Device-associated infection rates and bacterial resistance in the intensive care units of a Turkish referral hospital

To determine device-associated infection [DAT] rates, and the microbiological and antibiotic resistance profiles of infecting pathogens in our hospital. Prospective surveillance of healthcare-associated infections was performed from January 2007 to March 2010 in 4 different intensive care units [ICUs] of SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. During the study period, 6,005 patients were followed-up in ICUs for a total of 46,355 patient-days. The total number of DATs was 969. Catheter-associated urinary tract infection [CAUTI] was the most common DAI [55.3% of DAIs; 11.9 cases per 1000 catheter-days], followed by ventilator-associated pneumonia [VAP] [38.9% of DAIs; 21.2 cases per 1000 ventilator-days], and central line-associated blood stream infection [CLABSI] [5.8% of DAIs; 2.8 cases per 1000 central line-days]. The most frequently isolated pathogens in patients with VAP were Acinetobacter species [24.5%] and Escherichia coli in CAUTI [24.2%]. Coagulase negative Staphylococci and Candida species were the leading pathogens in patients with CLABSI. We observed considerably high rates of VAP and CAUTI and a high rate of CLABSI in our ICUs when compared with the National Healthcare Safety Network data. These findings emphasize the need to improve infection control practices and management of invasive device use in our hospital

Clinical characteristics of 74 pandemic HlNl influenza patients from Turkey. Risk factors for fatality

To evaluate the clinical characteristics and certain risk factors that may be associated with fatal outcome in patients with HlNl influenza. This retrospective study was conducted between October and December 2009 in the Department of Infectious Diseases and Clinical Microbiology, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. Data regarding the epidemiological and clinical characteristics of 74 hospitalized cases of confirmed pandemic HlNl influenza were reviewed. The median age was 49 [18-83] years, and 34 [46%] were males. The most common symptom and signs on admission were cough [91.9%] and fever >38°C [71.7%]. More than two-thirds of patients [68.9%] had at least one underlying condition; most frequently chronic respiratory disease, including asthma and diabetes. Seventy-seven percent had evidence of pneumonia on their chest x-rays at presentation. Of the 74 cases, 16 [21.6%] were followed up in the Intensive Care Unit, and 10 [13.5%] died. Obesity and oxygen saturation below 92% at the time of admission were found to be significantly related with fatal outcome. In addition, fatal patients had significantly higher levels of alanine aminotransferase [ALT], aspartate aminotransferase [AST], lactate dehydrogenase [LDH], urea, creatinine, d-dimer on admission and prothrombin time [PT], activated partial thromboplastin time, and the international normalized ratio [INR] was longer. Timely identification and management of patients with higher risk for fatality may improve outcomes

An Outbreak of Oropharyngeal Tularemia with Cervical Adenopathy Predominantly in the Left Side

PURPOSE: We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey. MATERIALS AND METHODS: Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests. RESULTS: Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days. CONCLUSION: This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the 1eft side were found, which had not been previously reported.

Compliance and efficacy of hand rubbing during in hospital practice

To compare alcohol-based hand rubbing with hand washing using antimicrobial soap regarding antimicrobial efficacy and compliance with routine practice in hospital and intensive care units. From February to June 2003, 35 nurses were randomly selected from a nursing staff of 141 and divided into two groups: hand rubbing and hand washing groups. Hand cultures were obtained before and after health care procedures. The nurses were observed on days 1, 7 and 14 of the study, in order to determine compliance and efficacy of the hand hygiene methods. A total of 368 routine patient care activities were observed during the study period. Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap [54 and 27%, respectively; p < 0.01]. Compliance was also better in the hand rubbing group than in the hand washing group [72.5 and 15.4%, respectively; p < 0.001]. Compliance with hand rubbing was markedly lower among the nurses who had experience of more than 3 years in hospital practice. Both hand rubbing and hand washing compliance were poorer among nurses working inintensive care units than among nurses working in the other hospital wards. Generally, after taking off gloves, nurses preferred hand washing to hand rubbing. These data indicate that alcohol-based hand rubbing reduces mean bacterial counts on the hands of nurses more effectively than hand washing with antimicrobial soaps, and compliance rates with hand rubbing were also higher than with hand washing. Nevertheless, the compliance with hand rubbing was markedly lower in more experienced nurses

Lower doses venlafaxine-associated toxic hepatitis a patient with chronic hepatitis

Toxic hepatitis is observed with high doses of Venlafaxine. But toxic hepatitis has not been yet reported at lower doses of Venlafaxine such as 37.5 mg per day. In this case report, a case of Venlafaxine-associated toxic hepatitis with lower doses in patient with history of chronic hepatitis is presented. We suggest that liver function should be regularly monitored in patients with history of chronic hepatitis receiving Venlafaxine even at lower doses and even when their liver enzymes are normal