Evaluating the efficiency of public policy measures against COVID-19

The World Health Organization (WHO) declared COVID-19 as a Public Health Emergency of international concern on January 30, 2020, and a pandemic on March 11, 2020. Afterward, it spread rapidly all over the world, causing almost 4 million deaths as of June 2021. It is clear that effective preventive measures are needed in this devastating disease, which still has no cure. In addition to mask using, social distancing, and hygiene practices, which enter our lives as the most basic precautions, communities aim to reduce the effects of the COVID-19 pandemic. All over the world, the measures taken and activities performed in the COVID-19 pandemic are discussed, and information in this regard is shared. Mask usage, social distancing, hygiene, avoiding crowded and closed areas, contact tracing, rapid and accurate testing, increased indoor air quality, vaccination, and lockdown measures constitute the main preventive measures. This review summarizes the efficiency of public policy measures against COVID-19.

COVID-19: Prevention and control measures in community

On January 30, 2020, the WHO declared the COVID-19 outbreak a public health emergency of international concern and, in March 2020, began to characterize it as a pandemic in order to emphasize the gravity of the situation and urge all countries to take action in detecting infection and preventing spread. Unfortunately, there is no medication that has been approved by the FDA, gone through controlled studies and demonstrated an effect on the virus for this global pandemic. Although there are cures for illnesses and developments made by leaps and bounds in our day, the strongest and most effective weapon that society has against this virus that is affecting not just health but also economics, politics, and social order, is the prevention of its spread. The main points in preventing the spread in society are hand hygiene, social distancing and quarantine. With increased testing capacity, detecting more COVID-19 positive patients in the community will also enable the reduction of secondary cases with stricter quarantine rules.

Investigation of influenza and respiratory viruses in hospitalised patients with influenza-like illness in an emergency room.

INTRODUCTION: Influenza-like illness (ILI) surveillance is usually performed using outpatient data, and information on the surveillance of patients hospitalised for ILI, which is critical for the complete assessment of the influenza burden, is lacking. METHODOLOGY: In this prospective active surveillance study, patients with community-acquired ILI hospitalised for at least 24 hours in the Emergency Room (ER) of Gazi University Hospital were identified according to the ICD-10 codes at hospital admission through active surveillance of the 2013-2014 and 2014-2015 influenza seasons. The presence of influenza and other respiratory viruses was analysed in the nasopharyngeal or pharyngeal specimens by real-time polymerase chain reaction. RESULTS: 351 patients admitted to emergency room with certain ICD-10 codes were assessed, and 111 patients with ILI were included in the study. We detected 15 influenza and 23 other respiratory viruses in 33 of the 111 patients. More than one virus was detected in 5 patients. No virus was detected in a majority of the patients with ILI. The sensitivity of hospital admission/discharge ICD-10 codes used in the study to detect real influenza cases was low. Patients with influenza were admitted to the hospital more frequently with high fever symptoms compared with patients with influenza virus-negative and other respiratory virus-positive (p < 0.05). CONCLUSIONS: This study revealed that non-influenza respiratory viruses were a major contributor to ILI. Patients admitted with fever during the influenza seasons should be evaluated for influenza virus infection, and the use of diagnostic codes in surveillance studies can lead to incorrect results.

Catheter-associated urinary tract infections in intensive care units at a university hospital in Turkey.

In this study, urinary catheter utilization rates, the causative agents for catheter-associated urinary tract infection (CAUTI) and their antimicrobial susceptibilities in intensive care units (ICUs) in 2009 were investigated at Gazi university hospital. We aimed to determine the causative agents and risk factors for CAUTIs, and antimicrobial susceptibilities of the pathogens; and also sensitivities of Candida spp. to antifungal agents with Microdilution and E-test. The most common etiological agents of CAUTIs were Candida spp. (34.7%). The most frequently isolated Candida spp. was C.albicans (52.4%). All C. albicans spp. were sensitive to fluconazole. Microdilution, used as a reference method to determine the sensitivity to antifungal agents, was compared with E test. E test was found to be sufficient to analyze sensitivity to amphotericin B, caspofungin, fluconazole and voriconazole, but inappropriate for itraconazole. E.coli and Klebsiella spp. were found to be causative agents for CAUTI in 20.6% and 9.9% of cases respectively. Pseudomonas spp. and Acinetobacter spp. were isolated in 14% and 8.2% of the cases, respectively. All E.coli and Klebsiella strains were found sensitive to carbapenems. Carbapenem sensitivity was found in 47.1% and 30% of the cases infected with Pseudomonas and Acinetobacter strains, respectively. According to our results, fluconazole therapy seems to be an appropriate choice for the treatment of CAUTIs caused by C.albicans. Third and fourth generation cephalosporins should not be used for empirical treatment because of the high prevalence of extended spectrum beta-lactamase production among E.coli and Klebsiella isolates.

Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors.

INTRODUCTION: Risk factors for nosocomial carbapenem-resistant Klebsiella spp. (CRK) infections were analyzed in this study. METHODOLOGY: The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of CRK infections during a seven-year period (2004-2010) were retrospectively analyzed. RESULTS: A total of 720 patients were included in the study. Carbapenem resistance among Klebsiella spp. were significantly increased between 2003 and 2007 (p<0.001). CRK strains were mostly isolated from ICUs (p<0.001). Use of imipenem and cefoperazone-sulbactam within prior three months, stay in ICU, receiving immunspressive therapy, receiving H2 receptor antagonists, tracheostomy, mechanical ventilation, hemodialysis, urinary catheter were found to be significant risk factors for carbapenem resistance Klebsiella spp. infections. In a multivariate analysis, prior use of imipenem (OR 3.35; CI 1.675-6.726, p<0.001), stay in ICU (OR 3.36; 95% CI 1.193-9.508; p=0.022), receiving H2 receptor antagonist (OR 4.49; 95% CI 1.011-19.951; p=0.048) were independently associated with carbapenem resistance. Respiratory tract infections were the most seen nosocomial infection. Attack mortality rate was significantly higher in patients infected with CRK strains (p<0.001). CRK strains showed significantly higher resistance rates to other antibiotics. CONCLUSIONS: In conclusion, the emergence and rapid spread of CRK strains in our hospital is worrisome. The patients in ICU are most important risk group for the acquisition of CRK strains. High resistant rates to other antibiotics except than colistin and tigecycline limits therapeutic options, and increases mortality rates.

Nosocomial transmission of Candida pelliculosa fungemia in a pediatric intensive care unit and review of the literature.

Horizontal transmission of Candida species in the hospital environment and the fungemia rates have increased in the past decade. We describe a nosocomial cluster of fungemia caused by Candida pelliculosa (teleomorph Pichia anomala) in four infants hospitalized in the pediatric intensive care unit. Candida isolates had strictly related fingerprints, as generated by randomly amplified polymorphic DNA analysis using five different primer sets. The four babies were all treated successfully and recovered. All of the isolates were susceptible to the antifungals tested including amphotericin B, flucytosine, fluconazole, miconazole, micafungin, itraconazole, and voriconazole. Infection control procedures were adapted in the unit and no relapse was detected. In addition, 30 publications presenting 450 pediatric and 28 adult cases are reviewed.

Nosocomial Burkholderia cepacia infections in a Turkish university hospital: a five-year surveillance.

BACKGROUND: Burkholderia cepacia has the potential to cause fatal infections in ICUs, and multidrug resistance makes them a serious threat in hospital settings. The aim of this study was to evaluate the epidemiology of B. cepacia infections in our hospital. METHODOLOGY: The incidence, clinical characteristics, antimicrobial susceptibility, and outcomes of nosocomial B. cepacia infections during a five-year period were retrospectively analysed according to the infection control committee records. RESULTS: A total of 39 cases with nosocomial B. cepacia infection were included in the study. B. cepacia was identified from 0.7% of the nosocomial isolates. Its incidence was 0.26 per 1,000 admissions with 53.8% crude mortality rate. The most frequent nosocomial B. cepacia infection was pneumonia (58.9%), followed by bloodstream infections (25.6%), surgical site infections (7.6%), urinary tract infections, (5.1%), and skin-soft tissue infections (2.5%). Nosocomial B. cepacia infections were most commonly observed in intensive care units (61.5%). The most active antimicrobial agents were piperacillin-tazobactam, cefoperazone-sulbactam, and carbapenems. CONCLUSIONS: The incidence of nosocomial B. cepacia infections was rare in our hospital, and no outbreak was detected during the study period. However, infections caused by B. cepacia should be taken into consideration because of their high mortality due to multidrug resistance in ICU settings.

Crimean-Congo hemorrhagic fever treated with ribavirin in a pregnant woman.

We report a case of Crimean-Congo Hemorrhagic Fever (CCHF) infection in a 36-week pregnant woman. She was treated with ribavirin. She did not transmit the disease to her baby. Her baby was the first known to survive being delivered by a woman with CCHF. The initialization of ribavirin treatment probably resulted in the survival of the mother and her baby.

