Ertugrul Guclu

Objective: The COVID-19 pandemic led to substantial structural changes in intensive care unit (ICU) organization worldwide. However, data on long-term changes in healthcare-associated infection (HAI) epidemiology after COVID-19–related ICU reorganization remain limited. This study compared HAI epidemiology before and after COVID-19–related ICU reorganization while excluding the pandemic transition period. Methods: This retrospective surveillance study included HAI episodes among adult patients admitted to level II and III ICUs of a 600-bed tertiary teaching and research hospital between January 2015 and June 2025. Healthcare-associated infection episodes diagnosed during the pandemic transition period (March 2020-June 2021) were excluded. The pre-COVID period (January 2015-March 2020) was compared with the post-reorganization period (July 2021-June 2025). Healthcare-associated infections were identified using Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definitions applicable during each surveillance year. Patient-level characteristics, episode-level infection types and microbiological findings, device-associated infection rates, and in-hospital mortality were compared. Results: A total of 3015 HAI episodes occurring in 2351 patients were included: 1062 episodes in 828 patients during the pre-COVID period and 1953 episodes in 1523 patients during the post-reorganization period. The overall HAI rate increased significantly from 5.64% to 6.42% (rate ratio [RR], 1.14; 95% CI, 1.06-1.23; P < .001). Device-associated infection rates also increased significantly, including catheter-associated urinary tract infection (RR, 1.31; P = .011), ventilator-associated pneumonia (RR, 3.03; P < .001), and central line-associated bloodstream infection (RR, 1.52; P < .001). The post-reorganization period showed higher proportions of ventilator-associated pneumonia and non-ventilator-associated pneumonia, predominance of gram-negative pathogens, increased frequencies of Acinetobacter spp. and Pseudomonas spp., emergence of Candida auris, and higher in-hospital mortality (69.1% vs. 54.3%; P < .001). Conclusion: Healthcare-associated infection epidemiology differed substantially between the pre-COVID and post-reorganization periods. Increased device-associated infection rates, shifts in pathogen distribution, emergence of Candida auris, and higher in-hospital mortality highlight the need for sustained infection prevention and control efforts beyond the pandemic period. Cite this article as: Vatan A, Kabukçu S, Karabay O, Güçlü E, Öğütlü A. Changes in healthcare-associated infections before and after COVID-19–related intensive care unit reorganization: a long-term comparative surveillance study. Cerrahpaşa Med J 2026, 50, 0119, doi: 10.5152/cjm.2026.26119.

Tenofovir alafenamide (TAF) is widely used in antiretroviral therapy due to its improved renal and bone safety compared to tenofovir disoproxil fumarate (TDF). However, concerns remain regarding its potential metabolic effects and cardiovascular risk. We aimed to compare lipid parameters and surrogate markers of subclinical atherosclerosis and arterial stiffness, namely carotid intima-media thickness (CIMT) and the cardio-ankle vascular index (CAVI), among people living with HIV (PLWH) receiving TAF- or TDF-based regimens and ART-naive individuals. In this cross-sectional study, a total of 178 PLWH were included and classified into three groups: TAF-based therapy (n = 79), TDF-based therapy (n = 49), and ART-naive individuals (n = 53). Lipid profiles, CIMT, and CAVI were assessed contemporaneously during antiretroviral treatment and compared across groups. Multivariate logistic regression analysis was performed to identify factors independently associated with increased arterial stiffness. Total cholesterol, triglyceride levels, CIMT, and CAVI were significantly higher in the TAF group compared with both the TDF and ART-naive groups (all p < 0.05). No significant differences were observed between the TDF and ART-naive groups. Subclinical atherosclerosis (CIMT ≥ 1 mm) and increased arterial stiffness (CAVI ≥ 8) were most frequently observed among individuals receiving TAF. In multivariate analysis, TAF use (p = 0.01) and age (p < 0.001) were independently associated with CAVI ≥ 8. Although TAF provides important renal and bone safety advantages, TAF-based regimens were associated with less favorable metabolic parameters and higher subclinical vascular markers in this cross-sectional cohort. These findings should be interpreted cautiously and do not establish a causal relationship. Not applicable.

