Aziz Ogutlu

Effects of Carbapenem consumption on the prevalence of Acinetobacter infection in intensive care unit patients

BackgroundThe consumption of carbapenems has increased worldwide, together with the increase in resistant gram negative bacilli. Subsequently, the prevalence of carbapenem-resistant Acinetobacter infections has increased rapidly and become a significant problem particularly in intensive care unit patients. The aim of the present study was to evaluate the changes in the prevalence of Acinetobacter infection by restricting the consumption of carbapenems in intensive care unit patients.MethodsThis study was conducted between May 1, 2011 and February 28, 2013. The amount of carbapenem consumption and the number of patients with multi-drug resistant Acinetobacter baumannii (MDRAB) isolates during the study period were retrospectively obtained from the records of the patients, who were hospitalized in the intensive care unit. The study period was divided into two periods named as: Carbapenem non-restricted period (CNRP) and carbapenem-restricted period (CRP). During CNRP, no restrictions were made on the use of carbapenems. During CRP, the use of carbapenems was not allowed if there was an alternative to carbapenems. Primary Endpoint: MDRAB infection after ICU admission. The definition of nosocomial infections related to Acinetobacter spp. was based on the criteria of the Center for Disease Control (CDC). The correlation between the amount of carbapenem consumption and the number of infections with MDRAB strains between the two periods were evaluated.ResultsDuring the study period, a total of 1822 patients’ (1053 patients in CNRP and 769 patients in CRP) records were evaluated retrospectively. A total of 10.82 defined daily dose (DDD/100 ICU days) of anti-pseudomonal carbapenem were used in CNRP, and this figure decreased to 6.95 DDD/100 ICU days in CRP. In the 8-month CNRP, 42 (3.98%) MDRAB-related nosocomial infections were detected, and 14 (1.82%) infections were detected in CRP (p = 0.012).ConclusionThe prevalence of MDRAB strains isolated in the CNRP was 2.24-fold higher than the prevalence in the CRP. The prevalence of Acinetobacter infections can be reduced by taking strict isolation measures as well as by implementing good antibiotics usage policy.

Tongue hyperpigmentation during interferon therapy

Dear Editor, Chronic hepatitis C virus (HCV) infection has been reported in association with some cutaneous disorders such as lichen planus, vasculitis and porphyria cutanea tarda. Also, there have been many cutaneous side-effects of interferon (IFN) treatment such as vasculitis, transient alopecia and trichomegaly. It seems that combination IFN and ribavirin (RBV) causes more toxic skin reactions than IFN alone. Here, we report a woman who developed tongue hyperpigmentation during pegylated (PEG)-IFNa2b and RBV treatment for HCV infection. Mucosal, especially the tongue hyperpigmentation associated with IFN and RBV treatment for HCV infection is rare and has been reported in only 15 patients to date. A 54-year-old woman had been diagnosed with chronic active hepatitis C 2 months prior. The liver biopsy was done and histological activity index (HAI) was 11 and fibrosis score was 2. PEG-IFN-a2b (1.5 mcg ⁄kg once weekly) and RBV (1 g daily) treat-

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.

AIM Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

Factors Affecting Hand Hygiene Adherence at a Private Hospital in Turkey

OBJECTIVE Nosocomial infections are the main problems rising morbidity and mortality in health care settings. Hand hygiene is the most effective method for preventing these infections. In this study, we aimed to investigate the factors related with hand hygiene adherence at a private hospital in Turkey. MATERIALS AND METHODS This study was conducted between March and June 2010 at a private hospital in Turkey. During the observation period, employees were informed about training, then posters and images were hanged in specific places of the hospital. After the initial observation, training on nosocomial infections and hand hygiene was provided to the hospital staff in March 2010. Contacts were classified according to occupational groups and whether invasive or not. These observations were evaluated in terms of compatibility with hand hygiene guidelines. RESULTS Hand hygiene adherence rate of trained doctors was higher than untrained ones before patient contact and after environment contact [48% (35/73) versus 82% (92/113) p<0.05 and 23% (5/22) versus 76% (37/49) p<0.05 respectively]. Hand hygiene adherence rate of trained nurses was higher than untrained ones before patient contact [63% (50/79) versus 76% (37/49) p<0.05]. Hand hygiene adherence rate of trained assistant health personnel was higher than untrained ones before asepsis [20% (2/10) versus 73% (16/22) p<0.05]. In addition, it was seen that hand antiseptics were used when hand washing was not possible. CONCLUSION The increase at the rate of hand washing after training reveals the importance of feedback of the observations, as well as the training. One of the most important ways of preventing nosocomial infections is hand hygiene training that should be continued with feedbacks.

