In this report, we present a case of cryptococcal meningitis with acute onset and multiple organ involvement. A 44-yearold male was hospitalized with complaints of nausea, vomiting, headache and deterioration in general condition one month after the initiation of antiretroviral therapy (ART) for HIV infection. Empirical antibiotic treatment was started for the diagnosis of pneumonia, retinitis and meningitis according to the clinical findings and examination results. India ink preparation of cerebrospinal fluid (CSF) revealed budding capsulated yeast cells. Cryptococcal antigen test was positive in CSF and C. neoformans was isolated from CSF culture. Liposomal amphotericin B and fluconazol was added to the treatment schedule. Histopathologic examination of the tissue obtained with renal biopsy revealed extensive parenchymal cryptococcal involvement. Antifungal therapy was continued as oral fluconazole after 40 days. Fluconazol was discontinued when CD4+ T cell count increased over 100/mm3 after 12 months. The patient had persistently elevated creatinin levels under ART without antifungal therapy. Last creatinine value was 2.4 mg/dL after a one-year follow-up. Especially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is <100/mm3 and the serum cryptococcal antigen is positive. In addition, cryptococcal infection should be considered in differential diagnosis of HIV-positive patients with impaired renal function and kidney biopsies should be performed as soon as possible. Early diagnosis will help to reduce mortality and morbidity. It should be kept in mind that cryptococcal infections in HIV-infected patients may be present with multiple organ involvement. Klimik Dergisi 2018; 31(2): 153-6.
在这个报告中，我们提出一个隐球菌性脑膜炎的病例急性发作和多器官受累。一名44岁男性在开始抗逆转录病毒治疗艾滋病毒感染一个月后，因恶心、呕吐、头痛和一般情况恶化而住院。根据临床表现和检查结果，对肺炎、视网膜炎和脑膜炎进行经验性抗生素治疗。印度墨水制备的脑脊液(CSF)显示出芽荚膜酵母细胞。脑脊液隐球菌抗原检测阳性，脑脊液培养分离到新生隐球菌。在治疗方案中加入两性霉素B脂质体和氟康唑。肾活检组织病理学检查显示广泛的实质隐球菌感染。40天后继续口服氟康唑进行抗真菌治疗。当12个月后CD4+ T细胞计数超过100/mm3时停用氟康唑。患者在抗逆转录病毒治疗下未进行抗真菌治疗，其创造素水平持续升高。随访1年后，最后肌酐值为2.4 mg/dL。特别是新诊断的hiv阳性病例，如果CD4+ T细胞计数<100/mm3且血清隐球菌抗原阳性，应按照指南要求进行CSF隐球菌抗原检测。此外，在鉴别诊断hiv阳性肾功能受损患者时应考虑隐球菌感染，并应尽早进行肾脏活检。早期诊断将有助于降低死亡率和发病率。应该记住，hiv感染患者的隐球菌感染可能存在多器官受累。Klimik Dergisi 2018;31(2): 153 - 6。
{"title":"Cryptococcus neoformans Meningitis With Renal Involvement in an HIV-Positive Patient: A Case Report","authors":"Figen Sarigul, Ulku User, N. Oztoprak","doi":"10.5152/kd.2018.36","DOIUrl":"https://doi.org/10.5152/kd.2018.36","url":null,"abstract":"In this report, we present a case of cryptococcal meningitis with acute onset and multiple organ involvement. A 44-yearold male was hospitalized with complaints of nausea, vomiting, headache and deterioration in general condition one month after the initiation of antiretroviral therapy (ART) for HIV infection. Empirical antibiotic treatment was started for the diagnosis of pneumonia, retinitis and meningitis according to the clinical findings and examination results. India ink preparation of cerebrospinal fluid (CSF) revealed budding capsulated yeast cells. Cryptococcal antigen test was positive in CSF and C. neoformans was isolated from CSF culture. Liposomal amphotericin B and fluconazol was added to the treatment schedule. Histopathologic examination of the tissue obtained with renal biopsy revealed extensive parenchymal cryptococcal involvement. Antifungal therapy was continued as oral fluconazole after 40 days. Fluconazol was discontinued when CD4+ T cell count increased over 100/mm3 after 12 months. The patient had persistently elevated creatinin levels under ART without antifungal therapy. Last creatinine value was 2.4 mg/dL after a one-year follow-up. Especially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is <100/mm3 and the serum cryptococcal antigen is positive. In addition, cryptococcal infection should be considered in differential diagnosis of HIV-positive patients with impaired renal function and kidney biopsies should be performed as soon as possible. Early diagnosis will help to reduce mortality and morbidity. It should be kept in mind that cryptococcal infections in HIV-infected patients may be present with multiple organ involvement. Klimik Dergisi 2018; 31(2): 153-6.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80507380","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}
