New Prognostic Parameter of West Nile Virus: Platelet Distribution Width.

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.

Comparison of patients using lamivudine, entecavir, and tenofovir according to liver fibrosis markers fibrosis-4 and aspartate aminotransferase-to-platelet ratio index scores.

OBJECTIVES: It was intended to assess the efficacy of lamivudine, entecavir, and tenofovir regimens in the management of chronic hepatitis B (CHB) guided by Fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) scores. MATERIALS AND METHODS: Our study was conducted on patients who applied to the hepatitis outpatient clinic between 2008 and 2015 retrospectively. Lamivudine, entecavir, and tenofovir regimens used in the practice of CHB cases were compared by measuring noninvasive FIB tests. RESULTS: Entirely 199 patients involved in the research were evaluated in three treatment arms; 48 used lamivudine, 46 used entecavir, and 105 used tenofovir. Similar statistical characteristics were observed between research arms regarding age, gender, and alanine aminotransferase normalization by years (P > 0.05). Totally 5 (13.5%) of patients developed Hepatitis B e antigen (HBeAg) seroconversion among 36 HBeAg positivity, and similar statistical features were seen by comparing the groups (P > 0.05). In the entecavir and tenofovir arms, a significant decrease was seen in FIB-4, and APRI index values in the 1st year of treatment (P < 0.001). At the graph curve, a plateau was observed in the APRI test after the 1st year, and a plateau was observed in the FIB-4 test after the 2nd year. CONCLUSION: Consistent with the study outcome, when we consider FIB regression, tenofovir and entecavir regimens were found more effective than lamivudine. In addition, entecavir was more effective than the other two drugs after the 1st year.

Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections.

PURPOSE: The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. MATERIALS: From 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression. RESULTS: 66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001). CONCLUSION: Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.

Antibiotic use and Influencing Factors Among Hospitalized Patients with COVID-19: A Multicenter Point-Prevalence Study from Turkey

Background: Broad-spectrum empirical antimicrobials are frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims: We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design: The study was a national, multicenter, retrospective, and single-day point prevalence study. Methods: This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results: A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age ± standard deviation of the patients was 65.0 ± 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (37.2%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005), presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein > 10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p < 0.001) were found to be independent factors associated with increased antibiotic use. Conclusion: The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.

Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections.

BACKGROUND: Urinary tract infections (UTIs) are one of the most seen infection among community. OBJECTIVES: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). METHODS: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. RESULTS: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. CONCLUSION: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI.

Novel coronavirus seropositivity and related factors among healthcare workers at a university hospital during the prevaccination period: a cross-sectional study.

BACKGROUND: This study aimed to investigate the specific risk factors for the transmission of novel coronavirus (SARS-CoV-2) among healthcare workers in different campuses of a university hospital and to reveal the risk factors for antibody positivity. METHODS: In this retrospective cross-sectional study, 2988 (82%) of 3620 healthcare workers in a university hospital participated. The coronavirus disease 2019 (COVID-19) antibody was investigated using serum from healthcare workers who underwent COVID-19 antibody testing. The antibody test results of the participants were evaluated based on their work campus, their profession and their workplace. The statistical significance level was p < 0.05 in all analyses. RESULTS: Of the participants in this study, 108 (3.6%) were antibody positive, and 2880 (96.4%) were negative. Antibody positivity rates were greater in nurses compared with other healthcare workers (p < 0.001). Regarding workplace, antibody positivity was greater in those working in intensive care compared to those working in other locations (p < 0.001). CONCLUSIONS: Healthcare workers are at the highest risk of being infected with COVID-19. Those who have a higher risk of infection among healthcare workers and those working in high-risk areas should be vaccinated early and use personal protective equipment during the pandemic. TRIAL REGISTRATION: Retrospective permission was obtained from both the local ethics committee and the Turkish Ministry of Health for this study (IRB No:71522473/050.01.04/370, Date: 05.20.2020).

Knowledge and attitudes towards COVID-19 among emergency medical service workers.

