were recruited from patients with nosocomial MDR-Pa infections. Two control cases were arranged to compare risk factors of MDR-Pa infections. One of the control groups was composed of patients with non-MDR-Pa infections and the other group with non-MDR Gram-negative bacterial infections except P. aeruginosa. Results: Overall, 225 patients were included in the study, 75 with MDR-Pa infections, 150 control cases (75 non-MDR-Pa and 75 MDR Gram-negative non P. aeruginosa infections). The incidence of MDR-Pa infections was found as 3.1/1,000 admissions. Multivariate analysis showed that multiple invasive procedures (Relative Risk 24.57 (95% Confidence Interval 4.45-135.73) p10 days) (RR 4.68 (CI=2.09-10.49) p<0.001), were found to be risk factors for MDR-Pa. Conclusions: This study revealed that severity of clinical course and carbapenem use are significant risk factors for MDR-Pa infections

Critical evaluation of antimicrobial use - A Turkish university hospital example

Geyik, Mehmet Faruk/0000-0002-0906-0902WOS: 000328083900015PubMed: 24240047Introduction: Antimicrobials are being used unnecessarily for different reasons. The aims of this study were: assessment of the quality of antimicrobial use and determination of the factors related to correct use. Method: Antimicrobial practice at Dicle University Hospital (DUH) was evaluated with a point prevalence approach. Using a standardized data collection form, the patients' data (clinic, epidemiology, laboratory and antimicrobial use) was collected. Possible influential factors on antimicrobial use were examined. Results: In the surveillance study 1,350 inpatients were evaluated; 461 (34.1%) of them were using antimicrobials for treatment and 187 (13.9%) for prophylaxis. Antimicrobial indication was found in 355 of 461 patients (77.0%), and the number of antimicrobials was 1.8 per patient in the treatment group. The most common reason for antimicrobial use was community-acquired infection (57.9%). Pneumonia (20.4%), skin and soft tissue infections (9.11%) and urinary tract infections (7.9%) were the most common infectious diseases. Positive culture results were available for 39 patients (8.5.0%) when antimicrobial treatment started. All steps of antimicrobial use were found appropriate in 243 patients (52.7%). In multivariate analyses, clinical manifestation of infection at the beginning (p<0.001), presence of leukocyte counting (p<0.001) and prescription by an infectious disease specialist were found significantly positive factors for wholly appropriate antimicrobial use. Hospitalization with a diagnosis other than infection was found a significantly negative factor for appropriate antimicrobial use (p=0.001). Conclusion: The quality of antimicrobial use could be improved with better clinical and laboratory diagnosis and consultation with infectious diseases specialist

Evaluation of false negativity of the Widal test among culture proven typhoid fever cases

Geyik, Mehmet Faruk/0000-0002-0906-0902WOS: 000208250300013PubMed: 19745527Background: The Widal test is the most common, specific and quick diagnostic method available in the world for diagnosis of typhoid fever; however, false negativity is one of the obstructive features of the test. The aim of this study was to evaluate the associated factors with Widal test negativity in an endemic area. Methods: Widal test negativity was retrospectively analyzed among culture-proven typhoid fever cases. The potential features including age, gender, previous antibiotic usage, duration of symptoms, leucopoenia, hematocrit value, and erythrocyte sedimentation rate (ESR) were evaluated for association with Widal test negativity. Results: A total of 166 culture-proven typhoid fever cases (93 or 56.0% males) were included in the study. The mean age +/- SD was 23.3 +/- 10.6 years. Mean time of interval between first symptom and test performance time was 10.6 +/- 7.8 days. The Widal test (STO and/or STH) was found positive in 75 cases (45.2%). The statistical analyses revealed that none of these variables were significant for false negativity of the Widal test. Age was found to be a possible factor for a false negative Widal test (p=0.06). Conclusion: Of existing compatible clinical findings, age should be considered in cases of Widal test negativity

The accuracy and validity of a weekly point-prevalence survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey

Geyik, Mehmet Faruk/0000-0002-0906-0902WOS: 000296092400005PubMed: 21757384Objective: To evaluate the validity of a weekly point-prevalence survey (WPS) by comparing it with a prospective-active incidence survey (PIS). Methods: WPS and PIS were conducted at a tertiary referral hospital between January and December 2006. Each Wednesday, an infection control team reviewed all clinical records of patients with hospital-acquired infections (HAIs) by WPS. Routine PIS was conducted with daily visits by the same team. The Rhame and Sudderth formula was used for converting the data between WPS and PIS. Results: During the study period, 1287 HAIs were detected in 37 466 patients by WPS. The mean observed prevalence and calculated prevalence were 5.42% and 5.45%, respectively. The reanimation intensive care unit (ICU) (49.4%) and burns unit (27.6%) had the highest prevalence rates. Pneumonia (0.94%) and urinary tract infections (0.37%) were the most frequent infections. Overall 602 HAIs were detected in 545 patients by PIS. The mean observed incidence and calculated incidence were 2.42/1000-admissions and 2.41/1000-admissions, respectively. The Critical care ICU (37.0/1000-admissions) and burns unit (24.8/1000-admissions) had the highest incidences of HAI. Pneumonia (0.64/1000-admissions) and urinary tract infections (0.37/1000-admissions) were the most frequent infections. Conclusions: This study confirms a close relationship between prevalence and incidence data. WPS may be a useful method for following HAIs when PIS cannot be performed. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved

The evaluation of geriatric infections: Dicle experience [Geri?atri?k i?nfeksi?yonlarin de?erlendi?ri? lmesi?: Di?cle deneyi?mi?]

• Objective: Although successes have been achieved in the treatment of the infectious diseases with antibiotics in nowadays, infectious diseases are still serious problem in the elderly. This study was conducted in order to determine the pattern of clinical infectious diseases in hospitalized elderly patients. • Material and Method: In this study, the data of all elderly patients aged 65 and older, were hospitalized to our clinic between May 2000 and May 2005 were evaluated retrospectively. We reviewed 301 patients for diagnostic studies, risk factors, isolated microorganisms and morbidity and mortality rates. • Results: Infections as a cause of hospitalization were identified as the following frequency; sepsis (19.2%), pneumonia (17.9%), acute gastroenteritis (16.9%), acute bacterial meningitis (5.3%) and urinary tract infection (3.6%), respectively. E. coli was the most isolated microorganism in these patients. Hypertension, chronic obstructive pulmonary disease and diabetes were seen as risk factors in our patients. Seventy-three patients died during hospital stay due to their infection and chronic diseases. • Conclusion: Under diagnosis of the elderly diseases is very common due to many factors related to elderly, family members and health workers. Prognosis is rather worse especially in sepsis due to pneumonia and urinary tract infections