Serife Akalin

Predictive factors for occupational bloodborne exposure in Turkish hospitals

BACKGROUND This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs). METHODS An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey, with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country. RESULTS The respondent group included 41.3% nurses, 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least 1 occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P = .000), being a doctor (P = .000), being a nurse (P=.000), young age (P = .025), and living in a poor region (P = .005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P = .000) and working at a university hospital (P = .003) were significant predictors of less occupational exposure. Overall, the mean number of PME incidents was 2.16/person/year. CONCLUSION Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs.

Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: A prospective cohort study

BACKGROUND Diabetes mellitus is a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. We attempted to determine the prevalence and risk factors for MRSA colonization in a population of outpatients with diabetes. METHODS This prospective cohort study enrolled patients with diabetes. Anterior nares cultures were obtained from patients with diabetes admitted to outpatient endocrinology and metabolism clinics, and risk factors for MRSA colonization were analyzed. RESULTS Out of the 304 patients evaluated, 127 (41.9%) were colonized with S aureus and 30 (9.9%) were colonized with MRSA. Overall, 23.6% of all S aureus isolates were MRSA. In multivariate analysis, factors independently associated with an increased risk of MRSA colonization included the presence of connective tissue disease (odds ratio, 7.075; 95% confidence interval, 2.157-23.209; P = .001) and insulin therapy (odds ratio, 3.910; 95% confidence interval, 1.652-9.251; P = .002). CONCLUSIONS The prevalence of MRSA colonization in our sample of diabetic outpatients was 9.9%. Independent risk factors for MRSA colonization were the presence of connective tissue disease and insulin use. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections.

Seroprevalence of human cystic echinococcosis and risk factors in animal breeders in rural communities in Denizli, Turkey

INTRODUCTION Cystic echinococcosis (CE) is a serious public health problem in sheep-raising regions of Turkey. The aim of this study was to determine the prevalence and associated risk factors of echinococcosis in rural regions of Denizli in Turkey. METHODOLOGY This study was undertaken in four townships in Denizli County between May 2009 and July 2009. Family members were interviewed to assess possible risk factors for infection and tested for anti-E. granulosus antibodies by enzyme-linked immunosorbent assay (ELISA). RESULTS Of the 1,133 individuals included in the study, 78 (6.9%) were found to be anti-EG seropositive. Multivariate analysis showed that the 30-39 year age group (odds ratio [OR]: 3.29; 95% confidence interval [CI]: 1.30 ± 8.33; p = 0.01), the ≥ 60 year group (OR: 4.08; 95% CI: 1.57 ± 10.61; p = 0.004), and the group that reported sometimes or never getting veterinary care for their animals (OR: 1.75; 95% CI: 1.05 ± 2.93; p = 0.032) had higher rates of seropositivity. Multivariate analysis showed that education was not significantly associated with seropositivity. Furthermore, no significant correlation with location, occupation, dog ownership or contact with dogs, or with cattle and/or sheep/goat ownership was found. Regular veterinary care and education had significant effects on lowering the prevalence of CE. CONCLUSIONS Our results suggest that preventive measures, such as regular veterinary care for animals and educative and supportive activities oriented to the people working in farming and animal husbandry should be taken to decrease the prevalence of human CE in Turkey.

Risk factors for occupational brucellosis among veterinary personnel in Turkey

Veterinarians and veterinary technicians are at risk for occupational brucellosis. We described the risk factors of occupational brucellosis among veterinary personnel in Turkey. A multicenter retrospective survey was performed among veterinary personnel who were actively working in the field. Of 712 veterinary personnel, 84 (11.8%) had occupational brucellosis. The median number of years since graduation was 7 (interquartile ranges [IQR], 4-11) years in the occupational brucellosis group, whereas this number was 9 (IQR, 4-16) years in the non-brucellosis group (p<0.001). In multivariable analysis, working in the private sector (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.55-5.28, p=0.001), being male (OR, 4.5; 95% CI, 1.05-18.84, p=0.041), number of performed deliveries (OR, 1.01; 95% CI, 1.002-1.02, p=0.014), and injury during Brucella vaccine administration (OR, 5.4; 95% CI, 3.16-9.3, p<0.001) were found to be risk factors for occupational brucellosis. We suggest that all veterinary personnel should be trained on brucellosis and the importance of using personal protective equipment in order to avoid this infection.

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.

Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: a multicenter retrospective analysis.

Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A). Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18–89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9–297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Acute Brucella melitensis M16 infection model in mice treated with tumor necrosis factor-alpha inhibitors

INTRODUCTION There is limited data in the literature about brucellosis related to an intracellular pathogen and anti-tumor necrosis factor alpha (anti-TNFα) medication. The aim of this study was to evaluate acute Brucella infections in mice receiving anti-TNFα drug treatment. METHODOLOGY Anti-TNFα drugs were injected in mice on the first and fifth days of the study, after which the mice were infected with B. melitensis M16 strain. Mice were sacrificed on the fourteenth day after infection. Bacterial loads in the liver and spleen were defined, and histopathological changes were evaluated. RESULTS Neither the liver nor the spleen showed an increased bacterial load in all anti-TNFα drug groups when compared to a non-treated, infected group. The most significant histopathological findings were neutrophil infiltrations in the red pulp of the spleen and apoptotic cells with hepatocellular pleomorphism in the liver. There was no significant difference among the groups in terms of previously reported histopathological findings, such as extramedullary hematopoiesis and granuloma formation. CONCLUSIONS There were no differences in hepatic and splenic bacterial load and granuloma formation, which indicate worsening of the acute Brucella infection in mice; in other words, anti-TNFα treatment did not exacerbate the acute Brucella spp. infection in mice.

Bartonella henselae seroprevalence in cattle breeders and veterinarians in the rural areas of Aydin and Denizli, Turkey.

Bartonella henselae infections are usually detected among people who have close contact with animals. Veterinarians and cattle breeders, in particular, are considered as the risk groups for B. henselae infections. In this study, the seroprevalence of antibodies to B. henselae was investigated in these two groups of subjects in the two cities of Aydin and Denizli, which are located in the same region in the southwest of Turkey. Total antibodies to B. henselae were evaluated by indirect immunofluorescence assay in serum samples taken from 63 cattle breeders and 27 veterinarians. Twenty samples (22.2%) were found to react on 1/64 titre with B. henselae antigens. Bartonella henselae seroprevalence was found to be significantly related to age (P = 0.033) and higher in those living in Aydin (P = 0.047). Age was the only independent factor in multivariate analysis (P = 0.008). Seroprevalence was found to be 2‐fold higher in those people who had had tick contact (P = 0.093). In conclusion, the physicians in the region should consider B. henselae infection among veterinarians and breeders in their differential diagnosis list of fever of unknown origin.