OBJECTIVE: Good knowledge of the coronavirus disease 2019 (COVID-19) among healthcare workers is essential for keeping health systems active and controlling the outbreak. We aimed to investigate the knowledge and attitudes of Emergency Medical Service (EMS) employees who fight COVID-19 at the forefront. METHODS: A total of 400 EMS workers (doctors, nurses, emergency medical technicians, paramedics, and ambulance drivers) were included in this study. Knowledge, attitude, and preventive behaviors for COVID-19 were evaluated using an online questionnaire. RESULTS: A total of 275 EMS workers participated in the study with a response rate of 68.8%. The respondents reported that their highest common sources of knowledge about COVID-19 were social media and television (n=240, 88%). Overall, > 96% of the participants had adequate knowledge about the transmission routes of COVID-19. Among the respondents, 36% of them were unaware of the correct hand washing or scrubbing technique. In addition, 78% of the participants had poor knowledge about floor and surface disinfection. The majority of the participants exhibited inaccurate attitudes toward the use of personal preventive equipment. More than half of EMS workers (52%) agreed that a surgical mask is not enough during the procedures that do not generate aerosol. Moreover, a significant proportion of the participants (66%) perceived that a N95 mask is required. CONCLUSIONS: As a consequence, although emergency workers have sufficient basic knowledge about COVID-19, there is a need for postgraduate training in many subjects.

Evaluation of Conjunctival Swab PCR Results in Patients with SARS-CoV-2 Infection.

PURPOSE: The study objective was to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in conjunctival swabs from patients with confirmed SARS-CoV-2 infection. METHODS: Forty patients who tested positive by real-time reverse transcription (rRT)-polymerase chain reaction (PCR) of nasopharyngeal and oropharyngeal swabs were enrolled. Conjunctival swabbing was used to collect the tear and conjunctival secretions of patients. RESULTS: Conjunctival swab rRT-PCR was positive for three patients and negative for 37 patients. Ten of the patients (25%) were diagnosed with conjunctivitis during the ophthalmic examination. Of these patients, one was found positive by conjunctival swab rRT-PCR, and nine were found negative. The difference between patients who tested positive or negative using conjunctival swab rRT-PCR was without statistical significance in terms of the presence of conjunctivitis (p = .720). CONCLUSION: The rate of positivity from conjunctival swab rRT-PCR was 7.5% in patients with confirmed SARS-CoV-2 infection.

The effect of cefoperazone sulbactam and piperacillin tazobactam on mortality in Gram-negative nosocomial infections.

Cefoperazone-sulbactam (CS) and piperacillin-tazobactam (TZP) are used in the treatment of Gram-negative nosocomial infections (NIs). We aimed to compare the effects of these two antibiotics on mortality and treatment success. Patients treated with CS or TZP empirically for at least three days with suspicion of NI were included in this retrospective study. In total, 308 (154 patients in both treatment arms) patients were analyzed. Treatment success rate in CS and TZP group respectively (50% vs 51.2%, p = 0.18), 28-day mortality rate (46.1% vs 42.8%, p = 0.56) and antibiotic-related side effects (50.6% vs 46.1%, p = 0.42) were similar except prolonged prothrombin time (19.4% vs 6.4%; p = 0.001). According to this study results, CS and TZP have equal effectivity and safety for the empirical treatment of Gram-negative NIs. CS may be an appropriate alternative to TZP for antibiotic cycling or mixing strategy to reduce antibiotic resistance.

[Travel Related Fever and Rash: Two Cases of Dengue Fever]. / Seyahat Iliskili Ates ve Döküntü: Iki Dengue Atesi Olgusu.