Immunocompromised patients, those with cancer or haematological malignancies and allogeneic bone marrow/haematopoietic stem cell transplant recipients carry a high risk of invasive fungal infection (IFI), which is frequently life threatening. The most common causes of IFIs are Aspergillus and Candida species. Patients who receive long-term corticosteroids or broadspectrum antimicrobial treatment or total parenteral nutrition; patients with central venous catheters, neutropenia, malignancies, or burns and low-weight premature infants are at highest risk of IFI. Early start of antifungal therapy is mandatory, but clinical findings often do not provide clear evidence of IFI. Antifungal agents preferentially used for systemic therapy of IFIs are amphotericin B preparations, fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, and isavuconazole. Local epidemiological data, current resistance profile against antifungal agents, and their pharmacological and economic aspects together with clinical experience must be considered for clinical management of patients with IFI. Klimik Dergisi 2019; 32(Suppl. 2): 168-73.
免疫功能低下的患者、癌症或血液恶性肿瘤患者以及同种异体骨髓/造血干细胞移植接受者具有侵袭性真菌感染(IFI)的高风险，这通常会危及生命。ifi最常见的病因是曲霉和念珠菌。长期接受皮质类固醇或广谱抗菌药物治疗或全肠外营养的患者;中心静脉置管、中性粒细胞减少、恶性肿瘤、烧伤和低体重早产儿的患者发生IFI的风险最高。早期抗真菌治疗是强制性的，但临床结果往往不能提供IFI的明确证据。用于ifi全身治疗的首选抗真菌药物是两性霉素B制剂、氟康唑、伏立康唑、泊沙康唑、卡泊芬净、阿尼杜拉芬净、米卡芬净和异舒康唑。IFI患者的临床管理必须考虑当地流行病学数据、当前抗真菌药物的耐药性、药理学和经济方面以及临床经验。Klimik Dergisi 2019;32(5。2): 168 - 73。
{"title":"Treatment of Invasive Fungal Infections in Haematology-Oncology Patients","authors":"S. Tekin","doi":"10.5152/kd.2019.62","DOIUrl":"https://doi.org/10.5152/kd.2019.62","url":null,"abstract":"Immunocompromised patients, those with cancer or haematological malignancies and allogeneic bone marrow/haematopoietic stem cell transplant recipients carry a high risk of invasive fungal infection (IFI), which is frequently life threatening. The most common causes of IFIs are Aspergillus and Candida species. Patients who receive long-term corticosteroids or broadspectrum antimicrobial treatment or total parenteral nutrition; patients with central venous catheters, neutropenia, malignancies, or burns and low-weight premature infants are at highest risk of IFI. Early start of antifungal therapy is mandatory, but clinical findings often do not provide clear evidence of IFI. Antifungal agents preferentially used for systemic therapy of IFIs are amphotericin B preparations, fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, and isavuconazole. Local epidemiological data, current resistance profile against antifungal agents, and their pharmacological and economic aspects together with clinical experience must be considered for clinical management of patients with IFI. Klimik Dergisi 2019; 32(Suppl. 2): 168-73.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83198923","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: We aimed to determine the relationship between the measles immunity status of the employees of Yozgat City Hospital and their age, gender, occupation, and work unit. Methods: The results of the measles serology of the 623 health care workers together with information on their age, gender, occupation and work unit were recorded retrospectively and analyzed by using SPSS for Windows. Version 15.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, USA) program. Results: The measles immunity in all health care workers was 88.1%. A statistically significant difference was found between the measles immunity and the age of health care workers (p<0.05). Immunity was 72% in ages 18-25 years, 88.8% in ages 26-35 years, 95.2% in ages 36-45 years, and 91.8% over 46 years. Measles immunity status increased as the age of the health care worker increased and the difference between the age groups was statistically significant (p<0.05). There was no statistically significant relationship between the measles immunity, gender (p=0.36), occupation and work unit (p>0.05). Conclusions: We concluded that measles immunity is inadequate among health care workers in general, especially in younger ages, and therefore health care workers should be vaccinated for measles regularly. Klimik Dergisi 2018; 31(2): 144-7.
