Firdevs Aksoy

Objective: To assess the effectiveness of intravenous immunoglobulin (IVIg) therapy in patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF) disease. Methods: A single-center retrospective cohort study was conducted on hospitalized patients with confirmed severe CCHF at a tertiary care hospital in Turkey between 2010 and 2022. Cases were categorized into two groups based on whether they received IVIg therapy, with the treatment plan determined by the primary healthcare provider. The clinical, epidemiological, and laboratory parameters of these patients were evaluated. Demographic, laboratory findings, platelet counts on the day of IVIg indication and the third day, bleeding status during follow-up beyond 24 hours after IVIg administration, and prognosis recorded in patient information forms were retrieved. Results: 72 patients were included in the analysis, with IVIg administered to 42 cases (58.3%) and not given to 30 cases (41.7%). Among the patients, 37 (51.4%) were female. Fever (65.3%) was the most common clinical presentation. The overall mortality rate was 19.4%, and IVIg administration did not significantly impact overall survival outcomes ( P =0.48). On Day 3 following IVIg administration or indication, the platelet count was higher in the IVIg-treated group compared to the non-treated group ( P =0.02). Furthermore, during follow-up beyond 24 hours after IVIg administration, bleeding was observed in 19.0% of the IVIg-treated group, compared to 46.6% in the non-treated group ( P =0.01). Conclusions: This study underscores the potential advantages of IVIg therapy in managing severe CCHF. Although IVIg administration did not significantly affect overall survival, it was associated with earlier improvement in platelet counts and a notable reduction in bleeding complications. These findings indicate that IVIg may serve as an adjunctive treatment in CCHF, particularly for addressing hemorrhagic manifestations.

Objective: To assess the effectiveness of intravenous immunoglobulin (IVIg) therapy in patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF) disease. Methods: A single-center retrospective cohort study was conducted on hospitalized patients with confirmed severe CCHF at a tertiary care hospital in Turkey between 2010 and 2022. Cases were categorized into two groups based on whether they received IVIg therapy, with the treatment plan determined by the primary healthcare provider. The clinical, epidemiological, and laboratory parameters of these patients were evaluated. Demographic, laboratory findings, platelet counts on the day of IVIg indication and the third day, bleeding status during follow-up beyond 24 hours after IVIg administration, and prognosis recorded in patient information forms were retrieved. Results: 72 patients were included in the analysis, with IVIg administered to 42 cases (58.3%) and not given to 30 cases (41.7%). Among the patients, 37 (51.4%) were female. Fever (65.3%) was the most common clinical presentation. The overall mortality rate was 19.4%, and IVIg administration did not significantly impact overall survival outcomes ( P =0.48). On Day 3 following IVIg administration or indication, the platelet count was higher in the IVIg-treated group compared to the non-treated group ( P =0.02). Furthermore, during follow-up beyond 24 hours after IVIg administration, bleeding was observed in 19.0% of the IVIg-treated group, compared to 46.6% in the non-treated group ( P =0.01). Conclusions: This study underscores the potential advantages of IVIg therapy in managing severe CCHF. Although IVIg administration did not significantly affect overall survival, it was associated with earlier improvement in platelet counts and a notable reduction in bleeding complications. These findings indicate that IVIg may serve as an adjunctive treatment in CCHF, particularly for addressing hemorrhagic manifestations.

OBJECTIVES: Community-acquired bloodstream infections (CA-BSIs) are a major cause of mortality in older adults, yet prospective international data are limited. This study evaluated clinical features, microbiology, and mortality predictors in older patients with CA-BSI. METHODS: This prospective, observational study was conducted in 72 referral centers across 16 countries between June 1 and September 1, 2024. Patients aged ≥65 years with confirmed CA-BSI were included. Demographic, clinical, laboratory, and treatment data were collected. The primary outcome was 30-day all-cause mortality. Univariate and multivariate logistic regression was used to identify predictors. RESULTS: 574 patients were enrolled (median age 74 years; 48.1% female), and 30-day mortality was 26.3%. Urinary tract infection was the most common source (33.7%), and 30.5% had no identifiable origin. Gram-negative organisms predominated (58.6%). Independent mortality predictors included SOFA score ≥5, thrombocytopenia (<50,000/µL), Staphylococcus aureus bacteremia, pneumonia, bacteremia of unknown origin, and higher Charlson Comorbidity Index. Higher Katz Activities of Daily Living scores were protective. CONCLUSION: CA-BSI in older adults is associated with high mortality. Outcomes are driven by comorbidity burden, functional status, infection severity, and causative pathogen, highlighting the need for early risk stratification and tailored management.

Background/aim: Postexposure prophylaxis (PEP) for human immunodeficiency virus (HIV) plays a vital role in preventing transmission among healthcare workers following occupational exposure. Despite its clinical importance, epidemiological data regarding PEP implementation in Türkiye remain scarce. This study aimed to assess PEP practices, prophylactic treatment regimens, and follow-up outcomes among healthcare workers at risk of occupational HIV exposure. Materials and methods: This retrospective, multicenter study was conducted between January 2020 and December 2024 across 16 healthcare facilities participating in the National HIV/AIDS Working Group. Healthcare workers aged 18 years and older who presented for evaluation following occupational exposure to HIV were included. Data on demographics, exposure characteristics, source patient test results, PEP initiation timing, regimen preferences, adverse effects, and follow-up outcomes were collected from hospital records and analyzed using SPSS v25.0. Results: A total of 369 healthcare workers were assessed. The PEP initiation rate was 49.1%. Needlestick injuries accounted for 79.4% of occupational exposures, and nurses constituted nearly half of presentations (49.6%). In univariable analyses, PEP initiation was less frequent among nurses than among other healthcare staff. In the multivariable model, male sex and age ≥40 years were independently associated with higher odds of PEP initiation, whereas the nursing profession was associated with lower odds. The median time to PEP initiation was 17.9 h (range: 0-120). Adverse effects were uncommon (3.5%), most frequently nausea and vomiting. No HIV seroconversions were identified among individuals with available follow-up results; however, follow-up testing at the predefined time points was incomplete, which limits the ability to exclude rare late seroconversions. Conclusion: Timely initiation of HIV PEP appears feasible and well tolerated in real-world occupational settings. These findings highlight the need for standardized institutional protocols and improved follow-up strategies for healthcare workers in Türkiye.

BACKGROUND: Entecavir (ETV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) are widely used in the treatment of chronic hepatitis B (CHB). This study aimed to investigate the blood lipid profile of CHB patients using these three drugs. METHODS: This Türkiye-wide retrospective cohort study included individuals who were older than 18 years of age, treatment-naive and were diagnosed with CHB for at least 1 year after 2010. The study aimed to evaluate the 48-month lipid profile changes of patients taking antivirals. RESULTS: In total, 1912 cases (ETV 756 [39.3%], TDF 1082 [56.3%] and TAF 74 [3.8%]) diagnosed with CHB and receiving antiviral treatment were included. There was no difference between the three drug groups in terms of age and comorbidities (P>0.05). While there was no difference in the initial total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides (TG) values between the three groups, all values were significantly lower in the TDF group in the first year (P<0.05). While TG, LDL and TC values were significantly lower in the TDF group in the second year (P<0.05), there was no difference in HDL and HDL/CHOL (P>0.05). CONCLUSIONS: TDF causes a decrease in LDL levels, TC and total cholesterol/HDL ratio. However, use of ETV and TAF did not significantly affect the lipid profile. It should not be forgotten that lipid profile changes may cause metabolic health problems in individuals receiving hepatitis B treatment and appropriate treatment should be planned by regular monitoring according to treatment groups.

