Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: a prospective observational cohort study.

OBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.

A brief report: Cerebrospinal fluid rhinorrhea after repetitive nasal swab testing for coronavirus disease 2019(COVID-19).

For the past year, COVID-19 Pandemic has been the biggest focal point of medicine. Due to its novelty and its highly infectious nature, the impact of Sars-Cov-2 on society has been growing rapidly. The primary route for prevention of this highly infectious virus is detection. The detection methods for Sars-Cov-2 include nasal swab tests, saliva samplings and antibody tests. The main preferred method has been the RT-PCR with Nasal Swab sampling which is performed on the nasopharyngeal region. However, the nasal swab testing may come with its own iatrogenic outcomes due to its invasiveness. In this report, we describe a rare case of iatrogenic unilateral cerebrospinal fluid rhinorrhea which occurred due to repetitive nasal swab testing for COVID-19.

The mortality rate of COVID-19 was high in cancer patients: a retrospective single-center study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has quickly turned into a global pandemic with close to 5 million cases and more than 320,000 deaths. Cancer patients constitute a group that is expected to be at risk and poor prognosis in COVID pandemic. We aimed to investigate how cancer patients are affected by COVID-19 infection, its clinical course and the factors affecting mortality. METHODS: In our single-center retrospective study, we included cancer patients with laboratory confirmed COVID-19 in our hospital. Demographic, clinical, treatment, and laboratory data were obtained from electronic medical records. Logistic regression methods were used to investigate risk factors associated with in-hospital death. RESULTS: In the hospital, 4489 patients were hospitalized with COVID infection and 77 were cancer patients. The mean age of cancer patients was 61.9 ± 10.9 and 44 of them were male (62%). While the mortality rate in non-cancer patients was 1.51% (n = 68), this rate was significantly higher in cancer patients, 23.9% (n = 17). The stage of the disease, receiving chemotherapy in the last 30 days also lymphopenia, elevated troponin I, D-dimer, CRP, and CT findings were associated with severe disease and mortality. Severe lung involvement (OR = 22.9, p = 0.01) and lymphopenia (OR = 0.99, p = 0.04) are the most important factors influencing survival in logistic regression. CONCLUSIONS: The disease is more severe in cancer patients and mortality is significantly higher than non-cancer patients. These data show that it may be beneficial to develop dynamic prevention, early diagnosis and treatment strategies for this vulnerable group of patients who are affected by the infection so much.

Polymethylmetacrylate Cement Augmentation of the Coccyx (Coccygeoplasty) for Fracture: A Case Report

Background: Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case Report: A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient's pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics. Conclusion: Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.