目的:了解约兹加特市医院职工麻疹免疫状况与年龄、性别、职业、工作单位的关系。方法:对623名医护人员的麻疹血清学结果及年龄、性别、职业、单位等信息进行回顾性记录，并采用SPSS软件进行统计分析。版本15.0(统计软件包的社会科学，SPSS公司，芝加哥，伊利诺伊州，美国)程序。结果:全体医护人员麻疹免疫率为88.1%。麻疹免疫水平与医护人员年龄差异有统计学意义(p0.05)。结论:我们的结论是，一般来说，卫生保健工作者的麻疹免疫力不足，特别是在年轻人中，因此卫生保健工作者应定期接种麻疹疫苗。Klimik Dergisi 2018;31(2): 144 - 7。
{"title":"Measles Seroprevalence in Yozgat City Hospital Employees","authors":"H. Köse, Fatih Temoçin","doi":"10.5152/kd.2018.34","DOIUrl":"https://doi.org/10.5152/kd.2018.34","url":null,"abstract":"Objective: We aimed to determine the relationship between the measles immunity status of the employees of Yozgat City Hospital and their age, gender, occupation, and work unit. Methods: The results of the measles serology of the 623 health care workers together with information on their age, gender, occupation and work unit were recorded retrospectively and analyzed by using SPSS for Windows. Version 15.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, USA) program. Results: The measles immunity in all health care workers was 88.1%. A statistically significant difference was found between the measles immunity and the age of health care workers (p<0.05). Immunity was 72% in ages 18-25 years, 88.8% in ages 26-35 years, 95.2% in ages 36-45 years, and 91.8% over 46 years. Measles immunity status increased as the age of the health care worker increased and the difference between the age groups was statistically significant (p<0.05). There was no statistically significant relationship between the measles immunity, gender (p=0.36), occupation and work unit (p>0.05). Conclusions: We concluded that measles immunity is inadequate among health care workers in general, especially in younger ages, and therefore health care workers should be vaccinated for measles regularly. Klimik Dergisi 2018; 31(2): 144-7.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76091789","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}
Invasive fungal infections remain as important issues in immunosuppressed patients, especially in patients with haematological malignancies. Difficulty of diagnosis and treatment and increased mortality in the presence of delayed diagnosis has led to the widespread use of antifungal prophylaxis. The cost and side effects resulting from this widespread use are against this approach. In this article, current practices and recommendations on antifungal prophylaxis have been reviewed. Klimik Dergisi 2019; 32(Suppl. 2): 163-7.