Otuz beş yaşında kadın hasta, diz ağrısı ve tekrarlayan oral aftlar nedeniyle Romatoloji polikliniğine başvurdu. Hemogram tetkiklerinde lökopeni ve nötropeni saptanması üzerine yapılan ileri tetkiklerde HIV pozitifliği tespit edildi. Antiretroviral tedavi başlandıktan 10 gün sonra sol göz çevresinde veziküler döküntü gelişen hastaya herpes zoster oftalmikus tanısı konuldu. Bu olgu, zona tanısı alan hastalarda HIV taramasının önemini ve HIV ile yaşayan bireylerde zona sıklığının arttığını hatırlatmaktadır.

Bloodstream infections (BSI) in intensive care units (ICU) are associated with high mortality, requiring reliable prognostic tools. The systemic inflammato

Bu sunumda, insan immün yetmezlik virüsü (HIV) ile yaşayan ve Pneumocystis jirovecii pnömonisi (PJP) tedavisi gören bir bireyde gelişen spontan pnömotoraks olgusu ele alınmıştır. HIV ile yaşayan 36 yaşındaki birey, PJP tanısı ile ko-trimoksazol tedavisi alırken, solunum sıkıntısı ve oksijen saturasyonunda düşüş gelişmiştir. Akciğer grafisinde sol pnömotoraks saptanmış ve göğüs cerrahisi tarafından torasentez ile tüp torakostomi uygulanmıştır. İşlem sonrası akciğer ekspanse olmuş ancak hasta, tedavi sürecinde komplikasyonlar nedeniyle merkezimizdeki takibinin 29. gününde hayatını kaybetmiştir. İleri evre Edinsel İmmun Yetmezlik Sendromu (AIDS) olan bireylerde enfeksiyon yönetimi dikkatli bir şekilde yapılmalı ve potansiyel komplikasyonlar izlenmelidir. PJP seyri sırasında pnömotoraks riski akılda tutulmalıdır.

Objective: Postgraduate education (PE) designed to improve health professionals' knowledge and awareness of HIV/AIDS has a positive impact on the provision of health services for people living with HIV. This study aimed to examine the effects of HIV/AIDS education on physician behavior. Materials and Methods: All doctors at Sakarya Training and Research Hospital invited to a one-day HIV/AIDS training on March 22, 2023. The training, which began with a pretest, lasted approximately 70 minutes, and after the training, a posttest was administered to the participants. Results: In total, 81 physicians participated in our research, showing that short-term training has positive effects on the knowledge level of healthcare professionals about HIV/AIDS. Regarding recognizing signs and symptoms of HIV infection, the mean score before training was 6.02±1.94, while the mean score after training was 8.65±1.26 (p

Objective: This study aimed to determine the seasonal distribution of the factor data of viral agents determined by the multiplex PCR method in routine practice in patients admitted to the hospital with upper respiratory tract infection symptoms and to detect oseltamivir resistance in viruses that are positive for Influenza A (H1N1). Methods: Nasopharyngeal swab and bronchoalveolar lavage samples of 354 patients between the ages of 0-94 who were admitted to the Sakarya University Sakarya Training and Research Hospital with symptoms of upper respiratory tract infection between 12 September 2019 and 19 February 2020 were studied with the multiplex PCR method. Oseltamivir resistance was investigated in 11 samples selected from Influenza A (H1N1) positive samples by Sanger sequence analysis method. Results: One or more respiratory viruses were identified in 233 (66%) of 354 respiratory samples evaluated. Of these, 64 (27.5%) are Influenza A/H1N1, 4 (1.7%) are Influenza A/H3N2, 24 (10.3%) are Influenza B, 64 (27.5) are Respiratory. Syncytial Virus A/B (RSV A/B), 58 (24.9%) Rhinovirus/Enterovirus, 18 (7.7%) Adenovirus, 12 (5.2%) Human Metapneumo Virus (hMPV) ), 10 (4.3%) Bocavirus, 4 (1.7%) Parainfluenza 1, 7 (3%) Parainfluenza 3, 3 (1.3%) Parainfluenza 4, 5 (2.1%) were found to be Coronavirus HKU1 and 13 (5.6%) were found to be Coronavirus NL63. More than one factor was detected simultaneously in 45 of 233 positive samples (19.3%). Oseltamivir resistance was not found in any of the 11 influenza A/H1N1 positive samples. Conclusion: No oseltamivir resistance was observed in any of the Influenza A/H1N1 positive samples evaluated in this study. Periodic analysis of influenza A/H1N1 strains for oseltamivir resistance is necessary to guide empirical treatment.