The frequency of travel-related infections in the world has increased due to the easily and widespread use of travel facilities in the 21st century. Vector-borne diseases are an important part of infectious diseases. Dengue fever is one of the travel-related infections that has been reported increasingly in recent years through the development of diagnostic methods. The aim of this report was to present two Dengue fever cases originating from travel. There was a story of mosquito bite during a trip to Sri Lanka travel in our first case. The patient was 30 years old and maculopapular rash appeared on the fifth day of contact. Three days after the onset of the rash, she has admitted to our clinic, complaining with fever and chills. Increased leukopenia and muscle enzymes were detected in the laboratory analysis. Real-time reverse transcriptase polimerase chain reaction (RT-PCR) was positive in the serum sample. The patient was followed up with supportive care and discharged by improvement. The second case, a 24-year-old male, had a story of mosquito bite during his trip to Malaysia. After the patient complained of fever, chills, fever, nausea, vomiting and muscle pain, the Dengue virus (DENV) NS1 antigen test performed in this country was found to be positive. In the second case, there was no maculopapular rash and laboratory analysis showed an increase in leukopenia, thrombocytopenia and muscle enzymes. RT-PCR positivity was detected in the serum sample. The patient was followed up with supportive treatment and discharged with cure. DENV infections are caused by DENV which is common in the tropical areas of the world. There are four DENV-1, DENV-2, DENV-3 and DENV-4 serotypes. DENV infections can present different clinical manifestations such as asymptomatic disease, viral syndrome, Dengue haemorrhagic fever, and Dengue shock syndrome. Dengue fever is often accompanied by arthritis, maculopapular rash and high fever. Our cases were defined as Dengue fever according to this definition. In the diagnosis of the disease, it is necessary first to be suspicious of the disease and the travel history must be questioned. In the definitive diagnosis, virus isolation, antigen, nucleic acid detection and serological tests are used. The virus can be isolated from blood, serum, urine and tissues. In the first five days after beginning of the symptoms associated with DENV infections, serum RT-PCR and Dengue NS1 antigen test may be positive.

The Effect of Concurrent Tetanus-diphtheria Vaccination on the Antibody Response to Rabies Vaccine: A Preliminary Study.

The number of studies in the literature investigating the effect of tetanus vaccination on rabies prophylaxis is rather limited. In this study, we aimed to investigate the effect of concurrent tetanus-diphtheria (Td) vaccination on the antibody response to rabies vaccine. The data of consecutive 80 patients who presented to Sakarya University Training and Research Hospital, Department of Emergency due to rabies suspected exposure between 15 October 2012 and 12 June 2013 were enrolled to this study. Postexposure rabies prophylaxis had been given to all cases, however concurrent tetanus vaccination had been administered to some of them according to their need. Cases were divided into two parts according to their receipt of tetanus prophylaxis as rabies only group (group R, n=37), and rabies and tetanus-diphtheria group (group R+Td, n=43). Rabies antibody levels were tested in sera of the cases at first and postvaccination 21st day. The median antibody levels of each group were measured and compared with each other statistically. In our study, postvaccination 21st day antibody level of group R was 0.68 IU/ml (IQR: 0.79), while the same for group R+Td was 0.52 IU/ml (IQR: 0.48) (p=0.022). Concurrent administration of Td vaccine was found to have a significant negative effect on the antibody response to rabies vaccine. Our results should be confirmed with further studies including more cases.

Novel thymol bearing oxypropanolamine derivatives as potent some metabolic enzyme inhibitors - Their antidiabetic, anticholinergic and antibacterial potentials.

A series of classical and newly synthesized thymol bearing oxypropanolamine compounds were synthesized and characterized. Their in vitro antibacterial activity on A. baumannii, P. aeruginosa, E. coli and S. aureus strains were investigated with agar well diffusion method. The results were compared with commercially available drug active compounds. As well as 3a, 3b and 3c have the most significant antibacterial effect among all the tested compounds; approximately all of them have more antibacterial activity than the reference drugs. These novel thymol bearing oxypropanolamine derivatives were effective inhibitors of the α-glycosidase, cytosolic carbonic anhydrase I and II isoforms (hCA I and II), and acetylcholinesterase enzymes (AChE) with Ki values in the range of 463.85-851.05 µM for α-glycosidase, 1.11-17.34 µM for hCA I, 2.97-17.83 µM for hCA II, and 13.58-31.45 µM for AChE, respectively.