侵袭性真菌感染仍然是免疫抑制患者的重要问题，特别是在血液恶性肿瘤患者中。诊断和治疗的困难以及诊断延迟导致的死亡率增加导致了抗真菌预防的广泛使用。这种广泛使用所产生的成本和副作用不利于这种方法。在这篇文章中，目前的做法和建议抗真菌预防已经审查。Klimik Dergisi 2019;32(5。2): 163 - 7。
{"title":"Antifungal Prophylaxis in Haematological Patients","authors":"Burak Deveci, R. Saba","doi":"10.5152/kd.2019.61","DOIUrl":"https://doi.org/10.5152/kd.2019.61","url":null,"abstract":"Invasive fungal infections remain as important issues in immunosuppressed patients, especially in patients with haematological malignancies. Difficulty of diagnosis and treatment and increased mortality in the presence of delayed diagnosis has led to the widespread use of antifungal prophylaxis. The cost and side effects resulting from this widespread use are against this approach. In this article, current practices and recommendations on antifungal prophylaxis have been reviewed. Klimik Dergisi 2019; 32(Suppl. 2): 163-7.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75708328","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}
Invasive fungal infection (IFI) is still one of the leading causes of morbidity and mortality in immunosupressed hosts. Although Candida species are the most common cause of IFIs and Candida albicans still remains the predominant cause of invasive candidiasis, emergence of non-albicans species has increased with the decreasing fluconazole sensitivity in the world. There is also an increase in the incidence of Aspergillus, new species such as Candida auris, and rare moulds. Many factors have likely contributed to this situation including the number of patients with increased immunosuppression and aggressive chemotherapy, increased use of invasive devices and antimicrobial prophylaxis or treatment approaches. Species and resistance distribution of IFI agents can vary between hospitals and even within different units in the same hospital as in the whole world and may vary according to predisposing factors of patients. Due to these reasons, understanding the changing epidemiology of IFIs is important in developing effective therapeutic and prophylactic approaches for these infections expected to increase in the next decade. Klimik Dergisi 2019; 32(Suppl. 2): 118-23.
侵袭性真菌感染(IFI)仍然是免疫抑制宿主发病和死亡的主要原因之一。虽然念珠菌是ifi的最常见原因，白色念珠菌仍然是侵袭性念珠菌病的主要原因，但随着世界上氟康唑敏感性的降低，非白色念珠菌的出现也在增加。曲霉、新菌种如耳念珠菌和稀有霉菌的发病率也有所增加。许多因素可能导致这种情况，包括免疫抑制和积极化疗增加的患者数量，侵入性设备和抗菌预防或治疗方法的使用增加。IFI药物的种类和耐药分布在不同医院之间，甚至在同一医院的不同单位内，甚至在全世界，都可能有所不同，并可能根据患者的易感因素而有所不同。由于这些原因，了解ifi不断变化的流行病学对于制定有效的治疗和预防方法至关重要，这些感染预计将在未来十年增加。Klimik Dergisi 2019;32(5。2): 118 - 23所示。
{"title":"Epidemiology of Invasive Fungal Infections","authors":"Z. Karakoç","doi":"10.5152/kd.2019.53","DOIUrl":"https://doi.org/10.5152/kd.2019.53","url":null,"abstract":"Invasive fungal infection (IFI) is still one of the leading causes of morbidity and mortality in immunosupressed hosts. Although Candida species are the most common cause of IFIs and Candida albicans still remains the predominant cause of invasive candidiasis, emergence of non-albicans species has increased with the decreasing fluconazole sensitivity in the world. There is also an increase in the incidence of Aspergillus, new species such as Candida auris, and rare moulds. Many factors have likely contributed to this situation including the number of patients with increased immunosuppression and aggressive chemotherapy, increased use of invasive devices and antimicrobial prophylaxis or treatment approaches. Species and resistance distribution of IFI agents can vary between hospitals and even within different units in the same hospital as in the whole world and may vary according to predisposing factors of patients. Due to these reasons, understanding the changing epidemiology of IFIs is important in developing effective therapeutic and prophylactic approaches for these infections expected to increase in the next decade. Klimik Dergisi 2019; 32(Suppl. 