Gul Ruhsar Yilmaz

Giriş: Santral venöz kateterizasyonun en sık görülen, ölümcül ve maliyetli komplikasyonlarından olan kateter ilişkili kan dolaşımı infeksiyonu aynı zamanda nozokomiyal bakteremilerin en sık nedenidir. Kateter ilişkili kan dolaşımı enfeksiyonları (KİKDE), hemodiyaliz hastalarında kardiyovasküler hastalıktan sonra ikinci önde gelen ölüm nedenidir. Bu infeksiyonlar infektif endokardit, spondilodiskit, paravertebral apse gibi birçok metastatik komplikasyona neden olabilir. Çalışmamızda KİKDE’nin ve metastatik komplikasyonların değerlendirilmesi amaçlanmıştır. Materyal-Metod: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji kliniğinde tedavi gören KİKDE olan hastalardaki infeksiyon epizodları retrospektif olarak değerlendirildi. Hastaların demografik verileri, klinik semptomları, eşlik eden hastalıkları, kateter özellikleri, fizik muayene bulguları, izole edilen mikroorganizma ve antibiyotik duyarlılığı, inflamasyon parametreleri, metastatik komplikasyonları kaydedildi. Bulgular: Belirlenen zaman aralığında toplam 51 hastada 63 KİKDE epizodu saptandı. Hastaların %54,9’u erkek olup yaş ortalaması 60,7±16,2 yıl olarak bulundu. Hastaların %82,4’ü diyaliz kateteri ile hemodiyalize alınan olgulardı. Toplam 63 epizodun %85,7’si hemodiyaliz alan olgularda saptandı. Elli bir hastanın %37,3’ünde toplam 20 komplikasyon saptandı. İlk üç sırada görülen komplikasyonlar diskit, infektif endokardit ve psoas apsesi olarak bulundu. Bu komplikasyonlarından en sık sorumlu olan etken metisilin duyarlı Staphylococcus aureus (MSSA) idi. Sonuç: Hemodiyaliz alan olgularda KİKDE’nin yanısıra infeksiyonla ilişkili komplikasyonlar da daha sıktır. Kateter bakımı ve kişisel hijyen konularında olguların eğitimi, hastanelerde KİKDE’yi önleme demetlerinin uygulanması ve hemodiyaliz olgularını mümkün olan durumlarda fistül seçeneğine yönlendirme bu komplikasyonların görülme oranını azaltabilir.

Background/aim: Post-exposure 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 version 25.0. 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 gender and age ≥40 years were independently associated with higher odds of PEP initiation, whereas nursing profession was associated with lower odds. The median time to PEP initiation was 17.9 hours (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. Antibacterial resistance and the increasing number of infections caused by multidrug-resistant bacteria threaten human health worldwide. The coronavirus disease 2019 (COVID-19) pandemic may have influenced antibacterial resistance patterns through changes in infection control practices and antibiotic prescribing. Aim. This single-centre, retrospective study aimed to describe changes in bacterial distribution, antibacterial resistance and antibiotic consumption in a university research and practice hospital before and during the COVID-19 pandemic. Methods. We analysed routine microbiology and pharmacy records from hospitalized patients between 01 April 2018 and 31 March 2022. The 2 years before 01 April 2020 was defined as the pre-pandemic period and the 2 years after 01 April 2020 as the pandemic period. Bacteria isolated from blood, urine and lower respiratory tract cultures, together with their antimicrobial susceptibility profiles, were compared between periods according to EUCAST criteria. Antibiotic consumption was calculated as defined daily doses per 1,000 inpatient days for commonly used agents. No patient-level clinical data or ward/ICU stratification was available. Results. A total of 7,275 isolates from 47,729 culture samples were obtained in the pre-pandemic period and 5,794 isolates from 47,210 samples during the pandemic. Coagulase-negative staphylococci remained the most frequently isolated species from blood cultures, Escherichia coli from urine cultures and Acinetobacter baumannii from lower respiratory tract cultures in both periods. Extended-spectrum β-lactamase (ESBL) rates and carbapenem resistance in E. coli and Klebsiella pneumoniae increased significantly during the pandemic, whereas teicoplanin and linezolid resistance in coagulase-negative staphylococci decreased. Carbapenem resistance in A. baumannii also decreased. Overall antibiotic consumption increased for most agents, particularly cephalosporins, carbapenems, aminoglycosides and fluoroquinolones, while vancomycin use decreased. Conclusion. In this single-centre, retrospective analysis, the overall distribution of major bacterial species remained largely stable before and during the COVID-19 pandemic, whereas important changes were observed in antimicrobial resistance profiles and antibiotic consumption. The increase in ESBL and carbapenem resistance in Enterobacterales, together with higher use of broad-spectrum antibiotics, underlines the need for strengthened antimicrobial stewardship and continuous local surveillance.

