Should Preventive Antifungal Treatment Be Given to Patients With Abdominal Contamination in the Intensive Care Unit?

Background Intra-abdominal contamination is a critical risk factor for candidemia. Because of the high mortality of candidemia and delayed results of cultures, preventive antifungal (AF) treatment can be administered. Especially in the intensive care unit (ICU), it may be necessary to determine the preventive AF approach due to the poor clinical condition of the patients. However, this practice is not standard among clinicians, and it is controversial whether it is beneficial or not. This study aimed to evaluate the effects of different AF treatment approaches (prophylactic, empirical, and culture-directed) on mortality, development of candidemia, and length of hospital stay in these patients. The primary outcome of the study was mortality, and the secondary outcomes were the development of candidemia and length of hospital stay. Methodology This is a retrospective, single-center, cohort study. Adult patients who were hospitalized in the ICU with the diagnosis of intra-abdominal contamination between January 1, 2017, and December 31, 2020, were reviewed retrospectively from electronic hospital records and Infectious Diseases ICU patient follow-up forms. Age, gender, comorbid diseases, the reason for hospitalization, history of surgical operation, surgical procedure type, length of hospital stay, culture results of blood and intraoperative intra-abdominal samples (pus, peritoneal fluid, abscess), type of AF agents, and mortality status of the patients were recorded. Furthermore, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) level, procalcitonin (PCT) level, and serum albumin levels in blood samples taken on three different days (the day of diagnosis, the day of operation, and the day of candidemia) were examined. The patients were grouped as without AF, receiving prophylactic AF, receiving empirical AF, and receiving culture-directed AF. Additionally, the study population was evaluated by dividing it into two groups, namely, those who developed candidemia and those who did not. The patients were evaluated regarding the development of candidemia, AF treatment approach, length of hospital stay, and mortality. Results A total of 196 patients were included in the study. Candidemia was determined in 31.6% of the patients. Candidemia was more common in patients with a history of previous surgery and presenting with acute abdominal pain than other causes. It was determined that 70% of the patients who developed candidemia had perforation, with the most common being colonic perforation. The hospital stay was longer in patients with candidemia than without candidemia (47.9 vs. 22.4 days; p < 0.001). When empirical and prophylactic AF recipients were compared, there was no difference in mortality and length of hospital stay. Prolongation of the time to empirical treatment after perforation/leak was associated with increased candidemia (p = 0.004). Furthermore, patients with a waiting time of ≥4.5 days until surgical operation were at a higher risk of developing candidemia. Conclusions Although the study did not demonstrate a difference in terms of reducing mortality, it was concluded that preventive AF therapy can be administered to reduce the risk of candidemia and hospitalization duration, especially in patients with a history of previous surgical operations and abdominal contamination with a prolonged waiting period until the surgical operation.

Clinical Entity Mimicking Infectious Cellulitis: Eosinophilic Cellulitis (Wells' Syndrome).

Eosinophilic cellulitis (EC) is a skin disease characterized by pruritic, non-purulent, erythematous plaques and histologically by edema and eosinophil infiltration in the dermis. The etiopathogenesis of the disease is not fully elucidated. It differs from infectious cellulitis by being unresponsive to antibiotics and recurring. This case report presents a late-diagnosed case of EC in a patient who did not respond to long-term and broad-spectrum antibiotics. This case underscores the importance of skin biopsy and histopathological diagnosis in patients with recurrent, non-responsive, antibiotic-resistant, and cellulitis-like clinical features resembling infectious cellulitis; "eosinophilic cellulitis" should be considered in the differential diagnosis.

Vaccine hesitancy and refusal among parents: An international ID-IRI survey.

INTRODUCTION: Although vaccines are the safest and most effective means to prevent and control infectious diseases, the increasing rate of vaccine hesitancy and refusal (VHR) has become a worldwide concern. We aimed to find opinions of parents on vaccinating their children and contribute to available literature in order to support the fight against vaccine refusal by investigating the reasons for VHR on a global scale. METHODOLOGY: In this international cross-sectional multicenter study conducted by the Infectious Diseases International Research Initiative (ID-IRI), a questionnaire consisting of 20 questions was used to determine parents' attitudes towards vaccination of their children. RESULTS: Four thousand and twenty-nine (4,029) parents were included in the study and 2,863 (78.1%) were females. The overall VHR rate of the parents was found to be 13.7%. Nineteen-point three percent (19.3%) of the parents did not fully comply with the vaccination programs. The VHR rate was higher in high-income (HI) countries. Our study has shown that parents with disabled children and immunocompromised children, with low education levels, and those who use social media networks as sources of information for childhood immunizations had higher VHR rates (p < 0.05 for all). CONCLUSIONS: Seemingly all factors leading to VHR are related to training of the community and the sources of training. Thus, it is necessary to develop strategies at a global level and provide reliable knowledge to combat VHR.