2): 118-23.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87516513","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":"Knowledge Levels of Students, Trainees and Faculty Members About Hand Hygiene at a University Hospital","authors":"Nazlım Aktug-Demir, S. Sumer, L. Demir, O. Ural","doi":"10.5152/kd.2018.26","DOIUrl":"https://doi.org/10.5152/kd.2018.26","url":null,"abstract":"","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76918271","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}
Yazışma Adresi / Address for Correspondence: Haluk Eraksoy, İstanbul Üniversitesi, İstanbul Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çapa, İstanbul, Türkiye E-posta/E-mail: haluk.eraksoy@gmail.com DOI: 10.5152/kd.2018.21 Sağlık çalışanları için en önemli mesleki risklerden biri, bir kesici ve delici alet yaralanması (KDAY)’na maruz kalmaktır. Her yıl dünyada en az 16 milyar injeksiyon uygulandığı bildirilmektedir. Bunların çok büyük bir çoğunluğu, tedavi edici işlemler için uygulanır. Bu uygulamaların güvenli olması, özellikle kanla bulaşan viruslar açısından önemlidir (1). Dünya üzerinde sağlık çalışanlarındaki hepatit B ve hepatit C olgularından %40 kadarının, HIV infeksiyonlarından %2.5’inin mesleki iğne kazalarına bağlı olduğu hesaplanmıştır (2). Klimik Dergisi’nin bu sayısında Karacaer ve arkadaşları (3)’nın, bir ikinci basamak hastanedeki KDAY sıklığını, türlerini, bunu etkileyen risk faktörlerini ve personelin bu konudaki bilgi ve tutumlarını değerlendirdikleri bir anket çalışmasının sonuçları yer alıyor. Anket çalışması bazı yönlerden ilginç sonuçlar vermiş. Örneğin, çalışanların yarıdan fazlasının son iki yıl içinde bir KDAY öyküsü tanımlamış olması ve bunların %85’ten fazlasının bir iğne kazası biçiminde ortaya çıkmış olması dikkati çekiyor. Çalışmaya katılan personelin %80’e yakınının mesleki yaralanmalar konusunda eğitim aldığı bildiriliyor. Buna karşılık, şaşırtıcı bir biçimde, eğitim alanlarda eğitim almayanlardan daha sık KDAY görülmüş. Bu durum, bir sağlık kuruluşunda eğitimle verilen bilgiler uygulamaya yansımadığı takdirde, aşılması gereken başka engellerin olduğunu düşünmek ve bunlara eğilen çalışmalar planlamak gerektiğini gösteriyor. Sakallı Celal’in ünlü özlü sözlerinden biri buraya adeta denk düşüyor. Aktuğ-Demir ve arkadaşları (4)’nın el hijyenine ilişkin farkındalığı ve bilgi düzeyini değerlendirdikleri bir araştırma da Klimik Dergisi’nin bu sayısında bir başka anket çalışması olarak yer alıyor. Çalışma, bir üniversite hastanesinde öğrencilerin, araştırma görevlilerinin ve öğretim üyelerinin üzerinde yapılmış. Son beş yıl içerisinde öğrencilerin %91’inin, araştırma görevlilerinin %73’ünün el hijyeni eğitimi aldığı; öğretim üyelerinin ise hiçbirinin el hijyeni eğitimi almadığı saptanmış. Son bir yıl içerisinde eğitim alma oranı ise araştırma görevlilerinde %23, öğrencilerde %39 olarak saptanmış. Öğrencilerin bilgi düzeyinin, araştırma görevlisi ve öğretim üyelerinden daha yüksek olarak saptanması, araştırmanın en ilginç bulgusunu oluşturuyor. Uygun indikasyonda el hijyeni sağlama oranını ≥%85 olarak bildiren katılımcı hiç olmamış; bu oranı %70-85 arasında bildirenler ise çalışmaya katılanların dörtte birinden bile azını oluşturmaktaymış. "Eldiven giymek el hijyeni yerine geçer" bilgisinin katılımcılar tarafından en yanlış bilinen bilgi olduğu saptanmış ki bu durumda el hijyenine uyumsuzluğa başka bir “mazeret” aranması gereği kalmıyor. İnfeksiyon kontrolüyle uğraşan bir komitenin böyle
