Aslı Vatan

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.

Pan-Immune-Inflammation Value and Functional Cure in Patients with Chronic Hepatitis B Receiving Long-Term Nucleos(t)ide Analogue Therapy - Viral Hepatitis Journal

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.

Background: In chronic hepatitis B (CHB) patients, hepatitis B surface antigen (HBsAg) seroclearance is the main target of therapy and is rarely observed. Objectives: This study aimed to investigate the factors affecting HBsAg loss by focusing especially on the relationship between weight loss and HBsAg loss. Methods: This study was designed retrospectively to assess HBsAg status and clinical and laboratory findings in CHB patients, as well as cross-sectionally to evaluate lifestyle factors. A total of 5600 hepatitis B (HB) infection patients who were treated or followed between 2008 and 2020 were evaluated retrospectively. In the HBsAg loss group, 94 CHB patients were examined based on exclusion criteria, and 95 patients without HBsAg loss were matched as controls. Patient data and laboratory findings were retrieved from patient files. All participants were surveyed using a questionnaire developed by the authors, which inquired about the lifestyle characteristics of CHB patients. The questionnaire covered topics such as the use of herbal products, coffee consumption, medication history, antiviral treatment, concurrent diseases, weight changes, and patient demographics. Statistical analysis was performed using SPSS version 25.0. The Student's t-test was used to compare quantitative variables, while the chi-square test was used for categorical variables. A paired samples t-test was used to compare dependent samples. The statistical significance level was set at a p value less than 0.05. Results: The basal mean hepatitis B virus (HBV) DNA level was significantly lower in the HBsAg loss group (P < 0.001). The prevalence of hyperlipidemia comorbidity (P = 0.008) and moderate/severe hepatosteatosis (P < 0.05) was significantly higher in the HBsAg loss group compared to the non-HBsAg loss group. Prior to HBsAg loss, 44 (47%) patients in the HBsAg loss group experienced weight loss, whereas only 22 (23%) patients in the non-HBsAg group had a history of weight loss (P < 0.001). Conversely, the incidence of weight gain was significantly lower in the HBsAg loss group (P = 0.001). A paired samples t-test was conducted to compare the baseline and last period body mass index (BMI) means of the HBsAg loss group, revealing a statistically significant decrease in mean BMI in the last period (P < 0.001). Conclusions: Weight loss was significantly associated with HBsAg seroclearance in patients with CHB infection. Conversely, weight gain was associated with HBsAg persistence.

Background: West Nile virus (WNV) infection is a viral disease caused by arboviruses. It can cause epidemics of febrile diseases and meningoencephalitis, especially at the end of the summer season. In this study, we aimed to determine the risk factors of WNV encephalitis with a case–control study of the patients followed in our clinic. Materials and Methods: Among the patients who applied to our hospital with sudden onset fever, headache, myalgia, nausea, vomiting, maculopapular rash, viral meningitis, or encephalitis findings in late summer and early autumn, those diagnosed with positive WNV PCR and antibody tests were defined as WNV cases. In the same date range, patients with clinically compatible but negative serological and PCR tests for WNV in our hospital were considered as the control group. Results: WNV infection was diagnosed in 26 of 48 patients who were examined with a preliminary diagnosis of WNV infection, and the other 22 patients were considered as the control group. A statistically significant difference was found between the two groups in C-reactive protein, procalcitonin, 1-h erythrocyte sedimentation rate, alkaline phosphatase, platelet, and platelet distribution width (PDW). PDW >17.85% indicated WNV infection with 82% sensitivity and 91% specificity. PDW percentage >17.85 increased the risk of WNV infection by 6.1 times. The power of the study was calculated as 83%. Conclusion: The most common findings in WNV cases were fever and confusion. WNV infection should be considered in the differential diagnosis in patients with fever and confusion in September and October in settlements on the migration route of birds. The percentage of PDW in whole blood examination can guide the differential diagnosis of WNV cases.

Predictive Factors For Severe And Critical Coronavirus Disease-19 In Young Adults Abstract Objective: Advanced age is associated with a poor prognosis in Coronavirus disease-2019 (COVID-19). The present study was conducted with the aim of investigating the predictive factors for disease severity in young adults. Materials and Methods: A total of 399 patients with COVID-19 aged under 60 who had been hospitalized at our hospital were retrospectively evaluated. Patients were stratified into mild, moderate, severe, and critical groups according to their respiratory rate, SpO2, and PaO2/FiO2 levels. The relationship between the signs and symptoms on hospital admission and the disease severity was evaluated. Results: The patients were classified as mild (n:112), moderate (n:192), severe and critical (n:95) according to disease severity. The mean age was 44. 43 of 399 patients were followed in the intensive care unit and 17 patients died. According to the binary logistic regression analysis, advanced age, hypertension, dyspnea on admission, elevated CRP, decreased lymphocyte and eosinophil count, presence of multiple bilateral ground glass appearance and consolidation were independently predicted the severity of disease. Conclusion: The signs and symptoms should be evaluated in detail also in young patients with COVID-19 and if risk factors are detected, they should be monitored more closely for predicting a poor prognosis.