BACKGROUND: Entecavir (ETV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) are widely used in the treatment of chronic hepatitis B (CHB). This study aimed to investigate the blood lipid profile of CHB patients using these three drugs. METHODS: This Türkiye-wide retrospective cohort study included individuals who were older than 18 years of age, treatment-naive and were diagnosed with CHB for at least 1 year after 2010. The study aimed to evaluate the 48-month lipid profile changes of patients taking antivirals. RESULTS: In total, 1912 cases (ETV 756 [39.3%], TDF 1082 [56.3%] and TAF 74 [3.8%]) diagnosed with CHB and receiving antiviral treatment were included. There was no difference between the three drug groups in terms of age and comorbidities (P>0.05). While there was no difference in the initial total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides (TG) values between the three groups, all values were significantly lower in the TDF group in the first year (P<0.05). While TG, LDL and TC values were significantly lower in the TDF group in the second year (P<0.05), there was no difference in HDL and HDL/CHOL (P>0.05). CONCLUSIONS: TDF causes a decrease in LDL levels, TC and total cholesterol/HDL ratio. However, use of ETV and TAF did not significantly affect the lipid profile. It should not be forgotten that lipid profile changes may cause metabolic health problems in individuals receiving hepatitis B treatment and appropriate treatment should be planned by regular monitoring according to treatment groups.

OBJECTIVES: Community-acquired bloodstream infections (CA-BSIs) are a major cause of mortality in older adults, yet prospective international data are limited. This study evaluated clinical features, microbiology, and mortality predictors in older patients with CA-BSI. METHODS: This prospective, observational study was conducted in 72 referral centers across 16 countries between June 1 and September 1, 2024. Patients aged ≥65 years with confirmed CA-BSI were included. Demographic, clinical, laboratory, and treatment data were collected. The primary outcome was 30-day all-cause mortality. Univariate and multivariate logistic regression was used to identify predictors. RESULTS: 574 patients were enrolled (median age 74 years; 48.1% female), and 30-day mortality was 26.3%. Urinary tract infection was the most common source (33.7%), and 30.5% had no identifiable origin. Gram-negative organisms predominated (58.6%). Independent mortality predictors included SOFA score ≥5, thrombocytopenia (<50,000/µL), Staphylococcus aureus bacteremia, pneumonia, bacteremia of unknown origin, and higher Charlson Comorbidity Index. Higher Katz Activities of Daily Living scores were protective. CONCLUSION: CA-BSI in older adults is associated with high mortality. Outcomes are driven by comorbidity burden, functional status, infection severity, and causative pathogen, highlighting the need for early risk stratification and tailored management.

Background/aim: Postexposure prophylaxis (PEP) for human immunodeficiency virus (HIV) plays a vital role in preventing transmission among healthcare workers following occupational exposure. Despite its clinical importance, epidemiological data regarding PEP implementation in Türkiye remain scarce. This study aimed to assess PEP practices, prophylactic treatment regimens, and follow-up outcomes among healthcare workers at risk of occupational HIV exposure. Materials and methods: This retrospective, multicenter study was conducted between January 2020 and December 2024 across 16 healthcare facilities participating in the National HIV/AIDS Working Group. Healthcare workers aged 18 years and older who presented for evaluation following occupational exposure to HIV were included. Data on demographics, exposure characteristics, source patient test results, PEP initiation timing, regimen preferences, adverse effects, and follow-up outcomes were collected from hospital records and analyzed using SPSS v25.0. Results: A total of 369 healthcare workers were assessed. The PEP initiation rate was 49.1%. Needlestick injuries accounted for 79.4% of occupational exposures, and nurses constituted nearly half of presentations (49.6%). In univariable analyses, PEP initiation was less frequent among nurses than among other healthcare staff. In the multivariable model, male sex and age ≥40 years were independently associated with higher odds of PEP initiation, whereas the nursing profession was associated with lower odds. The median time to PEP initiation was 17.9 h (range: 0-120). Adverse effects were uncommon (3.5%), most frequently nausea and vomiting. No HIV seroconversions were identified among individuals with available follow-up results; however, follow-up testing at the predefined time points was incomplete, which limits the ability to exclude rare late seroconversions. Conclusion: Timely initiation of HIV PEP appears feasible and well tolerated in real-world occupational settings. These findings highlight the need for standardized institutional protocols and improved follow-up strategies for healthcare workers in Türkiye.

Introduction: Cytomegalovirus (CMV) infection during pregnancy poses a significant risk of congenital infection, particularly in seronegative women.This study aimed to assess CMV seroprevalence among pregnant women and evaluate the incidence of primary CMV infections during pregnancy.Materials and Methods: This retrospective multicenter study included pregnant women aged 18 year who were hospitalized between January 2018 and December 2022.Demographic data -including maternal age, gravidity, and educational and occupational status -along with CMV serological results, gestational age at CMV diagnosis, and fetal ultrasonographic (USG) findings were collected and analyzed.In cases with positive CMV immunoglobulin M (IgM) and IgG, CMV-IgG avidity values, amniotic fluid CMV-DNA polymerase chain reaction results, and fetal USG findings were recorded to assess the likelihood of primary infection.Results: Among 16,761 pregnant women, 261 (1.6%) tested positive for CMV-IgM.Of these, 126 (48.3%) underwent CMV-IgG avidity testing, and three cases demonstrated low avidity, indicating recent primary infection.Ultrasonographic abnormalities in these three fetuses included hydrops fetalis, polyhydramnios, skin edema, and hyperechogenic bowel.Additionally, five patients with high CMV-IgG levels underwent IgG avidity testing; fetal USG findings in these cases revealed intrauterine growth restriction, oligohydramnios, and cranial abnormalities. Conclusion:Primary CMV infection during pregnancy is associated with adverse outcomes such as fetal anomalies, spontaneous abortion, and preterm birth.Preventive strategies, including educating CMV-seronegative women about transmission routes and routine assessment of CMV-IgG avidity and fetal USG findings, are essential for early diagnosis and improved perinatal outcomes.

Background/Objectives: Cardiac implantable electronic device-related infective endocarditis (CIED-RIE) is a serious condition with significant morbidity and mortality. Although recent advances in imaging and therapeutic approaches have improved management, diagnosing and treating CIED-RIE continues to be challenging. This study aimed to identify factors associated with mortality in CIED-RIE patients. Methods: We conducted a retrospective, multicenter international study of adult patients diagnosed with CIED-RIE between January 2014 and June 2024. Data on demographics, clinical presentation, microbiological findings, imaging results, treatment modalities, and outcomes were collected and analyzed to determine predictors of short-term mortality. Results: A total of 197 patients (mean age: 65.3 ± 14.4 years; 75.1% male) were included. The most common device type was permanent pacemaker (48.2%). Staphylococcus species were the predominant pathogens (62.4%). Surgical intervention was performed in 67.5% of patients, and 90-day mortality occurred in 19.3%. Multivariable analysis identified higher Charlson comorbidity index (HR: 1.31), tricuspid valve involvement (HR: 2.35), vegetation size ≥ 10 mm (HR: 2.53), pulmonary embolism (HR: 3.92), and absence of surgical intervention (HR: 2.90) as independent predictors of increased 90-day mortality. Conclusions: Early identification of high-risk patients and prompt multidisciplinary management, including surgical intervention when indicated, are critical to improving outcomes in patients with CIED-RIE.