Introduction Antibacterial resistance and the increasing number of infections caused by multidrug-resistant bacteria threaten human health worldwide. The coronavirus disease 2019 (COVID-19) pandemic may have influenced antibacterial resistance patterns through changes in infection control practices and antibiotic prescribing. Aim This single-centre, retrospective study aimed to describe changes in bacterial distribution, antibacterial resistance and antibiotic consumption in a university research and practice hospital before and during the COVID-19 pandemic. Methods We analysed routine microbiology and pharmacy records from hospitalized patients between 01.04.2018 and 31.03.2022. The two years before 01.04.2020 were defined as the pre-pandemic period and the two years after 01.04.2020 as the pandemic period. Bacteria isolated from blood, urine and lower respiratory tract cultures, together with their antimicrobial susceptibility profiles, were compared between periods according to EUCAST criteria. Antibiotic consumption was calculated as defined daily doses (DDD) per 1000 inpatient-days for commonly used agents. No patient-level clinical data or ward/ICU stratification were available. Results A total of 7275 isolates from 47,729 culture samples were obtained in the pre-pandemic period and 5794 isolates from 47,210 samples during the pandemic. Coagulase-negative staphylococci remained the most frequently isolated species from blood cultures, Escherichia coli from urine cultures and Acinetobacter baumannii from lower respiratory tract cultures in both periods. Extended-spectrum β-lactamase (ESBL) rates and carbapenem resistance in E. coli and Klebsiella pneumoniae increased significantly during the pandemic, whereas teicoplanin and linezolid resistance in coagulase-negative staphylococci decreased. Carbapenem resistance in A. baumannii also decreased. Overall antibiotic consumption increased for most agents, particularly cephalosporins, carbapenems, aminoglycosides and fluoroquinolones, while vancomycin use decreased. Conclusion In this single-centre, retrospective analysis, the overall distribution of major bacterial species remained largely stable before and during the COVID-19 pandemic, whereas important changes were observed in antimicrobial resistance profiles and antibiotic consumption. The increase in ESBL and carbapenem resistance in Enterobacterales, together with higher use of broad-spectrum antibiotics, underlines the need for strengthened antimicrobial stewardship and continuous local surveillance.

Introduction Antibacterial resistance and the increasing number of infections caused by multidrug-resistant bacteria threaten human health worldwide. The coronavirus disease 2019 (COVID-19) pandemic may have influenced antibacterial resistance patterns through changes in infection control practices and antibiotic prescribing. Aim This single-centre, retrospective study aimed to describe changes in bacterial distribution, antibacterial resistance and antibiotic consumption in a university research and practice hospital before and during the COVID-19 pandemic. Methods We analysed routine microbiology and pharmacy records from hospitalized patients between 01.04.2018 and 31.03.2022. The two years before 01.04.2020 were defined as the pre-pandemic period and the two years after 01.04.2020 as the pandemic period. Bacteria isolated from blood, urine and lower respiratory tract cultures, together with their antimicrobial susceptibility profiles, were compared between periods according to EUCAST criteria. Antibiotic consumption was calculated as defined daily doses (DDD) per 1000 inpatient-days for commonly used agents. No patient-level clinical data or ward/ICU stratification were available. Results A total of 7275 isolates from 47,729 culture samples were obtained in the pre-pandemic period and 5794 isolates from 47,210 samples during the pandemic. Coagulase-negative staphylococci remained the most frequently isolated species from blood cultures, Escherichia coli from urine cultures and Acinetobacter baumannii from lower respiratory tract cultures in both periods. Extended-spectrum β-lactamase (ESBL) rates and carbapenem resistance in E. coli and Klebsiella pneumoniae increased significantly during the pandemic, whereas teicoplanin and linezolid resistance in coagulase-negative staphylococci decreased. Carbapenem resistance in A. baumannii also decreased. Overall antibiotic consumption increased for most agents, particularly cephalosporins, carbapenems, aminoglycosides and fluoroquinolones, while vancomycin use decreased. Conclusion In this single-centre, retrospective analysis, the overall distribution of major bacterial species remained largely stable before and during the COVID-19 pandemic, whereas important changes were observed in antimicrobial resistance profiles and antibiotic consumption. The increase in ESBL and carbapenem resistance in Enterobacterales, together with higher use of broad-spectrum antibiotics, underlines the need for strengthened antimicrobial stewardship and continuous local surveillance.

