Zeynep Türe

Epidemiology and cost implications of candidemia, a 6-year analysis from a developing country.

Surveillance of candidemia is essential to monitor trends in species distribution and change in the incidence and antifungal resistance. In this study, we aimed to investigate prevalence, resistance rates, antifungal utilization and costs. A 6‐year retrospective analysis of the data belonging to patients with candidemia hospitalized between 2010 and 2016 was performed. The annual usage of fluconazole and caspofungin and the usage of these antifungals in different units were described in defined daily doses (DDD) per 1000 patient days. In total, 351 patients of candidemia were included. Median age of the patients was 45 (0‐88) and 55.1% of them were male. Overall, 48.1% of the candidemia episodes (169/351) were due to C. albicans, followed by C. parapsilosis (25.1%), C. glabrata (11.7%). Length of hospital stay was longer with a median of 20 days among patients with non‐albicans candidemia. Presence of a central venous catheter was found to be an associated risk for candidemia caused by non‐albicans strains. Annual incidence of candidemia increased from 0.10 to 0.30 cases/1000 patient days. Antifungal use was increased over years correlated with the cost paid for it. The policy against candidemia should be specified by each institution with respect to candidemia prevalence, resistance rates, antifungal use and costs.

Tigecycline for the treatment of Clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients

Tigecycline for the treatment of Clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients Gökhan Metan, Zeynep Türe, Leylagül Kaynar, Elife Berk, Şebnem Gürsoy, Emine Alp, Hüseyin Kılıç, Mustafa Çetin Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Gastroenterology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey

Crimean‐Congo hemorrhagic fever with hyperbilirubinemia and ascites: An unusual presentation

Crimean‐Congo hemorrhagic fever (CCHF) is a fatal systemic viral infection which is an important health problem in Turkey. Many systemic symptoms have been reported including fever, hemorrhage, headache, fatigue, muscle ache, abdominal pain, nausea and vomiting. A 45‐year‐old male farmer with CCHF presented with massive peritoneal effusion and hyperbilirubinemia. To our knowledge, this is the first case of peritoneal effusion and hyperbilirubinemia in an adult patient with CCHF. His clinical symptoms successfully improved with supportive therapy. In patients who live in endemic areas with atypical presentation for the diagnosis of CCHF should be kept in mind. J. Med. Virol. 88:159–162, 2016.

Infection control measures to prevent hospital transmission of candida

ABSTRACT Invasive candida infections are the most important causes of nosocomial infections in intensive care units and in risky groups such as immunosuppressed patients. These infections lead to undesirable consequences such as increased morbidity and mortality in patients, prolongation of hospital stay, and increased hospital costs. In recent years, the incidence of non-albicans Candida spp.’s has increased. Unfortunately, some of these species are naturally resistant to first-line antifungals. In addition, biofilm formation on the central venous catheter and invasive devices may cause treatment failure. The age of the patients, co-morbid diseases, the units where they are treated, the antibiotics and antifungals that are used for the treatment, and invasive devices are risk factors for invasive candida infections. Some of these risk factors can be reduced by the behavior of health-care workers. The most important goal is to take precautions before the occurrence of invasive candida infections. Infection control measures to prevent hospital transmission of candida are very important. Compliance with hand hygiene before and after contact with the patient is the most important step to prevent the spreading of Candida spp. Observation of maximal barrier precautions during invasive catheterization is another important clause of this aim. Avoiding unnecessary invasive devices, antibiotics, and parenteral nutrition are also important to reduce the colonization of candida.

The role of nonsteroidal anti-inflammatory drugs intramuscular injection in the development and severity of deep soft tissue infection in mice

The aim of this study was to determine the role of nonsteroidal anti‐inflammatory drugs (NSAID) injection on the severity of local infection and the effect on the progression of soft tissue infection (STI).The mouse model of STI with Group A streptococcus (GAS) was developed and treated with diclofenac sodium (DS) intramuscularly. Mice were divided into five groups: administered DS for 48 h before GAS (Group 1), GAS‐DS and maintained DS for 48 h (Group 2), DS for 48 h (Group 3), GAS on zero time (Group 4), and control (Group 5). In vitro, a high concentration (40 mg/L) of DS inhibited GAS growth, whereas a lower concentration (0.4 mg/L) was not effective. Sepsis was observed in animals with DS and GAS inoculation (group 1 and 2). Group 4 had statistically significant higher bacterial load than groups 1 and 2. All groups had a higher inflammation rate than the control group. The median of TNF‐alpha and mean IL‐6 in the groups 1, 2, and 4 was significantly higher than those in the control group. Even if the animals that were treated with DS injection prior to the GAS inoculation had similar inflammation score, similar cytokine levels and low bacterial load in the tissue, they had a rather high rate of sepsis. In conclusion, DS injection prior to bacterial inoculation might predispose to bacteremia and sepsis.

Telaprevir-based triple therapy for re-treatment Chronic HCV patients with Genotype 1, including the Null-Response: A single center experience from Turkey

Background: Telaprevir with peginterferon/ribavirin (TVR/PR) leads to significantly higher sustained virological response (SVR) rates with partial response or relapse after prior treatment with peginterferon alpha (PegIFN)/ribavirin (RBV) in patients infected with hepatitis C. We studied the efficacy of TVR/PR in patients with prior treatment failure, including those with a null response (<2 Log10 decline in HCV RNA), to peginterferon/ribavirin). Objectives: It was aimed to evaluate efficacy, safety and side effects of the addition of telaprevir to a regimen of peg-interferon plus ribavirin in patients with chronic HCV genotype 1 infection who did not have a sustained virologic response to previous treatment. Method: This study is in a retrospective design with patients receiving TVR based triple therapy for chronic hepatitis C in a single center of a Middle Anatolia. The patient who did not have the response with the previous peg-interferon alpha with ribavirin treatment included the study. Virological response results were assessed at weeks 4, 12, and 24 during the triple treatment. If the HCV RNA levels was > 1000 IU/mL at week 4 or negative at week 4 but >1000 IU/mL at week 12, treatment was discontinued. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The adverse events were evaluated during the therapy. Results: Twenty-six patients infected with genotypes 1a or 1b hepatitis C virus were included the study. All of the patients had been previously treated with PegIFN plus RBV. Sustained virologic response occurred in 21 out of 22 previous relapse patients (95.5%) and 2 out of the 4 non-responder or partial responder patients (50%). The most common side effects were fatigue, insomnia, myalgia and anaemia. Conclusions: In conclusion, the response to TVR treatment rate was high in previous relapsers but it was low in non-responder or partial responder patients. Correspondence to: İlhami Çelik, SBU, Kayseri Training and Research Hospital, Department of İnfectious Diseases 38010, Kayseri, Turkey, Tel: +90 352 336 88 84; E-mail: ilhamicelik@hotmail.com

Predictive factors for percutaneous and mucocutaneous exposure among healthcare workers in a developing country

The aim of this study is to determine the risk factors for percutaneous and mucocutaneous exposures in healthcare workers (HCW) in one of the largest centers of a middle income country, Turkey. This study has a retrospective design. HCWs who presented between August 2011 and June 2013, with Occupational Exposures (OEs) (cases) and those without (controls) were included. Demographic information was collected from infection control committee documents. A questionnaire was used to ask the HCWs about their awareness of preventive measures. HCWs who work with intensive work loads such as those found in emergency departments or intensive care units have a higher risk of OEs. Having heavy workloads and hours increases the risk of percutaneous and mucocutaneous exposures. For that reason the most common occupation groups are nurses and cleaning staff who are at risk of OEs. Increasing work experience has reduced the frequency of OEs.