Serhat Uysal

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.

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

BackgroundTraining of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.MethodsA cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.ResultsA total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.ConclusionsThe results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

Risk factors for amputation in patients with diabetic foot infection: a prospective study

There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures.

Changes in acute viral hepatitis epidemiology in the Turkish adult population: A multicenter study

BACKGROUND/AIMS The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. MATERIALS AND METHODS Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. RESULTS The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. CONCLUSION In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.

Human myiasis in patients with diabetic foot: 18 cases

BACKGROUND Myiasis complication of diabetic foot ulcer has only been presented in a few case reports. Therefore, there is a need for additional data on this infestation. OBJECTIVE Evaluate clinical characteristics of human myiasis in patients with diabetic foot. DESIGN Case series. SETTINGS A tertiary referral healthcare institution and a diabetic foot center. PATIENTS AND METHODS Patients with diabetic foot infection complicated by myiasis who were admitted between June 2012 and July 2017. MAIN OUTCOME MEASURES Bacterial infection rate, accompanying bacterial agents, amputation (morbidity) and mortality rate. SAMPLE SIZE 18. RESULTS Eight (44.4%) of the patients were female. Sixteen (88.9%) had moderate-to-severe infections; 15 (83.3%) had necrotic tissue. Larval debridement therapy was performed on all patients at the bedside in consecutive sessions. A third-stage larva of Calliphora was detected in one case (5.6%). Second- and third-stage larvae of Lucilia sericata were detected in 5 (27.8%) and 7 (38.9%) patients, respectively. All the patients had a bacterial infection with myiasis. Twelve (66.7%) patients underwent amputation. Three (16.7%) patients died. Myiasis was more frequent in the months of May, June and July. CONCLUSION To our knowledge, this is the largest reported series of cases of diabetic foot with myiasis. The most common parasitic agent was Lucilia sericata. Bacterial soft tissue infections were observed in all cases. Poor hygienic conditions were noteworthy and all patients were in need of radical surgery. Myiasis complication of diabetic foot is more frequently seen in the spring and summer. LIMITATIONS Insufficient follow-up time for analysis of possible confounding factors.

Antibacterial resistance patterns and incidence of hospital-acquired Staphylococcus aureus bacteremia in a tertiary care educational hospital in Turkey: a perspective from 2001 to 2013

Background/aim: Staphylococcus aureus is an important nosocomial pathogen and a successful antimicrobial-resistance developer. In this study we retrospectively evaluated the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related S. aureus strains between 2001 and 2013. Materials and methods: Any patient in whom S. aureus was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72 h after hospital admission) was considered to have MCNB. Results: The methicillin-resistant S. aureus (MRSA) rate in 2001 was 73.8% whereas it was 36.2% in 2013. When the 2001-2003 and 2011?2013 periods were compared, resistance to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin decreased significantly (P < 0.05). When we evaluated the total S. aureus, MRSA, and methicillin-sensitive S. aureus (MSSA) bacteremia rates per 1000 days and 1000 patients, there was an increase in the 2004?2005 period, which was followed by a slight decrease until 2013 (P < 0.05). There was a plateau in MCNB-related S. aureus rates between 2008 and 2011. Conclusion: There was a decrease in overall S. aureus and MRSA bacteremia incidence as well as MRSA rates except for a plateau between 2008 and 2011. This steady decrease in the resistance rates is most probably due to the 2003 budget application and application of antimicrobial stewardship.

Intralesional epidermal growth factor therapy fordiabetic foot ulcers: an evaluation of 15 cases

Background/aim: Intralesional recombinant epidermal growth factor (EGF) is a new treatment approach for diabetic foot ulcer, approved in 2006. EGF therapy is given as an adjunct to the standard treatment regimen of antibiotics, surgery, and hyperbaric oxygen. EGF accelerates the healing of diabetic foot ulcers and reduces healing time. This single-center study was conducted to evaluate the outcomes of intralesional EGF therapy in patients with diabetic foot ulcers.Materials and methods: We present the data of the follow-up patients treated in our clinics. Fifteen patients with diabetic foot ulcers or infections, who had been followed up and treated in our clinics, were included in this retrospective study. All patients were administered intralesional injections of 75 μg of EGF after treatment for infection on their diabetic foot ulcers, three times a week on alternate days. The patients were monitored with respect to treatment response and side effects of EGF.Results: Thirteen patients (86.7%) developed new granulation tissue, 10 patients (66.7%) had complete wound closure, and three patients (20%) showed partial wound closure. No serious side effects requiring discontinuation of EGF therapy were observed. A total of twenty-one bacterial agents were isolated in thirteen patients, and no bacterial growth was observed in the tissue cultures of two patients. Pseudomonas aeruginosa was the most common isolated infectious agent in the tissue cultures (n: 6, 28%). Conclusion: Intralesional injection of EGF on top of the standard treatment regimen appears to be a useful adjuvant therapy option in selected patients.