Introduction Antibacterial resistance and the increase in the number of infections caused by multidrug resistant bacteria threaten human health. The COVID-19 pandemic can have a positive or negative effect on antibacterial resistance. Hypothesis Antibacterial consumption and antibacterial resistance must have decreased in hospitals during the pandemic period. Aim This study was conducted to investigate how the pandemic affected the bacterial distribution, antibacterial resistance and antibiotic consumption in our hospital. Method The distribution of bacterial isolation and antibacterial resistance in same, in blood, urine and lower respiratory tract cultures of hospitalized patients between 01.04.2018 and 31.03.2022 were investigated. In addition, the consumption of commonly used antibacterials before and during the pandemic was evaluated by standardizing it according to the daily dose defined per 1000 days of inpatient treatment. Results In both periods, coagulase-negative staphylococci were the most frequently isolated bacterial species in blood cultures, E. coli in urine cultures, and A. baumannii in lower respiratory tract cultures. It was observed that the 3rd generation cephalosporin and carbapenem resistance and extended-spectrum beta-lactamase (ESBL) rate of E. coli and K. pneumoniae isolates increased during the pandemic period. Antibiotic consumption had also increased. Conclussion The pandemic did not have a significant effect on the bacterial distribution in our hospital. Contrary to our wishes, an increase in antibiotic consumption and antibacterial resistance was observed. Our results show that we are one of the institutions that could not turn the COVID-19 pandemic into an advantage to reduce antibiotic consumption and antibacterial resistance. Approaches to reduce antibiotic resistance should be prioritized.

Objective: Spondylodiscitis is an infectious disease that affects the vertebral body, intervertebral disc, and/or adjacent paraspinal tissue, and it is a significant cause of morbidity, especially in older individuals. This study aims to evaluate cases of spondylodiscitis followed at ** Hospital. Material and Method: Between January 2017 and December 2021, the medical records and electronic files of patients who began antimicrobial treatment with a diagnosis of spondylodiscitis at ** Hospital were retrospectively evaluated. Results: A total of 33 patients were included in the study, consisting of 17 females and 16 males. The average age of the patients was 56.0 ± 13.6 years. Twenty patients (60.6%) were hospitalized, while 13 patients (39.4%) were followed as outpatients. Spinal surgery due to discopathy was performed in 9 cases (27.3%), and 4 of these patients had a history of recurrent surgical interventions. The most commonly affected region was the lumbar vertebrae (44.1%). The lumbosacral region (20.6%) and thoracolumbar region (14.7%) followed as the second and third most affected areas, respectively. Brucellosis complications were present in 14 cases (42.4%) of spondylodiscitis. Pyogenic microorganisms and tuberculosis were responsible for the remaining 11 (33,3%), and 2 (6%) patients respectively. In 11 patients (33.3.%), the causative microorganism was identified in tissue/abscess/blood cultures as methicillin-sensitive Staphylococcus aureus (3), methicillin-resistant coagulase-negative Staphylococcus (1), methicillin-resistant S. aureus (1), methicillin-sensitive coagulase-negative Staphylococcus (1), Klebsiella pneumonia (2), Enterococcus faecalis (2), Acinetobacter spp. (1), Escherichia coli (1). Staphylococcus aureus (12%) was the most common pathogen among pyogenic microorganisms. In one case, the identified pathogen was Mycobacterium tuberculosis. One of the patients was considered to have tuberculosis spondylodiscitis based on histopathological evaluation. Conclusion: The fact that nearly half of spondylodiscitis cases observed in our hospital were complicated by brucellosis indicates the importance of evaluating patients presenting with back pain for brucellosis. Collaborative training programs with surgical specialities should be periodically repeated to prevent cases of spondylodiscitis that develop after spinal surgeries.

The importance of doctors’ knowledge and awareness of infectious diseases was felt worldwide during the COVID-19 pandemic. With this study, we aimed to evaluate the effect of the long and dynamic pandemic process on resident physicians’ knowledge and protective behaviors for infection control in a tertiary hospital setting and protective behaviors for infection control in a tertiary hospital setting. The population of this cross-sectional study consisted of assistant physicians working at Suleyman Demirel University Faculty of Medicine Training and Research Hospital. A questionnaire evaluating information and protective practices for COVID-19 was applied to the participants through face-to-face interviews using the convenience sampling method, with an interval of one year. In the second year of the pandemic, resident physicians’ awareness of the correct use of personal protective equipment decreased (p = 0.001). Despite the continuous training, it was determined that the residents preferred masks with high protection at a lower rate when they encountered patients who received oxygen support of 5 lt/min and above (p < 0.001). To prevent the spread of COVID-19 infection in the hospital as the pandemic progresses, it has been determined that resident physicians are less prone to evaluate possible infection symptoms in patients hospitalized for non-COVID-19 reasons (p = 0.013). As a result, the data we obtained showed that despite the regular training during the pandemic and the death of many health workers, the residents’ adherence to infection control and prevention practices, which also protect them, decreased significantly in the second year of the pandemic. These valuable data showed us that good knowledge does not predict good infection control and prevention practices. Our findings show that physicians need a new education system that motivates them. In addition, psychosocial determinants, physical and mental fatigue, and institutional control factors contributing to these results and affecting individual risk perception should be recognized and prevented.