Sabiha Salar-Gül, Nurullah Çiftçi, Hatice Türk-Dagı, Uğur Arslan
{"title":"Investigation of Respiratory Pathogens Responsible for Coinfection in COVID-19 Patients","authors":"Sabiha Salar-Gül, Nurullah Çiftçi, Hatice Türk-Dagı, Uğur Arslan","doi":"10.36519/kd.2024.4769","DOIUrl":"https://doi.org/10.36519/kd.2024.4769","url":null,"abstract":"","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141796703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sare Başağa, Zeynep Ture, Gamze Kalın Unver, G. Zararsiz, Orhan Yıldız, Bilge Aygen
Background: Since the New Coronavirus Disease (COVID-19) can also be spread by asymptomatic individuals, identifying asymptomatic carriers is a key point in the fight against the COVID-19 pandemic. With this study, it was aimed to draw attention to the COVID-19 polymerase chain reaction (PCR) test positivity rate sent before the operation / interventional procedure in asymptomatic individuals and to determine an estimated time about the decay time of the pandemic. Methods: All patients over the age of 18 who were sent COVID-19 PCR test before the operation or interventional procedure between July 1 and October 31, 2020 were included in the study. The patients were divided into two groups according to the periods when the peak was experienced or not. Results: 1070 patients were included in the study. PCR positivity was detected in 55 (5.14%) of the patients. The mean case incidence rate was 0.76% (2/263) in the months when the study was conducted and there was no COVID-19 peak, and 6.57% (53/807) in the months when the peak was observed. These rates were taken as reference for the months with and without peak. The time to reach 67%, which is accepted as the herd immunity limit, was calculated by adding 6.57% to the months corresponding to peak periods with 20-day periods starting from April 1, and the rate of 0.76% to the other months. Since there were two peaks after April 2020, the mass immunity rate reached until today has been calculated . If no COVID-19 peak occurs since this date, the possible pandemic attenuation time was determined as March 2022, and if the only peak occurs, May 2021. Conclusions: The incidence fluctuates with the restrictions, the risk of re-infection, the virüs being open to new mutations, and the initiation of vaccination programs make it difficult to predict the pandemic attenuation time. Key Words: COVID-19, SARS-COV-2, asymptomatic, herd immunity
{"title":"COVID-19 Pandemic Estimated End Date in Turkey","authors":"Sare Başağa, Zeynep Ture, Gamze Kalın Unver, G. Zararsiz, Orhan Yıldız, Bilge Aygen","doi":"10.36519/KD.2021.3704","DOIUrl":"https://doi.org/10.36519/KD.2021.3704","url":null,"abstract":"Background: Since the New Coronavirus Disease (COVID-19) can also be spread by asymptomatic individuals, identifying asymptomatic carriers is a key point in the fight against the COVID-19 pandemic. With this study, it was aimed to draw attention to the COVID-19 polymerase chain reaction (PCR) test positivity rate sent before the operation / interventional procedure in asymptomatic individuals and to determine an estimated time about the decay time of the pandemic.\u0000\u0000Methods: All patients over the age of 18 who were sent COVID-19 PCR test before the operation or interventional procedure between July 1 and October 31, 2020 were included in the study. The patients were divided into two groups according to the periods when the peak was experienced or not.\u0000\u0000Results: 1070 patients were included in the study. PCR positivity was detected in 55 (5.14%) of the patients. The mean case incidence rate was 0.76% (2/263) in the months when the study was conducted and there was no COVID-19 peak, and 6.57% (53/807) in the months when the peak was observed. These rates were taken as reference for the months with and without peak. The time to reach 67%, which is accepted as the herd immunity limit, was calculated by adding 6.57% to the months corresponding to peak periods with 20-day periods starting from April 1, and the rate of 0.76% to the other months. Since there were two peaks after April 2020, the mass immunity rate reached until today has been calculated . If no COVID-19 peak occurs since this date, the possible pandemic attenuation time was determined as March 2022, and if the only peak occurs, May 2021.