Positive effect of restrictions on antibiotic consumption

Background/aim: This study aimed to examine the change in the etiology of hospital infections with restricting and releasing of group 2 carbapenems (G2C) (meropenem/imipenem/doripenem). Materials and methods: This study was planned in three periods. Study period 1 (SP-1): Carbapenems were prescribed without restriction by infectious disease specialists. SP-2: G2C prescription was restricted. SP-3: Carbapenem prescription was released. Results: In total, 4443 cases [1053 in SP-1 (23.7%), 1332 in SP-2 (29.9%), and 2085 in SP-3 (46.9%)] were included in the study. Infection rates were 11%, 6.5%, and 7.9% in SP-1, SP-2, and SP-3, respectively (P = 0.001). Acinetobacter spp.-related hospital infection rates were 3.9%, 1.2%, and 1.8%, in SP-1, SP-2, and SP-3, respectively (P = 0.0001). Infection related mortality in SP-1, SP-2, and SP-3 was 7.3%, 5%, and 3.8%, respectively (P = 0.001). Conclusion: Hospital-acquired Acinetobacter infections, antibiotic consumption, and infection-related mortality were decreased significantly with the restriction of G2C. Positive behaviors that were obtained during the restricted period were continued with release of restriction.

Novel thymol bearing oxypropanolamine derivatives as potent some metabolic enzyme inhibitors – Their antidiabetic, anticholinergic and antibacterial potentials

A series of classical and newly synthesized thymol bearing oxypropanolamine compounds were synthesized and characterized. Their in vitro antibacterial activity on A. baumannii, P. aeruginosa, E. coli and S. aureus strains were investigated with agar well diffusion method. The results were compared with commercially available drug active compounds. As well as 3a, 3b and 3c have the most significant antibacterial effect among all the tested compounds; approximately all of them have more antibacterial activity than the reference drugs. These novel thymol bearing oxypropanolamine derivatives were effective inhibitors of the α-glycosidase, cytosolic carbonic anhydrase I and II isoforms (hCA I and II), and acetylcholinesterase enzymes (AChE) with Ki values in the range of 463.85-851.05 µM for α-glycosidase, 1.11-17.34 µM for hCA I, 2.97-17.83 µM for hCA II, and 13.58-31.45 µM for AChE, respectively.

Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study

This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.

Comparison of Novel Blood Culture System DL-Bt112TM with BacT/Alert 3DTM by Using Clinical Samples

BACKGROUND Blood cultures are the main diagnostic laboratory tool to detect bloodstream infections. Many clinical microbiology laboratories utilize automated blood culture systems to isolate infectious agents from blood samples. The diagnostic performance and time-to-detection values of the novel automated blood culture system, DLBt112TM (DL), was compared with BacT/Alert 3DTM (B3D) in this prospective comparative study with clinical samples. METHODS A total of 356 blood culture sets (178 sets for each system) were evaluated over a 6-month period in a university hospital. Two sets of blood culture samples (one for DL and one for B3D) were drawn from intensive care unit patients who were suspected to have bloodstream infections. BacT/ALERT FA FAN® Aerobic/Anaerobic blood culture bottles for B3D and FAN adult anaerobic/aerobic blood culture bottles for DL were used. The Vitek® 2 automated system was used for identification of the isolated bacteria. RESULTS We evaluated 178 sets from 105 patients consisting of 712 blood culture bottles in total. In total, 294 negative bottles and 47 positive bottles were detected by both systems. Recovery rate of the B3D (96.7%) was significantly higher than that of DL (79.0) (p < 0.05). We determined significant differences between DL and B3D in terms of time-to-detection values for gram negatives (p = 0.006) and contaminants (p = 0.048). Overall, B3D had shorter time-to-detection mean values. CONCLUSIONS The recovery rate of DL was unfavorably low and time-to-detection values for DL were significantly higher than that of B3D. This might result from the ingredients of the culture bottles since the detection technologies of the systems were similar.