Retrospective evaluation of seven different treatment protocols in hospitalized COVID-19 patients

Background/aim: As the experience has increased regarding SARS-CoV-2 in time, treatment trends have changed since the beginning of the pandemic. This study aimed to compare the outcomes of different treatment modalities for inpatients in a tertiary pandemic hospital in Antalya, Turkey. Materials and methods: Individuals aged 18 years and above who tested positive for SARS-CoV-2 in PCR with presenting COVID-related radiological findings, hospitalized for at least 3 days, and completed follow-up between March 15, 2020 and November 30, 2020 were included in the study. Patients' data were reviewed retrospectively. Seven treatment groups based on the single or combined use of hydroxychloroquine, oseltamivir, favipiravir, and remdesivir were formed and compared in terms of mortality, survival, length of hospital stay, need for intensive care, and mechanical ventilation. Results: A total of 321 patients were included in the study. The length of hospital stay, the need for intensive care, and mechanical ventilation were lower in Group 1 (hydroxychloroquine) and Group 2 (hydroxychloroquine + oseltamivir) compared to the other groups (p < 0.05). No significant difference was determined in survival between treatment groups. Analysis of prognostic factors affecting overall survival revealed that the need for intensive care and mechanical ventilation increased mortality [11.1 times (p < 0.001) and 6.48 times (p < 0.001), respectively]. Conclusion: No significant difference was determined between different treatment protocols in terms of their impact on survival. To end the COVID-19 pandemic, there is an urgent need to develop highly efficient, rapid-acting, and orally available antiviral drugs.

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods: A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated. Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion: Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

Monitoring the BK virus in liver transplant recipients: a prospective observational study.

OBJECTIVES: Because of the controversy regarding the effects of BK virus on nonrenal solid-organ transplant, we detected the BK virus via different methods and its effect on clinical findings, liver and kidney functions, and graft dysfunction in liver transplant recipients. MATERIALS AND METHODS: This prospective cohort study comprised patients over the age of 18, who consecutively received liver transplant from January 1 to December 31, 2011. The patients were examined once, every 2 weeks, for the first 3 months after transplant. Clinical findings were evaluated on each examination; blood and urine samples were collected, BK virus DNA was assessed with real-time polymerase chain reaction, and the presence of decoy cells (which are epithelial cells with large nuclei and large basophilic inclusions) in the urine was investigated. Patients were followed-up for 1 year to see if rejection occurred. RESULTS: Five of 39 patients (12.8%) showed BK viremia; 11 patients (28.2%) showed BK viruria, and 13 (33.3%) showed decoy cells. No statistically significant differences were found between BK virus positive and negative groups, respecting demographic variables, kidney and liver functions, and graft survival. BK virus DNA positivity in blood was the standard, while decoy cell assessment in urine and BK virus polymerase chain reaction test sensitivity in urine was 40%. CONCLUSIONS: No matter the method used to detect BK virus in the urine, the negativity of the tests is more valuable than their positivity. Although no statistically significant difference was found between the groups, we concluded that BK virus is a factor that should be considered when unexplained deterioration in kidney and liver function tests is observed in liver transplant recipients. Prospective studies with larger numbers of patients are warranted.

A case of fever of unknown origin: co-existence of Kikuchi-Fujimoto disease and acute disseminated encephalomyelitis (ADEM).

It is believed that viral infections and the hyperimmune reaction due to these infections are involved in the etiology of Kikuchi-Fujimoto Disease (KFD), a rare cause of fever of unknown origin. Axillary lymphadenopathy and neurologic involvement are rare in KFD. We present a patient diagnosed with KFD histopathologically during an investigation of the origin of fever and axillary lymphadenopathy. Subsequently, incidental sinus aspergilloma was diagnosed radiologically in the patient and acute disseminated encephalitis developed during follow-up. This report aims to draw attention to the co-existence of KFD and Acute Disseminated Encephalomyelitis, two diseases of which the origins are not clear.