\u0000\u0000Conclusions: The incidence fluctuates with the restrictions, the risk of re-infection, the virüs being open to new mutations, and the initiation of vaccination programs make it difficult to predict the pandemic attenuation time.\u0000\u0000Key Words: COVID-19, SARS-COV-2, asymptomatic, herd immunity","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84143881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Eren, A. Ulu-Kilic, Zeynep Türe, F. Cevahir, H. Kılıç, Emine Alp-Meşe
Objective: Carbapenem-resistant Klebsiella pneumoniae (CRKp) is among the leading causes of hospital-acquired infections worldwide and causes serious and life-threatening infections. Treatment options are very limited for blood stream infections (BSIs) and prognosis is poor due to increasing multi-drug resistance. The aim of this study was to assess risk factors for the mortality due to CRKp-BSI. Methods: A retrospective study was conducted in a university hospital from September 2013 to October 2017. Patients (aged >16 years) with CRKp-BSI were included in this study. Data, including demographics, Charlson comorbidity index (CCI), acute physiology and chronic health evaluation II (APACHE II) score on hospitalisation date, minimum inhibitory concentration (MIC) of CRKp, antibiotic treatment and outcome (30-day mortality) data were collected from the electronic medical records and microbiology databases. Results: A total of 82 patients with CRKP-BSIs were analysed. The median age was 54.5 years, and 48 (58.5%) of them were male. The median APACHE II score on hospitalisation was 14 (IQR 6-28) and CCI was 4.0 (IQR 0-12). Forty-six (56.1%) patients had ICU-acquired bacteremia and 36 (43.9%) had central-line associated bacteremia and 25 (30.5%) had primary bacteremia. Fifty (61.0%) patients had combination therapy, colistin/tigecycline (28%) was the most used antibiotic combination. The mortality of all patients was 56.1% (46/82) and 65.2% (30/46) in ICU patients. In univariate analysis, risk factors for the mortality of CRKp-BSI were high CCI, not having clinical response on the fifth day of treatment, high APACHE II score on hospitalisation and infection date and multiple organ dysfunction syndrome. In multivariate analysis, the most significant risk factor for mortality was APACHE II score on infection day (OR: 1.190; 95% CI: 1.088-1.301). Treatment regimens and combination therapy vs. monotherapy were not found to be significantly associated with survival. In addition, MIC values of CRKp were not associated with mortality. Conclusions: Patients with CRKp-BSI had high mortality (56.1%). APACHE II score on infection day was significantly associated with mortality. The outcome was similar between patients receiving combination (54.3%) or monotherapy (45.7%).
{"title":"Risk Factors of Mortality in Patients with Bloodstream Infections Due to Carbapenem Resistant Klebsiella pneumoniae","authors":"E. Eren, A. Ulu-Kilic, Zeynep Türe, F. Cevahir, H. Kılıç, Emine Alp-Meşe","doi":"10.36519/KD.2021.10","DOIUrl":"https://doi.org/10.36519/KD.2021.10","url":null,"abstract":"Objective: Carbapenem-resistant Klebsiella pneumoniae (CRKp) is among the leading causes of hospital-acquired infections worldwide and causes serious and life-threatening infections. Treatment options are very limited for blood stream infections (BSIs) and prognosis is poor due to increasing multi-drug resistance. The aim of this study was to assess risk factors for the mortality due to CRKp-BSI. Methods: A retrospective study was conducted in a university hospital from September 2013 to October 2017. Patients (aged >16 years) with CRKp-BSI were included in this study. Data, including demographics, Charlson comorbidity index (CCI), acute physiology and chronic health evaluation II (APACHE II) score on hospitalisation date, minimum inhibitory concentration (MIC) of CRKp, antibiotic treatment and outcome (30-day