Cigdem Yildirim

Introduction: Urinary tract infections (UTIs) remain a significant public health issue worldwide, particularly affecting the geriatric population with increased morbidity and mortality. Aging-related immune changes, comorbidities, and urogenital abnormalities contribute to the higher incidence and complexity of UTIs in elderly patients. Antimicrobial resistance, especially extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance, poses a major challenge in managing UTIs in this group. Methods: This retrospective, multicenter study included 776 patients aged 65 and older, hospitalized with a diagnosis of urinary tract infection between January 2019 and August 2024. Clinical, laboratory, and microbiological data were collected and analyzed. Urine samples were obtained under sterile conditions and pathogens identified using conventional and automated systems. Antibiotic susceptibility testing was performed according to CLSI standards. Logistic regression analyses were conducted to identify factors associated with ESBL production, carbapenem resistance, and mortality. Results: Among the patients, the median age was 78.9 years, with 45.5% female. ESBL production was detected in 56.8% of E. coli isolates and carbapenem resistance in 1.2%. Klebsiella species exhibited higher carbapenem resistance (37.8%). Independent predictors of ESBL production included the presence of urogenital cancer and antibiotic use within the past three months. Carbapenem resistance was associated with recent hospitalization, absence of kidney stones, and infection with non-E. coli pathogens. Mortality was independently associated with intensive care admission at presentation, altered mental status, Gram-positive infections, and comorbidities such as chronic obstructive pulmonary disease and urinary incontinence. Discussion: Our findings suggest that urinary pathogens and resistance patterns in elderly patients are similar to those in younger adults reported in the literature, highlighting the need for age-specific awareness in empiric therapy. The identification of risk factors for multidrug-resistant organisms emphasizes the importance of targeted antibiotic stewardship, especially in high-risk geriatric populations. Multicenter data contribute to regional understanding of resistance trends, aiding clinicians in optimizing management strategies for elderly patients with UTIs. Conclusions: This study highlights that E. coli and Klebsiella species are the primary causes of UTIs in the elderly, with resistance patterns similar to those seen in younger adults. The findings also contribute important data on risk factors for ESBL production and carbapenem resistance, supported by a robust patient sample.

Objective: We aimed to investigate the vaccination status and the risk factors for the intensive care unit (ICU) support need of the laboratory-confirmed breakthrough COVID-19 infection inpatients. Materials and Methods: This multi-center point-prevalence study was conducted on inpatients, divided into two groups as ‘fully’ and ‘partially’ vaccinated according to COVID-19 vaccination status. Results: Totally 516 patients were included in the study. The median age was 65 (55-77), and 53.5% (n=276) of the patients were male. Hypertension (41.9%, n=216), diabetes mellitus (DM) (31.8%, n=164), and coronary artery disease (CAD) (16.3%, n=84) were the predominant comorbidities. Patients were divided into two groups ICU (n=196) and non-ICU (n=301). Hypertension (p=0.026), DM (p=0.048), and congestive heart failure (CHF) (p=0.005) were significantly higher in ICU patients and the median age was younger among non-ICU patients (p=0.033). Of patients, 16.9% (n=87) were fully vaccinated, and this group’s need for ICU support was statistically significantly lower (p=0.021). Conclusion: We conclude that older age, hypertension, DM, CHF, and being partially vaccinated were associated with the need for ICU support. Therefore, all countries should continuously monitor post-vaccination breakthrough COVID-19 infections to determine the national booster vaccine administration approach that will provide vulnerable individuals the highest protection. Keywords: COVID-19 vaccine, intensive care unit, risk factor, SARS-CoV-2 infection, vaccine breakthrough infections, variant of concerns

En tr Aim: Occupational exposure to blood and other potentially infectious body fluids, and sharp injuries, poses a significant risk to blood-borne infections for healthcare workers. The aim of this study is to evaluate the serology of Hepatitis A, Hepatitis B, Hepatitis C and HIV infection and determine the knowledge level of healthcare workers about the risk of occupational exposure. Materials and Methods: 89 healthcare workers who applied to Ege University Medical Faculty Hospital Infectious Diseases outpatient clinic were evaluated with a questionnaire about knowledge levels of occupational injury and attitudes though screening their status by serological test along with Hepatitis A, Hepatitis B, Hepatitis C and HIV infection. Results: 66 of the participants (74%) were female and 23 (26%) were male. The mean age was 39.94 ± 12.54 years (min-max; 24-66 years). 41 people (46%) who defined occupational injuries were identified with a history of 56 injuries. Of these, 19 (34%) had needlestick injury, 22 (39%) had penetrating stab wounds, and 15 (27%) had blood/patient excretion on the eye. As a result of injuries, hepatitis B, hepatitis C and HIV transmission were not observed. Conclusion: Due to the possibility of mucosal contact with blood or body fluids, we think that it is important to inform healthcare workers in terms of hepatitis B, hepatitis C and HIV transmission and raise awareness through practices aimed at reducing these injuries. Amaç: Kesici delici alet yaralanmaları yanında kan ve diğer potansiyel enfekte vücut sıvılarıyla her türlü mesleki maruziyet sağlık çalışanları için kan yoluyla bulaşan enfeksiyonlar açısından önemli bir risk teşkil etmektedir. Bu çalışmada sağlık çalışanlarının bilgi düzeyleri ve mesleki maruziyet riski nedeniyle Hepatit A, Hepatit B, Hepatit C ve HIV enfeksiyonu yönünden serolojik değerlendirilmesi amaçlandı. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları polikliniğine başvuran 89 sağlık çalışanının 10 soruluk bir anket ile mesleki yaralanma, bilgi düzeyleri ve tutumları ile birlikte Hepatit A, Hepatit B, Hepatit C ve HIV enfeksiyonu yönünden durumları serolojik testle değerlendirildi. Bulgular: Çalışanların 66’sı (%74) kadın, 23’ü (%26) erkek olup, yaş ortalaması 39.94± 12.54 yıl (min-maks;24-66) idi. Mesleki yaralanma tanımlayan 41 kişi (%46) 56 yaralanma öyküsü tanımlandı. Bunların 19’u (%34) iğne batması, 22’si (%39) kesici delici alet yaralanması, 15’i (%27) göze kan/ hasta çıkartısı sıçraması şeklindeydi. Bu yaralanmalar sonucu hepatit B, hepatit C ve HIV bulaşı olmadığı test sonuçları ile görüldü. Sonuç: Kan ya da vücut sıvılarıyla mukozal temas ihtimali olması nedeniyle hepatit B, hepatit C ve HIV bulaşı açısından sağlık çalışanlarının bilgilendirilmesi ve bu yaralanmaları azaltmaya yönelik uygulamalarla farkındalık yaratılmasının önemli olduğunu düşünmekteyiz.