Positive effect of restrictions on antibiotic consumption

Background/aim: This study aimed to examine the change in the etiology of hospital infections with restricting and releasing of group 2 carbapenems (G2C) (meropenem/imipenem/doripenem). Materials and methods: This study was planned in three periods. Study period 1 (SP-1): Carbapenems were prescribed without restriction by infectious disease specialists. SP-2: G2C prescription was restricted. SP-3: Carbapenem prescription was released. Results: In total, 4443 cases [1053 in SP-1 (23.7%), 1332 in SP-2 (29.9%), and 2085 in SP-3 (46.9%)] were included in the study. Infection rates were 11%, 6.5%, and 7.9% in SP-1, SP-2, and SP-3, respectively (P = 0.001). Acinetobacter spp.-related hospital infection rates were 3.9%, 1.2%, and 1.8%, in SP-1, SP-2, and SP-3, respectively (P = 0.0001). Infection related mortality in SP-1, SP-2, and SP-3 was 7.3%, 5%, and 3.8%, respectively (P = 0.001). Conclusion: Hospital-acquired Acinetobacter infections, antibiotic consumption, and infection-related mortality were decreased significantly with the restriction of G2C. Positive behaviors that were obtained during the restricted period were continued with release of restriction.

Comparison of Novel Blood Culture System DL-Bt112TM with BacT/Alert 3DTM by Using Clinical Samples.

BACKGROUND: Blood cultures are the main diagnostic laboratory tool to detect bloodstream infections. Many clinical microbiology laboratories utilize automated blood culture systems to isolate infectious agents from blood samples. The diagnostic performance and time-to-detection values of the novel automated blood culture system, DLBt112TM (DL), was compared with BacT/Alert 3DTM (B3D) in this prospective comparative study with clinical samples. METHODS: A total of 356 blood culture sets (178 sets for each system) were evaluated over a 6-month period in a university hospital. Two sets of blood culture samples (one for DL and one for B3D) were drawn from intensive care unit patients who were suspected to have bloodstream infections. BacT/ALERT FA FAN® Aerobic/Anaerobic blood culture bottles for B3D and FAN adult anaerobic/aerobic blood culture bottles for DL were used. The Vitek® 2 automated system was used for identification of the isolated bacteria. RESULTS: We evaluated 178 sets from 105 patients consisting of 712 blood culture bottles in total. In total, 294 negative bottles and 47 positive bottles were detected by both systems. Recovery rate of the B3D (96.7%) was significantly higher than that of DL (79.0) (p < 0.05). We determined significant differences between DL and B3D in terms of time-to-detection values for gram negatives (p = 0.006) and contaminants (p = 0.048). Overall, B3D had shorter time-to-detection mean values. CONCLUSIONS: The recovery rate of DL was unfavorably low and time-to-detection values for DL were significantly higher than that of B3D. This might result from the ingredients of the culture bottles since the detection technologies of the systems were similar.

Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study.

This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.

Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein.

INTRODUCTION: Influenza-like illness (ILI) and acute respiratory infection (ARI) are common presentations during winter and indiscriminate antibiotic use contributes significantly to the emerging post-antibiotic era. METHODOLOGY: Otherwise healthy 152 patients, presenting to outpatient clinics with ILI/ARI, were included. Patients had history & physical, CRP, hemogram and nasopharyngeal swabs for rhinovirus A/B, influenza A/B, adenovirus A/B/C/D/E, coronavirus 229E/NL63 and OC43, parainfluenza virus 1/2/3, respiratory syncytial virusA/B, metapneumovirus and Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and Bordetella pertussis by PCR and for ABHS culture. RESULTS: Median (IR) age was 26.5 (16.5). Time to presentation was shorter in men (p = 0.027). Patients with rhinovirus had lower rates (20%) of myalgia (p = 0.043). Patients with influenza virus had higher rates (97%) of elevated CRP (p = 0.016). Logistic regression revealed that patients with ILI/ARI and CRP ≥ 5 mg/L were 60 times more likely to have influenza virus infection than other viral agents (OR = 60.0, 95% CI = 2.65 to 1,358.2, p = 0.010). Rhinovirus predominated in December (54%), March (36%), and April (33%). Influenza virus predominated in January (51%). Fever was most common with adenovirus (p = 0.198). All GABHS cultures were negative. Atypical organisms and Bordetella pertussis were negative in all but one patient. CONCLUSIONS: Influenza virus is the most likely pathogen in ILI/ARI when CRP ≥ 5 mg/L. This might be explained by tissue destruction. Myalgia is rare with rhinovirus probably due to absence of viremia. Negative bacteria by PCR and culture suggest unnecessary antibiotic use in ILI/ARI.