mortality) data were collected from the electronic medical records and microbiology databases. Results: A total of 82 patients with CRKP-BSIs were analysed. The median age was 54.5 years, and 48 (58.5%) of them were male. The median APACHE II score on hospitalisation was 14 (IQR 6-28) and CCI was 4.0 (IQR 0-12). Forty-six (56.1%) patients had ICU-acquired bacteremia and 36 (43.9%) had central-line associated bacteremia and 25 (30.5%) had primary bacteremia. Fifty (61.0%) patients had combination therapy, colistin/tigecycline (28%) was the most used antibiotic combination. The mortality of all patients was 56.1% (46/82) and 65.2% (30/46) in ICU patients. In univariate analysis, risk factors for the mortality of CRKp-BSI were high CCI, not having clinical response on the fifth day of treatment, high APACHE II score on hospitalisation and infection date and multiple organ dysfunction syndrome. In multivariate analysis, the most significant risk factor for mortality was APACHE II score on infection day (OR: 1.190; 95% CI: 1.088-1.301). Treatment regimens and combination therapy vs. monotherapy were not found to be significantly associated with survival. In addition, MIC values of CRKp were not associated with mortality. Conclusions: Patients with CRKp-BSI had high mortality (56.1%). APACHE II score on infection day was significantly associated with mortality. The outcome was similar between patients receiving combination (54.3%) or monotherapy (45.7%).","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80262125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fight Against Infectious Diseases from Ottoman Era to Republic of Turkey","authors":"O. Töre","doi":"10.36519/KD.2021.02","DOIUrl":"https://doi.org/10.36519/KD.2021.02","url":null,"abstract":"","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76602148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ayşe Gülsen Teker, A. Emecen, Selin Girgin, Hatice Şimşek-Keskin, N. Siyve, E. Sezgin, E. Basoğlu, Kübra Yıldırım-Karalar, Ö. Appak, A. Zeka, Gökçen Ömeroğlu, B. Ünal
Objective: It is important to put forward the characteristics of the COVID-19 cases to fight the disease effectively. The aim of this study is to determine the epidemiological characteristics of COVID-19 cases in Turkey. And also to determine the risk factors associated with intensive care unit (ICU) admission and death. Methods: In this cross-sectional study, the characteristics of the confirmed COVID-19 cases who applied to a University Hospital in Turkey between March 19th and June 11th, 2020, were analyzed. Variables such as epidemic trend, case fatality rate, need for hospitalization, ICU admission rate, and ICU mortality were calculated. In addition, risk factors affecting ICU admission and death were determined by logistic regression analysis. Results: 19.8% of 654 cases participating in the study were asymptomatic at admission. ICU admission rate was 7.6% and case fatality rate found to be 7.8%. Age, male gender, and cancer were associated with ICU admission. Each 1-unit increase in age increased ICU admissions by 8% (OR: 1.08; CI: 1.06-1.10). Men had a 2.71 times higher risk of ICU admission (OR: 2.71; CI: 1.37-5.39); and cancer patients showed 3.72 (OR: 3.72; CI: 1.35-10.20) times more ICU admissions (p<0.05). Age, cancer, and ICU admission were associated with death. Each 1-unit increase in age increased the risk of death by 10% (OR: 1.10; CI: 1.06-1.15). The risk of death was found to be 5.22 times higher in cancer patients (OR: 5.22; GA: 1.09-24.89) and 87.42 times higher in those admitted to ICU (OR: 87.42; GA: 30.15-153.46) (p<0.05). Conclusions: It was revealed that the course of the disease worsens, and deaths increase with age. Male gender has been associated with the increased need for intensive care. Cancer was significantly associated both with ICU admission and death. Attention should be paid to the groups of elderly, men and those with a comorbidity. More detailed studies with larger samples are of critical importance in fighting against the pandemic. Key Words: Turkey, COVID-19, coronavirus, SARS-CoV-2, epidemiology.