Objectives: Burkholderia cepacia complex (Bcc), a Gram-negative organism, is a well-recognized cause of hospital outbreaks, often linked to a contaminated shared source, such as multidose medications. In this study, we report an outbreak of Bcc infections in a tertiary care hospital, associated with the intrinsic contamination of a prepared solution used in interventional radiology (IR) procedures. Additionally, we provide a detailed explanation of the interventions implemented to control and interrupt the outbreak. Methods: Records from the infection control committee from 1 January 2023 to 31 October 2024 were screened to identify cases with Bcc growth in cultured blood, urine, or respiratory samples. Clinical and laboratory data were collected in March 2025. Bacterial identification was performed using conventional methods and MALDI-TOF (Bruker Daltonics, Bremen, Germany). Controls were matched to cases by ward, date of initial growth, and duration of hospitalization. Demographic and clinical data of these patients were systematically collected and analyzed. Microbiological cultures were obtained from environmental objects of concern and certain medications. Results: A total of 82 Burkholderia species were identified. We enrolled 77 cases and 77 matched controls. The source of contamination was identified in ready-to-use intravenous medications (remifentanil and magnesium preparations) in the IR department. These preparations were compounded in advance by the team and were used repeatedly. Although the outbreak originated from contaminated IV medications used in IR, secondary transmission likely affected 28 non-IR patients via fomites, shared environments, and possible lapses in isolation precautions. The mortality rate among the cases was 16.9%. Infection with Bcc was associated with prolonged intensive care unit stays (p = 0.018) and an extended overall hospitalization duration (p &lt; 0.001); however, it was not associated with increased mortality. The enforcement of contact precautions and comprehensive environmental decontamination successfully reduced the incidence of the Bcc outbreak. No pathogens were detected in cultures obtained after the disinfection. Conclusions: The hospital transmission of Bcc is likely driven by cross-contamination, invasive medical procedures, and the administration of contaminated medications. Implementing stringent infection control measures such as staff retraining, updated policies on medication use, enhanced environmental decontamination, and strict adherence to isolation precautions has proven effective in curbing the spread of virulent and transmissible Bcc.

Objectives: This study aims to evaluate the use and efficacy of antibiotic-lock therapy (ALT) in the management of catheter-related bloodstream infections (CRBSIs), focusing on its impact on infection resolution, catheter retention, and clinical outcomes. Methods: Patients aged ≥18 years diagnosed with CRBSIs who had long-term indwelling catheters and for whom catheter replacement posed clinical challenges were enrolled in the retrospective study from January 2019 to December 2024. Participants were divided into two groups based on treatment: Group 1 received intravenous (IV) antibiotics combined with antibiotic-lock therapy (ALT), while Group 2 received IV antibiotics alone. Patient demographics, pathogen distribution, administered antibiotic regimens, duration of treatment, laboratory parameters, clinical outcomes, and mortality rates were evaluated. Results: A total of 54 patients were included, of whom 42.6% were female, and the mean age was 66.3 ± 15.4 years. Group 1 comprised 50% of the study population. The median treatment duration was 14 days. The most common pathogen was Coagulase-negative staphylococci, and 33.3% of CRBSIs were caused by Gram-negative bacteria (GNB). Group 1 demonstrated lower C-reactive protein levels at treatment 48/72 h of treatment (p = 0.013) and a reduced frequency of catheter revision (p &lt; 0.0001) compared to Group 2. Overall, ALT achieved a success rate of 88.9%, with success rates of 86% for GNB infections and 90% for Gram-positive bacterial infections. Among patients receiving daily ALT, the success rate was 86%, while those receiving the therapy every three days had a success rate of 90%. Conclusions: Antimicrobial lock therapy can be considered a treatment option for managing CRBSIs, particularly in cases where removal of the implantable catheter is not feasible, allowing for salvage.

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicansCandida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among C. albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360-24.434; P = .017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053-0.792; P = .022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, and identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

OBJECTIVE: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients. METHODS: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements. RESULTS: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects. CONCLUSION: Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia. OBJECTIVE: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients. METHODS: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements. RESULTS: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects. CONCLUSION: Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia.

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicansCandida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among C. albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360-24.434; P = .017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053-0.792; P = .022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, and identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

Background/Objectives: Cardiac implantable electronic device-related infective endocarditis (CIED-RIE) is a serious condition with significant morbidity and mortality. Although recent advances in imaging and therapeutic approaches have improved management, diagnosing and treating CIED-RIE continues to be challenging. This study aimed to identify factors associated with mortality in CIED-RIE patients. Methods: We conducted a retrospective, multicenter international study of adult patients diagnosed with CIED-RIE between January 2014 and June 2024. Data on demographics, clinical presentation, microbiological findings, imaging results, treatment modalities, and outcomes were collected and analyzed to determine predictors of short-term mortality. Results: A total of 197 patients (mean age: 65.3 ± 14.4 years; 75.1% male) were included. The most common device type was permanent pacemaker (48.2%). Staphylococcus species were the predominant pathogens (62.4%). Surgical intervention was performed in 67.5% of patients, and 90-day mortality occurred in 19.3%. Multivariable analysis identified higher Charlson comorbidity index (HR: 1.31), tricuspid valve involvement (HR: 2.35), vegetation size ≥ 10 mm (HR: 2.53), pulmonary embolism (HR: 3.92), and absence of surgical intervention (HR: 2.90) as independent predictors of increased 90-day mortality. Conclusions: Early identification of high-risk patients and prompt multidisciplinary management, including surgical intervention when indicated, are critical to improving outcomes in patients with CIED-RIE.

OBJECTIVE: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients. METHODS: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements. RESULTS: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects. CONCLUSION: Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia. OBJECTIVE: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients. METHODS: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements. RESULTS: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects. CONCLUSION: Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia.

Objectives: This study aims to evaluate the use and efficacy of antibiotic-lock therapy (ALT) in the management of catheter-related bloodstream infections (CRBSIs), focusing on its impact on infection resolution, catheter retention, and clinical outcomes. Methods: Patients aged ≥18 years diagnosed with CRBSIs who had long-term indwelling catheters and for whom catheter replacement posed clinical challenges were enrolled in the retrospective study from January 2019 to December 2024. Participants were divided into two groups based on treatment: Group 1 received intravenous (IV) antibiotics combined with antibiotic-lock therapy (ALT), while Group 2 received IV antibiotics alone. Patient demographics, pathogen distribution, administered antibiotic regimens, duration of treatment, laboratory parameters, clinical outcomes, and mortality rates were evaluated. Results: A total of 54 patients were included, of whom 42.6% were female, and the mean age was 66.3 ± 15.4 years. Group 1 comprised 50% of the study population. The median treatment duration was 14 days. The most common pathogen was Coagulase-negative staphylococci, and 33.3% of CRBSIs were caused by Gram-negative bacteria (GNB). Group 1 demonstrated lower C-reactive protein levels at treatment 48/72 h of treatment (p = 0.013) and a reduced frequency of catheter revision (p &lt; 0.0001) compared to Group 2. Overall, ALT achieved a success rate of 88.9%, with success rates of 86% for GNB infections and 90% for Gram-positive bacterial infections. Among patients receiving daily ALT, the success rate was 86%, while those receiving the therapy every three days had a success rate of 90%. Conclusions: Antimicrobial lock therapy can be considered a treatment option for managing CRBSIs, particularly in cases where removal of the implantable catheter is not feasible, allowing for salvage.