Dyslipidemia and cardiovascular risk assessment in HIV-positive patients

OBJECTIVE Dyslipidemia is a major complication of antiretroviral treatment. Aim of the present study was to screen baseline lipid levels and cardiovascular disease risk in HIV-positive patients and analyze change in those parameters after initiation of antiretroviral treatment (ART). METHODS HIV-positive patients who presented at our clinic between April 2011 and August 2012 were included. Study included 19 female (22.1%) and 67 male (77.9%) patients (mean age 39.5±10.3 years). Blood pressure, smoking habit, alcohol consumption, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glucose level, and antiretroviral treatment status data were reviewed retrospectively. Changes in lipid profile and lifetime risk for atherosclerotic cardiovascular disease (ASCVD) according to the American College of Cardiology guidelines were compared with baseline data and analyzed. RESULTS At baseline, 13 (15.1%) patients were already receiving ART and 73 (84.9%) patients were treatment-naive or had stopped therapy ≥3 months prior to enrollment. At last visit, 73 (84.9%) patients were taking ART. Results of baseline and final visit TC levels were 175.5 mg/dL (range: 90-346 mg/dL) and 196.5 mg/dL (range: 104-317 mg/dL), respectively (p=0.001). HDL levels were 40 mg/dL (range: 21-81 mg/dL) and 35 mg/dL (range: 10-75 mg/dL; p=0.001), and LDL levels were 101.5 mg/dL (range: 32-191 mg/dL) and 120.5 mg/dL (range: 32-250 mg/dL; p<0.001). TG levels were 145.5 mg/dL (range: 43-2580 mg/dL and 152.5 mg/dL (range: 67-884 mg/dL; p=0.102). Baseline ASCVD risk score was 46% (range: 5-69%) while last visit ASCVD risk score was 50% (range: 5-69%; p<0.001). CONCLUSION HIV infection has adverse effects on lipid profiles and cardiovascular risk of HIV-positive patients. Therefore, patients should be closely monitored for lifestyle interventions and lipid-lowering agents.

Evaluation of Hepatosplenomegaly and Liver Function Tests in 102 Brucellosis Cases

Bulgular: Çalışmaya 102 olgu [43 kadın (%42.2), 59 erkek (%57.8), yaş ortalaması 47.1 ± 16] dahil edilmiştir. Seksen iki (%80.3) hastada 1/160 ve üzeri wright aglütinasyon testi olumluluğu ile üç hastada tanı wright aglütinasyon testi olumsuz olmasına karşın anti-human globülin testi ile tanı konuldu. On yedi (%16.7) hastanın tanısı ise sadece kan kültürü olumluluğu ile konuldu. En sık ilk üç semptom ateş (%63.7), halsizlik (%48) ve bel-kalça ağrısıydı (%48). Ultrasonografi ile hepatomegali ve splenomegali sırasıyla 16 (%15.8) ve 19 (% 18.8) olguda tespit edildi. Hastalarda AST, ALT, ALP, GGT ve toplam bilirubin testlerinde yükseklik sırasıyla %23.8, %24.8, %26.8, %36.6, %12.9 oranında saptandı. Kırk iki (%41.2) hastada bulgu veren karaciğer ilişkili patolojiye rastlanmadı. Herhangi bir patolojiye rastlanmayan hastaların yaş ortalaması 51.1 ± 14.9 yıl iken, diğer hastalarda 44.3 ± 16.3 yıl olarak bulundu (p= 0.035). Tüm hastalarda tedavi sonunda karaciğer fonksiyon testlerinde düzelme saptandı. Hastaların hiçbirinde ciddi yan etki görülmemiştir.