{"title":"Epidemiological Characteristics of COVID-19 Cases in A University Hospital in Turkey","authors":"Ayşe Gülsen Teker, A. Emecen, Selin Girgin, Hatice Şimşek-Keskin, N. Siyve, E. Sezgin, E. Basoğlu, Kübra Yıldırım-Karalar, Ö. Appak, A. Zeka, Gökçen Ömeroğlu, B. Ünal","doi":"10.36519/KD.2021.11","DOIUrl":"https://doi.org/10.36519/KD.2021.11","url":null,"abstract":"Objective: It is important to put forward the characteristics of the COVID-19 cases to fight the disease effectively. The aim of this study is to determine the epidemiological characteristics of COVID-19 cases in Turkey. And also to determine the risk factors associated with intensive care unit (ICU) admission and death. Methods: In this cross-sectional study, the characteristics of the confirmed COVID-19 cases who applied to a University Hospital in Turkey between March 19th and June 11th, 2020, were analyzed. Variables such as epidemic trend, case fatality rate, need for hospitalization, ICU admission rate, and ICU mortality were calculated. In addition, risk factors affecting ICU admission and death were determined by logistic regression analysis. Results: 19.8% of 654 cases participating in the study were asymptomatic at admission. ICU admission rate was 7.6% and case fatality rate found to be 7.8%. Age, male gender, and cancer were associated with ICU admission. Each 1-unit increase in age increased ICU admissions by 8% (OR: 1.08; CI: 1.06-1.10). Men had a 2.71 times higher risk of ICU admission (OR: 2.71; CI: 1.37-5.39); and cancer patients showed 3.72 (OR: 3.72; CI: 1.35-10.20) times more ICU admissions (p<0.05). Age, cancer, and ICU admission were associated with death. Each 1-unit increase in age increased the risk of death by 10% (OR: 1.10; CI: 1.06-1.15). The risk of death was found to be 5.22 times higher in cancer patients (OR: 5.22; GA: 1.09-24.89) and 87.42 times higher in those admitted to ICU (OR: 87.42; GA: 30.15-153.46) (p<0.05). Conclusions: It was revealed that the course of the disease worsens, and deaths increase with age. Male gender has been associated with the increased need for intensive care. Cancer was significantly associated both with ICU admission and death. Attention should be paid to the groups of elderly, men and those with a comorbidity. More detailed studies with larger samples are of critical importance in fighting against the pandemic. Key Words: Turkey, COVID-19, coronavirus, SARS-CoV-2, epidemiology.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91011641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Staphylococcus aureus continues to be a major health problem due to widespread methicillin resistance. The aim of this study was to determine the susceptibility to various antibiotics of 100 methicillin-resistant S. aureus (MRSA) and 100 methicillin-susceptible S. aureus (MSSA) strains isolated from various clinical samples between January 2016 and November 2019. Methods: Gradient test strips were used to test the susceptibilities of isolates to vancomycin, teicoplanin, and linezolid. The susceptibilities to other antibiotics were determined by automated system and evaluated based on EUCAST recommendations. Results: Seventy five percent of MRSA strains and 66% of MSSA strains included in the study were isolated from inpatients and 40% of MRSA and 21% of MSSA strains were isolated from intensive care patients. Isolates were obtained from tissue-abscess, blood, sterile body fluid, deep tracheal aspirate and sputum, urine, and catheter tip cultures, respectively. We did not detect S. aureus resistance to vancomycin, teicoplanin and linezolid in our study. Vancomycin, teicoplanin and linezolid MIC50/MIC90 values for MSSA strains were found to be 1/1.5 µg/ml, 0.75/1.5 µg/mL, 0.75/1 µg/mL and 1.5/2 µg/mL, 1.5/2 µg/mL, 0.75/1.5 µg/mL for MRSA strains, respectively. Based on MIC90 values, linezolid was 1.3 times more effective than vancomycin and 2 times more effective than teicoplanin in MRSA strains; linezolid was 1.5 times more effective than vancomycin and teicoplanin in MSSA strains. MRSA strains showed high resistance rates to all antibiotics, except daptomycin, tigecycline, cotrimoxazole and fusidic acid. All antibiotics were found to be highly effective in MSSA strains. Conclusions: MIC values of glycopeptides in MSSA isolates were found to be close to MIC values of MRSA isolates. Regarding the MIC90 values, linezolid was found to be more effective than glycopeptides. All other antibiotics were highly effective in MSSA strains