Objectives: Burkholderia cepacia complex (Bcc), a Gram-negative organism, is a well-recognized cause of hospital outbreaks, often linked to a contaminated shared source, such as multidose medications. In this study, we report an outbreak of Bcc infections in a tertiary care hospital, associated with the intrinsic contamination of a prepared solution used in interventional radiology (IR) procedures. Additionally, we provide a detailed explanation of the interventions implemented to control and interrupt the outbreak. Methods: Records from the infection control committee from 1 January 2023 to 31 October 2024 were screened to identify cases with Bcc growth in cultured blood, urine, or respiratory samples. Clinical and laboratory data were collected in March 2025. Bacterial identification was performed using conventional methods and MALDI-TOF (Bruker Daltonics, Bremen, Germany). Controls were matched to cases by ward, date of initial growth, and duration of hospitalization. Demographic and clinical data of these patients were systematically collected and analyzed. Microbiological cultures were obtained from environmental objects of concern and certain medications. Results: A total of 82 Burkholderia species were identified. We enrolled 77 cases and 77 matched controls. The source of contamination was identified in ready-to-use intravenous medications (remifentanil and magnesium preparations) in the IR department. These preparations were compounded in advance by the team and were used repeatedly. Although the outbreak originated from contaminated IV medications used in IR, secondary transmission likely affected 28 non-IR patients via fomites, shared environments, and possible lapses in isolation precautions. The mortality rate among the cases was 16.9%. Infection with Bcc was associated with prolonged intensive care unit stays (p = 0.018) and an extended overall hospitalization duration (p &lt; 0.001); however, it was not associated with increased mortality. The enforcement of contact precautions and comprehensive environmental decontamination successfully reduced the incidence of the Bcc outbreak. No pathogens were detected in cultures obtained after the disinfection. Conclusions: The hospital transmission of Bcc is likely driven by cross-contamination, invasive medical procedures, and the administration of contaminated medications. Implementing stringent infection control measures such as staff retraining, updated policies on medication use, enhanced environmental decontamination, and strict adherence to isolation precautions has proven effective in curbing the spread of virulent and transmissible Bcc.

Introduction: Cytomegalovirus (CMV) infection during pregnancy poses a significant risk of congenital infection, particularly in seronegative women.This study aimed to assess CMV seroprevalence among pregnant women and evaluate the incidence of primary CMV infections during pregnancy.Materials and Methods: This retrospective multicenter study included pregnant women aged 18 year who were hospitalized between January 2018 and December 2022.Demographic data -including maternal age, gravidity, and educational and occupational status -along with CMV serological results, gestational age at CMV diagnosis, and fetal ultrasonographic (USG) findings were collected and analyzed.In cases with positive CMV immunoglobulin M (IgM) and IgG, CMV-IgG avidity values, amniotic fluid CMV-DNA polymerase chain reaction results, and fetal USG findings were recorded to assess the likelihood of primary infection.Results: Among 16,761 pregnant women, 261 (1.6%) tested positive for CMV-IgM.Of these, 126 (48.3%) underwent CMV-IgG avidity testing, and three cases demonstrated low avidity, indicating recent primary infection.Ultrasonographic abnormalities in these three fetuses included hydrops fetalis, polyhydramnios, skin edema, and hyperechogenic bowel.Additionally, five patients with high CMV-IgG levels underwent IgG avidity testing; fetal USG findings in these cases revealed intrauterine growth restriction, oligohydramnios, and cranial abnormalities. Conclusion:Primary CMV infection during pregnancy is associated with adverse outcomes such as fetal anomalies, spontaneous abortion, and preterm birth.Preventive strategies, including educating CMV-seronegative women about transmission routes and routine assessment of CMV-IgG avidity and fetal USG findings, are essential for early diagnosis and improved perinatal outcomes.

BACKGROUND: Crimean-Congo hemorrhagic fever virus (CCHFV), a zoonotic agent in the Nairoviridae family (genus Orthonairovirus), is a high-priority pathogen. CCHFV infection causes Crimean-Congo hemorrhagic fever (CCHF), a human disease with case fatality rates of up to 40%. Serological surveillance of CCHFV in animals and humans is crucial for ecological studies and public health. METHODS: We developed CCHFV mix-and-read assays utilizing split-NanoLuc technology (NanoBiT) to detect anti-CCHFV antibodies against the nucleoprotein (NP) stalk region and the GP38 glycoprotein. These species- and isotype-agnostic assays provide results in ∼30 min. Using serum samples from RT-PCR-confirmed CCHF cases collected during and after hospitalization, we investigated anti-NP and anti-GP38 antibody development. The performance of the mix-and-read assays was compared to the NP-based IDScreen® CCHF commercial assay using human sera, and cross-reactivity potential was evaluated using a diverse panel of anti-orthonairovirus antisera raised in mice. FINDINGS: In human convalescent cases (n = 21), mix-and-read assay concordance between anti-GP38 and anti-NP antibody detection was 100%. Both mix-and-read assays and IDScreen® CCHF demonstrated identical sensitivity of 95.2% in convalescent patients. The specificity of the NP assay was 98.9%, and that of GP38 was 99.7%, both comparable to IDScreen® CCHF (specificity: 99.7%). Cross-reactivity against CCHF NP and GP38, regardless of assay type, was primarily observed in antisera raised against other orthonairoviruses within the Nairobi sheep disease genogroup. INTERPRETATION: The simplicity and robust performance of the CCHFV mix-and-read assays make them ideal tools for supporting serological surveillance in humans and animals. Furthermore, the inclusion of the GP38 antigen alongside NP enhances the precise identification of retrospective CCHF cases, further strengthening broad surveillance efforts. FUNDING: CDC Emerging Infectious Disease Research Core Funds, funding for reagent, CDC personal, travel. Defence Threat Reduction Agency (HDTRA12210007): E.K. salary. Oak Ridge Institute for Science and Education (ORISE): E.K. salary and travel. National Institute of Allergy and Infectious Diseases (1R01AI180125-01A1): sample acquisition. Funding sources did not have a role in the writing or decision to submit the publication.

BACKGROUND: Crimean-Congo hemorrhagic fever virus (CCHFV), a zoonotic agent in the Nairoviridae family (genus Orthonairovirus), is a high-priority pathogen. CCHFV infection causes Crimean-Congo hemorrhagic fever (CCHF), a human disease with case fatality rates of up to 40%. Serological surveillance of CCHFV in animals and humans is crucial for ecological studies and public health. METHODS: We developed CCHFV mix-and-read assays utilizing split-NanoLuc technology (NanoBiT) to detect anti-CCHFV antibodies against the nucleoprotein (NP) stalk region and the GP38 glycoprotein. These species- and isotype-agnostic assays provide results in ∼30 min. Using serum samples from RT-PCR-confirmed CCHF cases collected during and after hospitalization, we investigated anti-NP and anti-GP38 antibody development. The performance of the mix-and-read assays was compared to the NP-based IDScreen® CCHF commercial assay using human sera, and cross-reactivity potential was evaluated using a diverse panel of anti-orthonairovirus antisera raised in mice. FINDINGS: In human convalescent cases (n = 21), mix-and-read assay concordance between anti-GP38 and anti-NP antibody detection was 100%. Both mix-and-read assays and IDScreen® CCHF demonstrated identical sensitivity of 95.2% in convalescent patients. The specificity of the NP assay was 98.9%, and that of GP38 was 99.7%, both comparable to IDScreen® CCHF (specificity: 99.7%). Cross-reactivity against CCHF NP and GP38, regardless of assay type, was primarily observed in antisera raised against other orthonairoviruses within the Nairobi sheep disease genogroup. INTERPRETATION: The simplicity and robust performance of the CCHFV mix-and-read assays make them ideal tools for supporting serological surveillance in humans and animals. Furthermore, the inclusion of the GP38 antigen alongside NP enhances the precise identification of retrospective CCHF cases, further strengthening broad surveillance efforts. FUNDING: CDC Emerging Infectious Disease Research Core Funds, funding for reagent, CDC personal, travel. Defence Threat Reduction Agency (HDTRA12210007): E.K. salary. Oak Ridge Institute for Science and Education (ORISE): E.K. salary and travel. National Institute of Allergy and Infectious Diseases (1R01AI180125-01A1): sample acquisition. Funding sources did not have a role in the writing or decision to submit the publication.