A Study on the Age-Related Changes in Hepatitis B and C Virus Serology.

OBJECTIVE: There are a limited number of studies on the seroprevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection in Turkey. This study aimed to compare HBV and HCV seroprevalence rates before and after the implementation of national hepatitis B vaccination program (NHPVP) and to explore age-related changes in the seroprevalences. MATERIALS AND METHODS: Results of Hepatitis B surface antigen (HBsAg), Hepatitis B virus surface antibody (antiHBs) and anti-HCV tests performed during 2009 and 2010 in a state hospital laboratory were reviewed retrospectively. As NHPVP was started in 1998, 12 years of age and younger children were considered post- NHPVP period subjects. RESULTS: A total of 3280 HBsAg, 2444 antiHBs and 3188 anti-HCV test results were reviewed, representing approximately 3% of the population of the city where the study was conducted. HBsAg, antiHBs and anti-HCV positivity were 3.2%, 36.12% and 0.97%, respectively. HBsAg and antiHBs positivity were higher among males (p<0.001). When assessed by age groups, HBsAg positivity was found to be the lowest in the age group 0-12 and highest in the age group 51-60. HBsAg positivity was lower in the post-NHPVP period versus pre-NHPVP period (p=0.01). Anti-HCV positivity was similar for pre- and post- NHPVP periods (p>0.05). CONCLUSION: Owing to the use of NHPVP, HBsAg seropositivity has decreased, and it is expected to decrease further in the next years with a wider implementation of the program. Efforts should be continued to increase the level of awareness in the community for HBV and the importance of immunization.

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.

AIM: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS: The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS: A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS: Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

Factors Affecting Hand Hygiene Adherence at a Private Hospital in Turkey.

OBJECTIVE: Nosocomial infections are the main problems rising morbidity and mortality in health care settings. Hand hygiene is the most effective method for preventing these infections. In this study, we aimed to investigate the factors related with hand hygiene adherence at a private hospital in Turkey. MATERIALS AND METHODS: This study was conducted between March and June 2010 at a private hospital in Turkey. During the observation period, employees were informed about training, then posters and images were hanged in specific places of the hospital. After the initial observation, training on nosocomial infections and hand hygiene was provided to the hospital staff in March 2010. Contacts were classified according to occupational groups and whether invasive or not. These observations were evaluated in terms of compatibility with hand hygiene guidelines. RESULTS: Hand hygiene adherence rate of trained doctors was higher than untrained ones before patient contact and after environment contact [48% (35/73) versus 82% (92/113) p<0.05 and 23% (5/22) versus 76% (37/49) p<0.05 respectively]. Hand hygiene adherence rate of trained nurses was higher than untrained ones before patient contact [63% (50/79) versus 76% (37/49) p<0.05]. Hand hygiene adherence rate of trained assistant health personnel was higher than untrained ones before asepsis [20% (2/10) versus 73% (16/22) p<0.05]. In addition, it was seen that hand antiseptics were used when hand washing was not possible. CONCLUSION: The increase at the rate of hand washing after training reveals the importance of feedback of the observations, as well as the training. One of the most important ways of preventing nosocomial infections is hand hygiene training that should be continued with feedbacks.