{"title":"Evaluation of the Susceptibility of Staphylococcus aureus Strains to Various Antibiotics","authors":"Çiğdem Arabacı, B. Uzun","doi":"10.36519/KD.2021.12","DOIUrl":"https://doi.org/10.36519/KD.2021.12","url":null,"abstract":"Objective: Staphylococcus aureus continues to be a major health problem due to widespread methicillin resistance. The aim of this study was to determine the susceptibility to various antibiotics of 100 methicillin-resistant S. aureus (MRSA) and 100 methicillin-susceptible S. aureus (MSSA) strains isolated from various clinical samples between January 2016 and November 2019. Methods: Gradient test strips were used to test the susceptibilities of isolates to vancomycin, teicoplanin, and linezolid. The susceptibilities to other antibiotics were determined by automated system and evaluated based on EUCAST recommendations. Results: Seventy five percent of MRSA strains and 66% of MSSA strains included in the study were isolated from inpatients and 40% of MRSA and 21% of MSSA strains were isolated from intensive care patients. Isolates were obtained from tissue-abscess, blood, sterile body fluid, deep tracheal aspirate and sputum, urine, and catheter tip cultures, respectively. We did not detect S. aureus resistance to vancomycin, teicoplanin and linezolid in our study. Vancomycin, teicoplanin and linezolid MIC50/MIC90 values for MSSA strains were found to be 1/1.5 µg/ml, 0.75/1.5 µg/mL, 0.75/1 µg/mL and 1.5/2 µg/mL, 1.5/2 µg/mL, 0.75/1.5 µg/mL for MRSA strains, respectively. Based on MIC90 values, linezolid was 1.3 times more effective than vancomycin and 2 times more effective than teicoplanin in MRSA strains; linezolid was 1.5 times more effective than vancomycin and teicoplanin in MSSA strains. MRSA strains showed high resistance rates to all antibiotics, except daptomycin, tigecycline, cotrimoxazole and fusidic acid. All antibiotics were found to be highly effective in MSSA strains. Conclusions: MIC values of glycopeptides in MSSA isolates were found to be close to MIC values of MRSA isolates. Regarding the MIC90 values, linezolid was found to be more effective than glycopeptides. All other antibiotics were highly effective in MSSA strains","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88843281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Yeşilbağ, Yasemin Tekdöş-Şeker, S. Şenoğlu, G. Hergünsel
Objective: Klebsiella pneumoniae infections have been a problem in intensive care units (ICU) in recent years due to multi-drug resistance. In this study, it was aimed to analyze K. pneumoniae infections in ICU, determine distribution of carbapenem resistance rates and risk factors. Methods: Nosocomial infections (NI) with K. pneumoniae between January 2017-January 2020 were evaluated retrospectively. In cases with recurrent K. pneumoniae infection, only the first episode was included. Results: K. pneumoniae infections were developed in a total of 78 patients. Bloodstream infections (BSI) were the most common (51.3%), followed by pneumonia (41%) and urinary tract infections (7.7%). Among BSI cases, 52.5% were associated with central venous catheter (CVC) and 81.2% of pneumonia cases were ventilator-associated pneumonia (VIP). It was observed that while the proportion of BSI was gradually decreasing in years, pneumonia rates have increased. Among BSI, it was observed that the rate of CVC-related BSI was increased from 33.3% in 2017 to 62.5% in 2019. Carbapenem resistance was 52.6% and colistin resistance was 17.9% in K. pneumoniae isolates and both increased over 3 years. When carbapenem-resistant K. pneumoniae infections were compared with carbapenem-sensitive K. pneumoniae infections, the independent risk factors associated with carbapenem resistance were found to be carbapenem use (p=0.008, OR: 8.45, 95% CI: 1.76-40.64), prior NI developing with different microorganism (p=0.005, OR: 8.70, 95% CI: 1.91-39.65) and total parenteral nutrition (TPN) use (p=0.04, OR: 4.2, 95% CI: 1.06-16.67). Conclusions: Carbapenem-resistant K. pneumoniae infections are gradually increasing in ICUs, and colistin resistance has started to be observed recently. Our study showed that carbapenems are independent risk factors in carbapenem resistance and suggested that carbapenem use should be restricted in our unit. It is important for each center to reveal its own data of frequency and resistance, in order to decrease infection rates with the infection control measures and determine the antibiotic using policies.