{"title":"Needle Stick Injuries and Hand Hygiene Practices in Hospitals","authors":"H. Eraksoy","doi":"10.5152/kd.2018.21","DOIUrl":"https://doi.org/10.5152/kd.2018.21","url":null,"abstract":"Yazışma Adresi / Address for Correspondence: Haluk Eraksoy, İstanbul Üniversitesi, İstanbul Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çapa, İstanbul, Türkiye E-posta/E-mail: haluk.eraksoy@gmail.com DOI: 10.5152/kd.2018.21 Sağlık çalışanları için en önemli mesleki risklerden biri, bir kesici ve delici alet yaralanması (KDAY)’na maruz kalmaktır. Her yıl dünyada en az 16 milyar injeksiyon uygulandığı bildirilmektedir. Bunların çok büyük bir çoğunluğu, tedavi edici işlemler için uygulanır. Bu uygulamaların güvenli olması, özellikle kanla bulaşan viruslar açısından önemlidir (1). Dünya üzerinde sağlık çalışanlarındaki hepatit B ve hepatit C olgularından %40 kadarının, HIV infeksiyonlarından %2.5’inin mesleki iğne kazalarına bağlı olduğu hesaplanmıştır (2). Klimik Dergisi’nin bu sayısında Karacaer ve arkadaşları (3)’nın, bir ikinci basamak hastanedeki KDAY sıklığını, türlerini, bunu etkileyen risk faktörlerini ve personelin bu konudaki bilgi ve tutumlarını değerlendirdikleri bir anket çalışmasının sonuçları yer alıyor. Anket çalışması bazı yönlerden ilginç sonuçlar vermiş. Örneğin, çalışanların yarıdan fazlasının son iki yıl içinde bir KDAY öyküsü tanımlamış olması ve bunların %85’ten fazlasının bir iğne kazası biçiminde ortaya çıkmış olması dikkati çekiyor. Çalışmaya katılan personelin %80’e yakınının mesleki yaralanmalar konusunda eğitim aldığı bildiriliyor. Buna karşılık, şaşırtıcı bir biçimde, eğitim alanlarda eğitim almayanlardan daha sık KDAY görülmüş. Bu durum, bir sağlık kuruluşunda eğitimle verilen bilgiler uygulamaya yansımadığı takdirde, aşılması gereken başka engellerin olduğunu düşünmek ve bunlara eğilen çalışmalar planlamak gerektiğini gösteriyor. Sakallı Celal’in ünlü özlü sözlerinden biri buraya adeta denk düşüyor. Aktuğ-Demir ve arkadaşları (4)’nın el hijyenine ilişkin farkındalığı ve bilgi düzeyini değerlendirdikleri bir araştırma da Klimik Dergisi’nin bu sayısında bir başka anket çalışması olarak yer alıyor. Çalışma, bir üniversite hastanesinde öğrencilerin, araştırma görevlilerinin ve öğretim üyelerinin üzerinde yapılmış. Son beş yıl içerisinde öğrencilerin %91’inin, araştırma görevlilerinin %73’ünün el hijyeni eğitimi aldığı; öğretim üyelerinin ise hiçbirinin el hijyeni eğitimi almadığı saptanmış. Son bir yıl içerisinde eğitim alma oranı ise araştırma görevlilerinde %23, öğrencilerde %39 olarak saptanmış. Öğrencilerin bilgi düzeyinin, araştırma görevlisi ve öğretim üyelerinden daha yüksek olarak saptanması, araştırmanın en ilginç bulgusunu oluşturuyor. Uygun indikasyonda el hijyeni sağlama oranını ≥%85 olarak bildiren katılımcı hiç olmamış; bu oranı %70-85 arasında bildirenler ise çalışmaya katılanların dörtte birinden bile azını oluşturmaktaymış. \"Eldiven giymek el hijyeni yerine geçer\" bilgisinin katılımcılar tarafından en yanlış bilinen bilgi olduğu saptanmış ki bu durumda el hijyenine uyumsuzluğa başka bir “mazeret” aranması gereği kalmıyor. İnfeksiyon kontrolüyle uğraşan bir komitenin böyle ","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77406351","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}
The number of fungal infections observed in hospitalized patients has been gradually increasing in recent years. Bloodstream infections due to Candida spp. constitute the majority of hospital-acquired fungal infections. Two-thirds of all candidemias occur in patients in the intensive care units. Early initiation of appropriate treatment decreases high mortality in these cases. On the other hand, difficulty in diagnosis, economic cost of drug treatments, development of resistance, and effect of unnecessary drug use on ecology are major obstacles to the initiation of treatment. The recommendations on which conditions, in which patients, and when and which antifungal therapy should be initiated are discussed in this review. Klimik Dergisi 2019; 32(Suppl. 2):154-62.