Molecular investigation of a fungemia outbreak due to Candida parapsilosis in an intensive care unit

We investigated a nosocomial cluster of four Candida parapsilosis fungemia episodes that occurred in a neurological intensive care unit over a two-week period. The four infected patients had received parenteral nutrition through central lines, and all four had catheter-related candidemia. All of the isolates were susceptible to all of the antifungals tested, including amphotericin B, fluconazole, voriconazole, and caspofungin. They had strictly related fingerprints, based on randomly amplified polymorphic DNA analysis. Additional DNA sequencing data revealed that they were same strain. Although no isolate of Candida parapsilosis was recovered from other clinical, surveillance, or environmental samples, nosocomial spread of this yeast ceased, following the reinforcement of infection-control measures. Candida parapsilosis may require an intravascular foreign body to cause fungemia, but this outbreak shows that it can be transmitted nosocomially and can cause epidemics.

[Investigation of the effect of constructions in hospital environment on the crucial units for immunocompromised patients and the development of opportunistic mold infections]. / Hastanede yapilan insaat calismalarinin immün sistemi baskilanmis hastalarin bulundugu cevre ve firsatçi küf enfeksiyonlari gelisimi uzerindeki etkisinin arastirilmasi.

This study was planned to determine the effect of building constructions in and around our hospital, on the development of opportunistic mold infections in immunocompromised patients hospitalized in bone marrow and kidney transplantation units and haematology and oncology units. Samples were collected from high risk units by an air sampler (Air Ideal) from indoors and outdoors of a total of 43 patient rooms. The most commonly isolated species from indoor air cultures of our hospital were Penicillium spp. (50.6%), Cladosporium spp. (20%), Chrysonilia spp. (11%) and Aspergillus (10.6%) species. When outdoor samples were considered, Penicillium spp. (38.8%) was still in the first line, followed by Cladosporium spp. (24.3%), Paecillomyces spp. (10.7%) and Aspergillus (8.7%) species. There was no statistically significant difference of total colony and spore numbers between the samples obtained from indoor and outdoor air (p > 0.05), indicating the close relation with the construction studies in and around the hospital. Clinical samples including bronchoalveoler lavage (BAL) fluid, sputum, endotracheal aspirate and sinus tissue were collected from the total of 43 patients staying at these air sampled rooms, and eight of them (18.6%) yielded positivity for the growth of molds. Of them four were identified as Penicillium chrysogenum (sputum isolates), two as Aspergillus fumigatus (sputum and BAL isolates), one as Aspergillus flavus (BAL isolate), and one as Valsa sordida (sinus tissue) which is considered as a plant pathogen. A total of 53 sera, BAL, and tissue supernatant samples were screened by ELISA for the presence of galactomannan antigen, and five of the eight patients whose cultures were positive were also found positive for galactomannan antigen. One patient has died due to invasive aspergillosis whose BAL specimen and indoor air sample were positive for A. fumigatus. In evaluation of indoor air samples before and after the change of HEPA filters, statistically significant decrease was detected in total colony and spore numbers between the samples taken before and after the filter changes (p < 0.005). This study has emphasized the importance of examination of mold flora of indoor air and clinical samples of high risk group patients intermittantly, in order to prevent opportunistic mold infections in crucial units especially during hospital constructions.

Molecular investigation of a fungemia outbreak due to Candida parapsilosis in an intensive care unit.

We investigated a nosocomial cluster of four Candida parapsilosis fungemia episodes that occurred in a neurological intensive care unit over a two-week period. The four infected patients had received parenteral nutrition through central lines, and all four had catheter-related candidemia. All of the isolates were susceptible to all of the antifungals tested, including amphotericin B, fluconazole, voriconazole, and caspofungin. They had strictly related fingerprints, based on randomly amplified polymorphic DNA analysis. Additional DNA sequencing data revealed that they were same strain. Although no isolate of Candida parapsilosis was recovered from other clinical, surveillance, or environmental samples, nosocomial spread of this yeast ceased, following the reinforcement of infection-control measures. Candida parapsilosis may require an intravascular foreign body to cause fungemia, but this outbreak shows that it can be transmitted nosocomially and can cause epidemics.

Nosocomial fungemia due to Trichosporon asteroides: firstly described bloodstream infection.

Trichosporon spp. are oppurtunistic yeasts that cause deep-seated, mucosa-associated, and superficial infections in immunocompromised patients. It is well known that Trichosporon asteroides is mainly responsible of superficial infections and does not cause systemic infections in humans so far. In this study, we present the first case of disseminated infection due to Trichosporon asteroides in an intensive care patient. Yeast colonies were isolated from the specimens of blood, urine, aspiration fluid of the endotracheal tube and catheter tip swabs of the patient. Conventional mycological studies were not adequate for the identification of the isolate to the species level. The genetic identification of the yeast isolate was performed and the DNA sequence of the isolate exactly matched the corresponding sequence of the Trichosporon asteroides rRNA gene from the GenBank DNA database (accession numbers: AB018017, AF075513). Therefore, our isolate was identified as Trichosporon asteroides as a causative agent of deep-seated fungemia.