{"title":"Klebsiella pneumoniae Infections in Intensive Care Unit and Risk Factors for Carbapenem Resistance","authors":"Z. Yeşilbağ, Yasemin Tekdöş-Şeker, S. Şenoğlu, G. Hergünsel","doi":"10.36519/KD.2021.05","DOIUrl":"https://doi.org/10.36519/KD.2021.05","url":null,"abstract":"Objective: Klebsiella pneumoniae infections have been a problem in intensive care units (ICU) in recent years due to multi-drug resistance. In this study, it was aimed to analyze K. pneumoniae infections in ICU, determine distribution of carbapenem resistance rates and risk factors. Methods: Nosocomial infections (NI) with K. pneumoniae between January 2017-January 2020 were evaluated retrospectively. In cases with recurrent K. pneumoniae infection, only the first episode was included. Results: K. pneumoniae infections were developed in a total of 78 patients. Bloodstream infections (BSI) were the most common (51.3%), followed by pneumonia (41%) and urinary tract infections (7.7%). Among BSI cases, 52.5% were associated with central venous catheter (CVC) and 81.2% of pneumonia cases were ventilator-associated pneumonia (VIP). It was observed that while the proportion of BSI was gradually decreasing in years, pneumonia rates have increased. Among BSI, it was observed that the rate of CVC-related BSI was increased from 33.3% in 2017 to 62.5% in 2019. Carbapenem resistance was 52.6% and colistin resistance was 17.9% in K. pneumoniae isolates and both increased over 3 years. When carbapenem-resistant K. pneumoniae infections were compared with carbapenem-sensitive K. pneumoniae infections, the independent risk factors associated with carbapenem resistance were found to be carbapenem use (p=0.008, OR: 8.45, 95% CI: 1.76-40.64), prior NI developing with different microorganism (p=0.005, OR: 8.70, 95% CI: 1.91-39.65) and total parenteral nutrition (TPN) use (p=0.04, OR: 4.2, 95% CI: 1.06-16.67). Conclusions: Carbapenem-resistant K. pneumoniae infections are gradually increasing in ICUs, and colistin resistance has started to be observed recently. Our study showed that carbapenems are independent risk factors in carbapenem resistance and suggested that carbapenem use should be restricted in our unit. It is important for each center to reveal its own data of frequency and resistance, in order to decrease infection rates with the infection control measures and determine the antibiotic using policies.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85680627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The presence of hepatitis B virus (HBV) infection in patients using biological drug therapy may cause reactivation. There is insufficient data on the frequency of HBV reactivation, especially after the use of new biological drugs such as tofacitinib, tocilizumab, and secukinumab. This study aims to examine HBV seroprevalence in rheumatology patients using biological drug therapy and investigate the frequency of reactivation in patients with previous HBV infection. Methods: The charts of 275 patients who were followed up in the rheumatology department and used biological drug therapy were examined to evaluate the HBsAg, anti-HBc IgG, and anti-HBs test results. The frequency of reactivation was investigated by examining the HBV DNA test results before and after the biological drug therapy and the alanin aminotransferase test results were checked throughout the biological drug therapy in anti-HBc IgG-positive patients. Results: Among the patients, HBsAg was positive in 0.4%, anti-HBs in 34.4%, and anti-HBc IgG in 25.1%. The reactivation frequency was investigated in 53 biological drug therapies applied in 41 patients. The use of prophylactic antiviral drugs, where reactivation was evaluated, was found as 28.6% in TNF inhibitors, 100% in rituximab, 75.0% in tofacitinib, 0% in tocilizumab, 50% in abatacept, and 0% in secukinumab. Reactivation was detected in one of the fifty-three biological drug therapies. The reactivation case was a patient with isolated anti-HBc IgG and initial HBV DNA tests positive, using tocilizumab and cortisone, and not using entecavir prophylactic treatment regularly. Conclusions: The frequency of previous HBV infection is high in patients using biological therapy. Although prophylactic antiviral drug therapy for HBV has not been used frequently during the use of biological drug therapies other than rituximab in anti-HBc IgG positive patients, reactivation is rare. The risk of reactivation may be low in those receiving tofacitinib and secukinumab therapy and high in those receiving tocilizumab therapy.