近年来，住院患者真菌感染的数量逐渐增加。念珠菌引起的血液感染是医院获得性真菌感染的主要原因。三分之二的念珠菌发生在重症监护病房的患者中。及早开始适当治疗可降低这些病例的高死亡率。另一方面，诊断困难、药物治疗的经济成本、耐药性的发展以及不必要的药物使用对生态的影响是开始治疗的主要障碍。在这篇综述中讨论了哪些条件，哪些患者，何时以及哪种抗真菌治疗应该开始的建议。Klimik Dergisi 2019;32(5。2): 154 - 62。
{"title":"Candida Infections in Intensive Care Unit: How to Treat?","authors":"E. Kazak","doi":"10.5152/kd.2019.60","DOIUrl":"https://doi.org/10.5152/kd.2019.60","url":null,"abstract":"The number of fungal infections observed in hospitalized patients has been gradually increasing in recent years. Bloodstream infections due to Candida spp. constitute the majority of hospital-acquired fungal infections. Two-thirds of all candidemias occur in patients in the intensive care units. Early initiation of appropriate treatment decreases high mortality in these cases. On the other hand, difficulty in diagnosis, economic cost of drug treatments, development of resistance, and effect of unnecessary drug use on ecology are major obstacles to the initiation of treatment. The recommendations on which conditions, in which patients, and when and which antifungal therapy should be initiated are discussed in this review. Klimik Dergisi 2019; 32(Suppl. 2):154-62.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90577100","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}
Invasive fungal infection (IFI) is an important cause of morbidity and mortality especially in immunosupressed patients. They can range widely in severity; while mucocutaneous infections are more frequent, fungal infections can be life threatening in some patients. Candida and Aspergillus species are the most common causes of IFIs. Candida spp. have become important causes of sepsis in hospitals, with incidence constantly growing over the last 20 years. Invasive aspergillosis is the second most common IFI, with increasing incidence over the last two decades along with the advances in the treatment of hematological malignancies. Mucormycosis is the second most common invasive mould infection. Agents like Mucor spp. can cause devastating infections. Klimik Dergisi 2019; 32(Suppl. 2): 124-7.
侵袭性真菌感染(IFI)是引起发病和死亡的重要原因，特别是在免疫抑制患者中。它们的严重程度差别很大;虽然皮肤粘膜感染更为常见，但真菌感染对一些患者可能会危及生命。念珠菌和曲霉菌是ifi最常见的病因。念珠菌已成为医院脓毒症的重要原因，近20年来发病率不断上升。侵袭性曲霉病是第二大最常见的IFI，在过去二十年中，随着血液系统恶性肿瘤治疗的进展，其发病率不断增加。毛霉病是第二常见的侵袭性霉菌感染。像毛霉菌这样的病原体可以引起毁灭性的感染。Klimik Dergisi 2019;32(5。2): 124 - 7。
{"title":"Clinical Features of Invasive Fungal Infections: Aspergillosis, Candidiasis and Mucormycosis","authors":"M. Alan","doi":"10.5152/kd.2019.54","DOIUrl":"https://doi.org/10.5152/kd.2019.54","url":null,"abstract":"Invasive fungal infection (IFI) is an important cause of morbidity and mortality especially in immunosupressed patients. They can range widely in severity; while mucocutaneous infections are more frequent, fungal infections can be life threatening in some patients. Candida and Aspergillus species are the most common causes of IFIs. Candida spp. have become important causes of sepsis in hospitals, with incidence constantly growing over the last 20 years. Invasive aspergillosis is the second most common IFI, with increasing incidence over the last two decades along with the advances in the treatment of hematological malignancies. Mucormycosis is the second most common invasive mould infection. Agents like Mucor spp. can cause devastating infections. Klimik Dergisi 2019; 32(Suppl. 2): 124-7.","PeriodicalId":17826,"journal":{"name":"Klimik Dergisi/Klimik Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83591531","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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