<bold>Background:</bold> Even though different vaccines and drugs have been investigated and even applied worldwide to fight COVID-19 pandemics we still are in search of new therapeutic options not only to prevent new cases but also enable fast recovery and reduce the long-lasting symptoms or sequelae of different organs, especially lung. <bold>Methods:</bold> A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind phase II clinical trial was conducted in Turkey. In the study, 80 adult patients were enrolled from 9 hospitals. They were randomized 1:1 to either inhaled Aviptadil treatment or placebo, in addition to the standard care as stated by the national guidelines. <bold>Results:</bold> The gender, age, and vital sign distributions were comparable between the Treatment and Placebo groups (p>0.05). The patients who received Aviptadil inhalation had a discharge rate of 89.7%, compared to 82.9% in the Placebo group. The rate of patients admitted to intensive care because of disease progression was 10.3% in the Aviptadil group, but 17.1% in the placebo group (p=0.376). On the other hand, the average discharge time was 7.8±4.0 days in the Treatment group and 10±5.0 days in the Placebo group (p=0.049). This rapid improvement is supported by patients' Modified-Borg Scales, which were statistically similar on Day 3 (p=0.090), but significantly lower in the Treatment group on Day 7 (p=0.033). The CT lung damage score was similar on Day 1 for both groups (p=0.962) but significantly improved in the Aviptadil group on Day 28 (p=0.028). The death rate was also lower in the Aviptadil group (5.1%) compared to the Placebo (12.2%). <bold>Conclusion</bold>: Inhaled Aviptadil could be a way to treat and fasten the recovery of lungs from COVID-19.

Introduction: The workload of physicians increased due to the number of patients presenting with suspicion of coronavirus 2019 (COVID-19) and the prolonged wait times in the emergency department during the COVID-19 pandemic. Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) is a protein present in platelets and endothelial cells; it is activated by inflammation from COVID-19 and may be associated with COVID-19’s known thrombotic risk. We aimed to determine whether SCUBE-1 levels are diagnostically correlated in suspected COVID-19 patients, and whether SCUBE-1 correlated with severity of disease and, therefore, might be useful to guide hospitalization/discharge decisions. Methods: The suspected COVID-19 patients cared for at tertiary healthcare institutions for one year between May 2021–May 2022 were examined in this study. The subjects were both suspected COVID-19 patients not ultimately found to have COVID-19 and those who were diagnosed with COVID-19. By modifying the disease severity scoring systems present in COVID-19 guidelines in 2021, the COVID-19-positive patient group was classified as mild, moderate, severe, and critical, and compared using the SCUBE-1 levels. Moreover, SCUBE-1 levels were compared between the COVID-19 positive group and the COVID-19 negative group. Results: A total of 507 patients were considered for the present study. After excluding 175 patients for incomplete data and alternate comorbid organ failure. we report on 332 patients (65.5%). Of these 332 patients, 80 (24.0%) were COVID-19 negative, and 252 (76.0%) were COVID-19 positive. Of 252 (100%) patients diagnosed with COVID-19, 74 (29.4%) were classified as mild, 95 (37.7%) moderate, 45 (17.8%) severe, and 38 (15.1%) critical. The SCUBE-1 levels were statistically different between COVID-19 positive (8.48 ± 7.42 nanograms per milliliter [ng/mL]) and COVID-19 negative (1.86 ± 0.92 ng/mL) patients (P &amp;lt; 0.001). In the COVID-19 positive group, SCUBE-1 levels increased with disease severity (mild = 3.20 ± 1.65 ng/mL, moderate = 4.78 ± 2.26 ng/mL, severe = 13.68 ± 3.95 ng/mL, and critical = 21.87 ± 5.39 ng/mL) (P &amp;lt; 0.001). The initial SCUBE-1 levels of discharged patients were significantly lower than those requiring hospitalization (discharged = 2.89 ng/mL [0.55–8.60 ng/mL]; ward admitted = 7.13 ng/mL [1.38–21.29 ng/mL], and ICU admitted = 21.19 ng/mL [10.58–37.86 ng/mL]) (P &amp;lt; 0.001). Conclusion: The SCUBE-1 levels were found to be differentiated between patients with and without COVID-19 and to be correlated with the severity of illness.

<bold>Background:</bold> Even though different vaccines and drugs have been investigated and even applied worldwide to fight COVID-19 pandemics we still are in search of new therapeutic options not only to prevent new cases but also enable fast recovery and reduce the long-lasting symptoms or sequelae of different organs, especially lung. <bold>Methods:</bold> A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind phase II clinical trial was conducted in Turkey. In the study, 80 adult patients were enrolled from 9 hospitals. They were randomized 1:1 to either inhaled Aviptadil treatment or placebo, in addition to the standard care as stated by the national guidelines. <bold>Results:</bold> The gender, age, and vital sign distributions were comparable between the Treatment and Placebo groups (p>0.05). The patients who received Aviptadil inhalation had a discharge rate of 89.7%, compared to 82.9% in the Placebo group. The rate of patients admitted to intensive care because of disease progression was 10.3% in the Aviptadil group, but 17.1% in the placebo group (p=0.376). On the other hand, the average discharge time was 7.8±4.0 days in the Treatment group and 10±5.0 days in the Placebo group (p=0.049). This rapid improvement is supported by patients' Modified-Borg Scales, which were statistically similar on Day 3 (p=0.090), but significantly lower in the Treatment group on Day 7 (p=0.033). The CT lung damage score was similar on Day 1 for both groups (p=0.962) but significantly improved in the Aviptadil group on Day 28 (p=0.028). The death rate was also lower in the Aviptadil group (5.1%) compared to the Placebo (12.2%). <bold>Conclusion</bold>: Inhaled Aviptadil could be a way to treat and fasten the recovery of lungs from COVID-19.

Introduction: The workload of physicians increased due to the number of patients presenting with suspicion of coronavirus 2019 (COVID-19) and the prolonged wait times in the emergency department during the COVID-19 pandemic. Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) is a protein present in platelets and endothelial cells; it is activated by inflammation from COVID-19 and may be associated with COVID-19’s known thrombotic risk. We aimed to determine whether SCUBE-1 levels are diagnostically correlated in suspected COVID-19 patients, and whether SCUBE-1 correlated with severity of disease and, therefore, might be useful to guide hospitalization/discharge decisions. Methods: The suspected COVID-19 patients cared for at tertiary healthcare institutions for one year between May 2021–May 2022 were examined in this study. The subjects were both suspected COVID-19 patients not ultimately found to have COVID-19 and those who were diagnosed with COVID-19. By modifying the disease severity scoring systems present in COVID-19 guidelines in 2021, the COVID-19-positive patient group was classified as mild, moderate, severe, and critical, and compared using the SCUBE-1 levels. Moreover, SCUBE-1 levels were compared between the COVID-19 positive group and the COVID-19 negative group. Results: A total of 507 patients were considered for the present study. After excluding 175 patients for incomplete data and alternate comorbid organ failure. we report on 332 patients (65.5%). Of these 332 patients, 80 (24.0%) were COVID-19 negative, and 252 (76.0%) were COVID-19 positive. Of 252 (100%) patients diagnosed with COVID-19, 74 (29.4%) were classified as mild, 95 (37.7%) moderate, 45 (17.8%) severe, and 38 (15.1%) critical. The SCUBE-1 levels were statistically different between COVID-19 positive (8.48 ± 7.42 nanograms per milliliter [ng/mL]) and COVID-19 negative (1.86 ± 0.92 ng/mL) patients (P &amp;lt; 0.001). In the COVID-19 positive group, SCUBE-1 levels increased with disease severity (mild = 3.20 ± 1.65 ng/mL, moderate = 4.78 ± 2.26 ng/mL, severe = 13.68 ± 3.95 ng/mL, and critical = 21.87 ± 5.39 ng/mL) (P &amp;lt; 0.001). The initial SCUBE-1 levels of discharged patients were significantly lower than those requiring hospitalization (discharged = 2.89 ng/mL [0.55–8.60 ng/mL]; ward admitted = 7.13 ng/mL [1.38–21.29 ng/mL], and ICU admitted = 21.19 ng/mL [10.58–37.86 ng/mL]) (P &amp;lt; 0.001). Conclusion: The SCUBE-1 levels were found to be differentiated between patients with and without COVID-19 and to be correlated with the severity of illness.

OBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.

Abstract Background Multidrug resistant (MDR) Gram-negative bacteria, including metallo-β-lactamase (MBL) producers, pose significant treatment challenges. This study investigated efficacy and safety of aztreonam-avibactam (ATM-AVI) in the treatment of complicated intra-abdominal infection (cIAI) or hospital-acquired)/ventilator-associated pneumonia (HAP/VAP) due to Gram-negative bacteria, including MBL-producing MDR pathogens, with limited or no treatment options. Methods REVISIT was a phase 3, prospective, randomized, multicenter, open-label, central assessor-blinded study in hospitalized adults. Patients were randomized 2:1 to ATM-AVI (± metronidazole [MTZ]; cIAI patients only) or meropenem (MER) ± colistin (COL) for 5–14 (cIAI) or 7–14 (HAP/VAP) days. Clinical cure at the test-of-cure (TOC) visit in the intent-to-treat (ITT) and clinically evaluable (CE) analysis sets were the primary efficacy endpoints. Key secondary endpoints included microbiological responses at TOC, 28-day mortality, and safety. No formal hypothesis testing was planned. Results In total, 422 patients were randomized (ATM-AVI ± MTZ, n=282; MER ± COL, n=140). Adjudicated clinical cure rates at TOC are shown in Table 1. Favorable microbiological response rates at TOC (micro-ITT analysis set) were 75.7% for ATM-AVI ± MTZ and 73.9% for MER ± COL; 28-day all-cause mortality rates for ATM-AVI ± MTZ and MER ± COL were 1.9% (4/208) vs 2.9% (3/104), and 10.8% (8/74) vs 19.4% (7/36) in cIAI and HAP/VAP, respectively. Adverse events (AEs) are summarized in Table 2. There were no treatment-related serious AEs in the ATM-AVI group. Conclusion ATM-AVI (± MTZ) was effective in treating patients with cIAI and HAP/VAP, displaying similar efficacy to MER ± COL. ATM-AVI was generally well tolerated. These data support potential use of ATM-AVI for the treatment of serious infections caused by susceptible Gram-negative bacteria. Further analyses will focus on MBL-producing pathogens. Trial registration. NCT03329092. Study sponsored by Pfizer. ATM-AVI is jointly developed with AbbVie, also supported by the United States Biomedical Advanced Research and Development Authority (BARDA) and the European Innovative Medicines Initiative (IMI), under the COMBACTE-CARE consortium. Disclosures Yehuda Carmeli, MD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Qpex: Advisor/Consultant|Qpex: Grant/Research Support|Qpex: Honoraria|Roche: Advisor/Consultant|Roche: Grant/Research Support|Roche: Honoraria Georgios L. Daikos, PhD, MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Viatris: Honoraria Rosa-María Jiménez Rodríguez, MD, PhD, Abex: Honoraria|B. Braun: Honoraria|Johnson &amp; Johnson: Honoraria Halley Rogers, MPH, Pfizer: Ownership Interest Michele Wible, MS, Pfizer: Ownership Interest Francis Arhin, PhD, Pfizer: Ownership Interest Joanne Leaney, PhD, Pfizer: Ownership Interest Rienk Pypstra, MD, MBA, Pfizer: Stocks/Bonds Joseph Chow, MD, Pfizer: Ownership Interest

Objective: Brucellosis is a systemic zoonosis that affects various organs or body systems and can mimic many diseases. Symptoms can range from acute febrile illness to chronic clinical manifestations with severe complications. In our study, we investigated the relationship between bacteremia and clinical and laboratory findings, and complications in patients with brucellosis.&#x0D; Material and Methods: Two hundred and twenty-three patients diagnosed with brucellosis between 2005 and 2020 in the department of infectious diseases and clinical microbiology of a tertiary care university hospital were included in the study. Rose Bengal test, Brucella standard tube agglutination test and culture (blood and/or bone marrow culture) were used for the diagnosis of brucellosis. The patients were divided into two groups according to their bacteremia status. Patients with positive culture were identified as bacteremia, and patients with negative culture were identified as non-bacteriemic.&#x0D; &#x0D; Results: A total of 223 patients were included in the study, of which 142 (63.7%) were male. While weight loss, fever and hematological complications were higher in bacteremia cases (p=0.001, p

Abstract Background Multidrug resistant (MDR) Gram-negative bacteria, including metallo-β-lactamase (MBL) producers, pose significant treatment challenges. This study investigated efficacy and safety of aztreonam-avibactam (ATM-AVI) in the treatment of complicated intra-abdominal infection (cIAI) or hospital-acquired)/ventilator-associated pneumonia (HAP/VAP) due to Gram-negative bacteria, including MBL-producing MDR pathogens, with limited or no treatment options. Methods REVISIT was a phase 3, prospective, randomized, multicenter, open-label, central assessor-blinded study in hospitalized adults. Patients were randomized 2:1 to ATM-AVI (± metronidazole [MTZ]; cIAI patients only) or meropenem (MER) ± colistin (COL) for 5–14 (cIAI) or 7–14 (HAP/VAP) days. Clinical cure at the test-of-cure (TOC) visit in the intent-to-treat (ITT) and clinically evaluable (CE) analysis sets were the primary efficacy endpoints. Key secondary endpoints included microbiological responses at TOC, 28-day mortality, and safety. No formal hypothesis testing was planned. Results In total, 422 patients were randomized (ATM-AVI ± MTZ, n=282; MER ± COL, n=140). Adjudicated clinical cure rates at TOC are shown in Table 1. Favorable microbiological response rates at TOC (micro-ITT analysis set) were 75.7% for ATM-AVI ± MTZ and 73.9% for MER ± COL; 28-day all-cause mortality rates for ATM-AVI ± MTZ and MER ± COL were 1.9% (4/208) vs 2.9% (3/104), and 10.8% (8/74) vs 19.4% (7/36) in cIAI and HAP/VAP, respectively. Adverse events (AEs) are summarized in Table 2. There were no treatment-related serious AEs in the ATM-AVI group. Conclusion ATM-AVI (± MTZ) was effective in treating patients with cIAI and HAP/VAP, displaying similar efficacy to MER ± COL. ATM-AVI was generally well tolerated. These data support potential use of ATM-AVI for the treatment of serious infections caused by susceptible Gram-negative bacteria. Further analyses will focus on MBL-producing pathogens. Trial registration. NCT03329092. Study sponsored by Pfizer. ATM-AVI is jointly developed with AbbVie, also supported by the United States Biomedical Advanced Research and Development Authority (BARDA) and the European Innovative Medicines Initiative (IMI), under the COMBACTE-CARE consortium. Disclosures Yehuda Carmeli, MD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Qpex: Advisor/Consultant|Qpex: Grant/Research Support|Qpex: Honoraria|Roche: Advisor/Consultant|Roche: Grant/Research Support|Roche: Honoraria Georgios L. Daikos, PhD, MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Viatris: Honoraria Rosa-María Jiménez Rodríguez, MD, PhD, Abex: Honoraria|B. Braun: Honoraria|Johnson &amp; Johnson: Honoraria Halley Rogers, MPH, Pfizer: Ownership Interest Michele Wible, MS, Pfizer: Ownership Interest Francis Arhin, PhD, Pfizer: Ownership Interest Joanne Leaney, PhD, Pfizer: Ownership Interest Rienk Pypstra, MD, MBA, Pfizer: Stocks/Bonds Joseph Chow, MD, Pfizer: Ownership Interest