A Study on the Age-Related Changes in Hepatitis B and C Virus Serology.

OBJECTIVE There are a limited number of studies on the seroprevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection in Turkey. This study aimed to compare HBV and HCV seroprevalence rates before and after the implementation of national hepatitis B vaccination program (NHPVP) and to explore age-related changes in the seroprevalences. MATERIALS AND METHODS Results of Hepatitis B surface antigen (HBsAg), Hepatitis B virus surface antibody (antiHBs) and anti-HCV tests performed during 2009 and 2010 in a state hospital laboratory were reviewed retrospectively. As NHPVP was started in 1998, 12 years of age and younger children were considered post- NHPVP period subjects. RESULTS A total of 3280 HBsAg, 2444 antiHBs and 3188 anti-HCV test results were reviewed, representing approximately 3% of the population of the city where the study was conducted. HBsAg, antiHBs and anti-HCV positivity were 3.2%, 36.12% and 0.97%, respectively. HBsAg and antiHBs positivity were higher among males (p<0.001). When assessed by age groups, HBsAg positivity was found to be the lowest in the age group 0-12 and highest in the age group 51-60. HBsAg positivity was lower in the post-NHPVP period versus pre-NHPVP period (p=0.01). Anti-HCV positivity was similar for pre- and post- NHPVP periods (p>0.05). CONCLUSION Owing to the use of NHPVP, HBsAg seropositivity has decreased, and it is expected to decrease further in the next years with a wider implementation of the program. Efforts should be continued to increase the level of awareness in the community for HBV and the importance of immunization.

Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein

INTRODUCTION Influenza-like illness (ILI) and acute respiratory infection (ARI) are common presentations during winter and indiscriminate antibiotic use contributes significantly to the emerging post-antibiotic era. METHODOLOGY Otherwise healthy 152 patients, presenting to outpatient clinics with ILI/ARI, were included. Patients had history & physical, CRP, hemogram and nasopharyngeal swabs for rhinovirus A/B, influenza A/B, adenovirus A/B/C/D/E, coronavirus 229E/NL63 and OC43, parainfluenza virus 1/2/3, respiratory syncytial virusA/B, metapneumovirus and Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and Bordetella pertussis by PCR and for ABHS culture. RESULTS Median (IR) age was 26.5 (16.5). Time to presentation was shorter in men (p = 0.027). Patients with rhinovirus had lower rates (20%) of myalgia (p = 0.043). Patients with influenza virus had higher rates (97%) of elevated CRP (p = 0.016). Logistic regression revealed that patients with ILI/ARI and CRP ≥ 5 mg/L were 60 times more likely to have influenza virus infection than other viral agents (OR = 60.0, 95% CI = 2.65 to 1,358.2, p = 0.010). Rhinovirus predominated in December (54%), March (36%), and April (33%). Influenza virus predominated in January (51%). Fever was most common with adenovirus (p = 0.198). All GABHS cultures were negative. Atypical organisms and Bordetella pertussis were negative in all but one patient. CONCLUSIONS Influenza virus is the most likely pathogen in ILI/ARI when CRP ≥ 5 mg/L. This might be explained by tissue destruction. Myalgia is rare with rhinovirus probably due to absence of viremia. Negative bacteria by PCR and culture suggest unnecessary antibiotic use in ILI/ARI.