{"title":"Evaluation of Hepatitis B Seroprevalence and Hepatitis B Reactivation Frequency in Rheumatology Patients Using Biological Drug Therapy","authors":"K. Ayar, A. Asan, T. D. Hattatoğlu","doi":"10.36519/KD.2021.08","DOIUrl":"https://doi.org/10.36519/KD.2021.08","url":null,"abstract":"Objective: The presence of hepatitis B virus (HBV) infection in patients using biological drug therapy may cause reactivation. There is insufficient data on the frequency of HBV reactivation, especially after the use of new biological drugs such as tofacitinib, tocilizumab, and secukinumab. This study aims to examine HBV seroprevalence in rheumatology patients using biological drug therapy and investigate the frequency of reactivation in patients with previous HBV infection. Methods: The charts of 275 patients who were followed up in the rheumatology department and used biological drug therapy were examined to evaluate the HBsAg, anti-HBc IgG, and anti-HBs test results. The frequency of reactivation was investigated by examining the HBV DNA test results before and after the biological drug therapy and the alanin aminotransferase test results were checked throughout the biological drug therapy in anti-HBc IgG-positive patients. Results: Among the patients, HBsAg was positive in 0.4%, anti-HBs in 34.4%, and anti-HBc IgG in 25.1%. The reactivation frequency was investigated in 53 biological drug therapies applied in 41 patients. The use of prophylactic antiviral drugs, where reactivation was evaluated, was found as 28.6% in TNF inhibitors, 100% in rituximab, 75.0% in tofacitinib, 0% in tocilizumab, 50% in abatacept, and 0% in secukinumab. Reactivation was detected in one of the fifty-three biological drug therapies. The reactivation case was a patient with isolated anti-HBc IgG and initial HBV DNA tests positive, using tocilizumab and cortisone, and not using entecavir prophylactic treatment regularly. Conclusions: The frequency of previous HBV infection is high in patients using biological therapy. Although prophylactic antiviral drug therapy for HBV has not been used frequently during the use of biological drug therapies other than rituximab in anti-HBc IgG positive patients, reactivation is rare. The risk of reactivation may be low in those receiving tofacitinib and secukinumab therapy and high in those receiving tocilizumab therapy.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83366932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ş. Sümer, Nazlım Aktug-Demir, O. Ural, Fatma Çölkesen
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that can affect all organs and tissues. The clinical forms of primary cutaneous tuberculosis are tuberculosis primary complex (tuberculosis chancre) and tuberculosis cutis miliaris (miliary cutaneous tuberculosis). Secondary cutaneous tuberculosis includes lupus vulgaris, tuberculosis cutis verrucosa, scrofuloderma, tuberculosis cutis officials, and metastatic tubercular abscesses. The most common form is lupus vulgaris. Cutaneous tuberculosis is a rare form of tuberculosis presenting with nonspecific lesions. It is difficult to diagnose due to its non-specific clinical characteristics thus it can be confused with many other diseases. In this paper, we reviewed five patients with cutaneous tuberculosis who presented to our clinic within the past one year and we aimed to emphasize that cutaneous tuberculosis can manifest in different clinical forms.
{"title":"A Rare Form of Tuberculosis: Cutaneous Tuberculosis Cases","authors":"Ş. Sümer, Nazlım Aktug-Demir, O. Ural, Fatma Çölkesen","doi":"10.36519/KD.2021.13","DOIUrl":"https://doi.org/10.36519/KD.2021.13","url":null,"abstract":"Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that can affect all organs and tissues. The clinical forms of primary cutaneous tuberculosis are tuberculosis primary complex (tuberculosis chancre) and tuberculosis cutis miliaris (miliary cutaneous tuberculosis). Secondary cutaneous tuberculosis includes lupus vulgaris, tuberculosis cutis verrucosa, scrofuloderma, tuberculosis cutis officials, and metastatic tubercular abscesses. The most common form is lupus vulgaris. Cutaneous tuberculosis is a rare form of tuberculosis presenting with nonspecific lesions. It is difficult to diagnose due to its non-specific clinical characteristics thus it can be confused with many other diseases. In this paper, we reviewed five patients with cutaneous tuberculosis who presented to our clinic within the past one year and we aimed to emphasize that cutaneous tuberculosis can manifest in different clinical forms.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87225200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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