Introduction: Fungemia due to rare yeasts other than Candida (RYOC) has been increasingly reported; however, data on the management of patients are limited. This study aimed to determine antifungal susceptibility profiles of the isolates and clinical characteristics, management, and outcomes of patients with fungemia due to RYOC in a tertiary-care university hospital. Materials and Methods: Between January 2013 and January 2022, cases of fungemia caused by RYOC were retrospectively examined. Antifungal susceptibility tests were performed according to the Clinical and Laboratory Standards Institute M27-A3. Results: The incidence of RYOC was %4,9 (n=31) among 637 fungemia episodes. The most common isolated fungi were Trichosporon asahii (n=11). An antifungal susceptibility test could be performed on 25/31 strains. Azole minimum inhibitory concentration (MIC) values ​​were low for T. asahii and T. coremiiforme. Amphotericin-B and voriconazole (VRC) MICs were low for Saprochaete clavata isolates, whereas those of fluconazole (FLC) and echinocandin ​​were high. The most commonly preferred empirical antifungal was liposomal amphotericin-B (n=7) followed by VRC (n=4) and FLC (n=2). Of the 13 patients who received appropriate treatment either started empirically or after identification, 10 survived (p=0.01). The overall mortality rate was 53% (n=16). The mortality rate of patients with hematologic malignancy was significantly higher than that other patients with risk factors (p=0.01). Of the patients in whom appropriate treatment was initiated, three died because the foci of infection could not be controlled. Conclusion: Maintaining high clinical suspicion of RYOC is crucial in empirical treatment. Early detection of species and determining antifungal susceptibility patterns of RYOC will guide clinicians in the treatment of these yeasts.

OBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.

Introduction: Fungemia due to rare yeasts other than Candida (RYOC) has been increasingly reported; however, data on the management of patients are limited. This study aimed to determine antifungal susceptibility profiles of the isolates and clinical characteristics, management, and outcomes of patients with fungemia due to RYOC in a tertiary-care university hospital. Materials and Methods: Between January 2013 and January 2022, cases of fungemia caused by RYOC were retrospectively examined. Antifungal susceptibility tests were performed according to the Clinical and Laboratory Standards Institute M27-A3. Results: The incidence of RYOC was %4,9 (n=31) among 637 fungemia episodes. The most common isolated fungi were Trichosporon asahii (n=11). An antifungal susceptibility test could be performed on 25/31 strains. Azole minimum inhibitory concentration (MIC) values ​​were low for T. asahii and T. coremiiforme. Amphotericin-B and voriconazole (VRC) MICs were low for Saprochaete clavata isolates, whereas those of fluconazole (FLC) and echinocandin ​​were high. The most commonly preferred empirical antifungal was liposomal amphotericin-B (n=7) followed by VRC (n=4) and FLC (n=2). Of the 13 patients who received appropriate treatment either started empirically or after identification, 10 survived (p=0.01). The overall mortality rate was 53% (n=16). The mortality rate of patients with hematologic malignancy was significantly higher than that other patients with risk factors (p=0.01). Of the patients in whom appropriate treatment was initiated, three died because the foci of infection could not be controlled. Conclusion: Maintaining high clinical suspicion of RYOC is crucial in empirical treatment. Early detection of species and determining antifungal susceptibility patterns of RYOC will guide clinicians in the treatment of these yeasts.

Objective: Brucellosis is a systemic zoonosis that affects various organs or body systems and can mimic many diseases. Symptoms can range from acute febrile illness to chronic clinical manifestations with severe complications. In our study, we investigated the relationship between bacteremia and clinical and laboratory findings, and complications in patients with brucellosis.&#x0D; Material and Methods: Two hundred and twenty-three patients diagnosed with brucellosis between 2005 and 2020 in the department of infectious diseases and clinical microbiology of a tertiary care university hospital were included in the study. Rose Bengal test, Brucella standard tube agglutination test and culture (blood and/or bone marrow culture) were used for the diagnosis of brucellosis. The patients were divided into two groups according to their bacteremia status. Patients with positive culture were identified as bacteremia, and patients with negative culture were identified as non-bacteriemic.&#x0D; &#x0D; Results: A total of 223 patients were included in the study, of which 142 (63.7%) were male. While weight loss, fever and hematological complications were higher in bacteremia cases (p=0.001, p

BACKGROUND: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. METHODS: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients' characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. RESULTS: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49-2.45). CONCLUSIONS: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

BACKGROUND: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. METHODS: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients' characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. RESULTS: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49-2.45). CONCLUSIONS: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

Giri: Staphylococcus aureus'a bal kan dolam infeksiyonu (SA-KDE), uygun tedaviye ramen yksek mortalite oranyla ilikilidir. SA-KDE'de mortalite riskini nceden ngrebilmenin klinik kararlar ynlendirme ve hastann riskini ynetebilme zerinde ciddi bir etkisi olabilir. Bu almann amac SA-KDE olan hastalarda mortalite iin risk faktrlerinin belirlenmesidir. almada ayrca bu risk faktrlerinden yola klarak mortaliteyi ngren bir skorlama sistemi oluturulmutur

Giri: Staphylococcus aureus'a bal kan dolam infeksiyonu (SA-KDE), uygun tedaviye ramen yksek mortalite oranyla ilikilidir. SA-KDE'de mortalite riskini nceden ngrebilmenin klinik kararlar ynlendirme ve hastann riskini ynetebilme zerinde ciddi bir etkisi olabilir. Bu almann amac SA-KDE olan hastalarda mortalite iin risk faktrlerinin belirlenmesidir. almada ayrca bu risk faktrlerinden yola klarak mortaliteyi ngren bir skorlama sistemi oluturulmutur

Amaç: Bu çalışmada, Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi ve Nöroloji-Nöroşirürji Yoğun Bakım Ünitesinde kandidemi ile ilişkili risk faktörlerinin değişkenlik gösterip göstermediğinin belirlenmesi amaçlandı.Gereç ve Yöntemler: Çalışmaya Ocak 2014-Kasım 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi’nde kandidemi tanısı alan 110 erişkin hasta dâhil edildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi. T-testi ve Ki-kare testiyle veriler değerlendirildi. İstatistiksel anlamlılık değeri p&amp;lt;0.05 olarak kabul edildi.Bulgular: Hastaların yaş ortalaması 62.5±19.5 /yıl idi. Hastaların %52.7 (n=58)’si erkek, %47.3 (n=52)’ü kadındı. Etkenlerin %47.3 (n=52)’ü Candida albicans, %52.7 (n=58)’si non-albicans Candida spp. idi. Yoğun bakım üniteleri arasında steroid kullanımı (p=0.001), total parenteral nütrisyon kullanımı (p=0.021) ve hemodiyaliz (p=0.005) açısından istatistiksel anlamlı farklılık vardı. Çalışmamızdaki kandidemi hastalarında genel mortalite oranı %59.1 (65/110)’di. C. albicans'ın etken olduğu hastalarda mortalite %63.5 (33/52), non-albicans Candida spp.’de %55.2 (32/58) olarak tespit edildi.Sonuç: Yoğun bakım ünitelerinde kandidemi için risk faktörleri etkenlere ve ünitelere göre değişkenlik gösterebilmekte ve yüksek mortalite ve morbiditeye neden olabilmektedir. Çalışmamızda total paranteral nutrisyon kullanımı, steroid kullanımı, hemodiyaliz, santral venöz kateter ve cerrahi girişim önemli risk faktörleri olarak belirlendi.

OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.

Amaç: Bu çalışmada, Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi ve Nöroloji-Nöroşirürji Yoğun Bakım Ünitesinde kandidemi ile ilişkili risk faktörlerinin değişkenlik gösterip göstermediğinin belirlenmesi amaçlandı.Gereç ve Yöntemler: Çalışmaya Ocak 2014-Kasım 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi’nde kandidemi tanısı alan 110 erişkin hasta dâhil edildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi. T-testi ve Ki-kare testiyle veriler değerlendirildi. İstatistiksel anlamlılık değeri p&amp;lt;0.05 olarak kabul edildi.Bulgular: Hastaların yaş ortalaması 62.5±19.5 /yıl idi. Hastaların %52.7 (n=58)’si erkek, %47.3 (n=52)’ü kadındı. Etkenlerin %47.3 (n=52)’ü Candida albicans, %52.7 (n=58)’si non-albicans Candida spp. idi. Yoğun bakım üniteleri arasında steroid kullanımı (p=0.001), total parenteral nütrisyon kullanımı (p=0.021) ve hemodiyaliz (p=0.005) açısından istatistiksel anlamlı farklılık vardı. Çalışmamızdaki kandidemi hastalarında genel mortalite oranı %59.1 (65/110)’di. C. albicans'ın etken olduğu hastalarda mortalite %63.5 (33/52), non-albicans Candida spp.’de %55.2 (32/58) olarak tespit edildi.Sonuç: Yoğun bakım ünitelerinde kandidemi için risk faktörleri etkenlere ve ünitelere göre değişkenlik gösterebilmekte ve yüksek mortalite ve morbiditeye neden olabilmektedir. Çalışmamızda total paranteral nutrisyon kullanımı, steroid kullanımı, hemodiyaliz, santral venöz kateter ve cerrahi girişim önemli risk faktörleri olarak belirlendi.

OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.

Amaç: Özellikle yoğun bakım ünitelerinde mortalite ile sonuçlanan enfeksiyonlara neden olan çoklu ilaca dirençli Acinetobacter baumannii ve Pseudomonas aeruginosa’nın sebep olduğu enfeksiyonlarda kolistin sıklıkla kullanılmaktadır. Etkenlerin antimikrobiyal direnç profilleri hastaneden hastaneye hatta hastane içinde farklı üniteler arasında değişiklik gösterebilmektedir. Çalışmamızda izole edilen A. baumannii ve P. aeruginosa suşlarında kolistin direnç oranlarının yıllara göre dağılımını ortaya koymak amaçlanmıştır.Gereç ve Yöntemler: Çalışmada Ocak 2013-Ekim 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi yoğun bakım ünitelerinde yatan hastalardan alınan kan ve kateter kültürlerinden izole edilen A. baumannii ve P. aeruginosa suşlarında kolistin direnç profili değerlendirildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi.Bulgular: Tekrarlayan üremeler çıkarıldıktan sonra izole edilen 1469 örneğin 555’i değerlendirilmeye alındı. Çalışmaya dâhil edilen 555 örnek, 389 hastadan izole edildi, üremelerin %66.7’si A. baumannii ve %33.3’ü P. aeruginosa idi. Beş yüz elli beş üremenin 18’i kolistin dirençli olup, tüm yoğun bakım ünitelerinde kolistin direnç oranı %3.2 idi. Kolistin direnç oranları nöroşirurji, iç hastalıkları, anesteziyoloji ve reanimasyon ve nöroloji yoğun bakım ünitelerinde sırasıyla; %6.3, %5.2, %2.6, %1.9 iken göğüs yoğun bakım ünitesinde hiç direnç saptanmadı. Yıllara göre her iki suşun da direnç oranının giderek arttığı, A. baumannii’de direnç oranının P. aeruginosa’dan daha yüksek olduğu görüldü. Kolistin dirençli üremesi olan hastalar arasında mortalite oranı %77.8, genel mortalite oranıysa %3.6 olarak hesaplandı.Sonuç: Çalışmamızda yıllar içinde kolistin direnç oranlarındaki artış dikkati çekmektedir. Ayrıca dirençli olan üremelerin mortaliteyi de artırdığı görüldüğünden; uygunsuz ve gereksiz kolistin kullanımının engellenmesi, dirence yol açan faktörlerin belirlenmesi, her merkezin kendi epidemiyolojik verilerini ve antimikrobiyal duyarlılık profilini takip ederek tedavi protokolleri oluşturması gerektiği düşünülmektedir.

Amaç: Özellikle yoğun bakım ünitelerinde mortalite ile sonuçlanan enfeksiyonlara neden olan çoklu ilaca dirençli Acinetobacter baumannii ve Pseudomonas aeruginosa’nın sebep olduğu enfeksiyonlarda kolistin sıklıkla kullanılmaktadır. Etkenlerin antimikrobiyal direnç profilleri hastaneden hastaneye hatta hastane içinde farklı üniteler arasında değişiklik gösterebilmektedir. Çalışmamızda izole edilen A. baumannii ve P. aeruginosa suşlarında kolistin direnç oranlarının yıllara göre dağılımını ortaya koymak amaçlanmıştır.Gereç ve Yöntemler: Çalışmada Ocak 2013-Ekim 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi yoğun bakım ünitelerinde yatan hastalardan alınan kan ve kateter kültürlerinden izole edilen A. baumannii ve P. aeruginosa suşlarında kolistin direnç profili değerlendirildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi.Bulgular: Tekrarlayan üremeler çıkarıldıktan sonra izole edilen 1469 örneğin 555’i değerlendirilmeye alındı. Çalışmaya dâhil edilen 555 örnek, 389 hastadan izole edildi, üremelerin %66.7’si A. baumannii ve %33.3’ü P. aeruginosa idi. Beş yüz elli beş üremenin 18’i kolistin dirençli olup, tüm yoğun bakım ünitelerinde kolistin direnç oranı %3.2 idi. Kolistin direnç oranları nöroşirurji, iç hastalıkları, anesteziyoloji ve reanimasyon ve nöroloji yoğun bakım ünitelerinde sırasıyla; %6.3, %5.2, %2.6, %1.9 iken göğüs yoğun bakım ünitesinde hiç direnç saptanmadı. Yıllara göre her iki suşun da direnç oranının giderek arttığı, A. baumannii’de direnç oranının P. aeruginosa’dan daha yüksek olduğu görüldü. Kolistin dirençli üremesi olan hastalar arasında mortalite oranı %77.8, genel mortalite oranıysa %3.6 olarak hesaplandı.Sonuç: Çalışmamızda yıllar içinde kolistin direnç oranlarındaki artış dikkati çekmektedir. Ayrıca dirençli olan üremelerin mortaliteyi de artırdığı görüldüğünden; uygunsuz ve gereksiz kolistin kullanımının engellenmesi, dirence yol açan faktörlerin belirlenmesi, her merkezin kendi epidemiyolojik verilerini ve antimikrobiyal duyarlılık profilini takip ederek tedavi protokolleri oluşturması gerektiği düşünülmektedir.