ESBL production and carbapenem resistance increased the secondary bloodstream infection rates in intensive care units in Turkey, 2014-2019.

Aim: Secondary bloodstream infections (SBSIs) are caused by another infection and differ from primary bloodstream infections (PBSIs) in terms of prevention and treatment strategies. The aim of this study was to determine the risk factors for bloodstream infections which were secondary to the most common healthcare-associated infections caused by the most common microorganisms in intensive care units (ICUs) and to examine whether extended-spectrum beta lactamase (ESBL) production and carbapenem resistance is related to the higher risk or not. Methods: The study population consisted of patients in ICUs with ventilator-associated pneumonia (VAP), ventilator-associated event (VAE) or catheter-associated urinary tract infection (CAUTI) caused by E. coli, K. pneumoniae, P. aeruginosa or A. baumannii between 2014 and 2019. The data were obtained through the National Healthcare-associated Infections Surveillance Network. Multivariate logistic regression analysis was performed separately for VAP/VAE and CAUTI to determine the risk factors for the development of SBSI. Results: Microorganism, ICU type, bed capasity and carbapenem resistance were found to be risk factors for SBSI for both types of infection. For VAPs/VAEs, female gender and hospital type were also identified as risk factors. The highest risk was in K.pneumoniae and in emergency ICUs. Among the hospitals, the highest risk in VAPs/VAEs was found in government education and research hospitals. ESBL production for K. pneumoniae and E. coli increased the risk in patients with VAP/VAE; however, it did not increase in patients with CAUTI. Discussion: By using the risk factors, it may be possible to recognize SBSIs earlier, especially in patients with CAUTIs or VAPs/VAEs caused by carbapenem-resistant or ESBL-producing K. pneumoniae.

Turkey's response to COVID-19 pandemic: strategy and key actions

COVID-19 emerged at the end of 2019 in Wuhan, China, and spread rapidly around the world causing many deaths. Due to the intercontinental escalation in the epidemic, while WHO declared a pandemic on March 11, 2020, our country's first case was diagnosed. Before this, the MoH established the Operations Center against possible risks regarding the Pandemic Influenza Preparedness Plan on January 10, 2020 and formed the Scientific Committee, which has a critical importance in epidemic management. National and Provincial Pandemic Coordination Boards were established within the scope of this plan. Fast, effective and frequently updated decisions were implemented. The epidemic was kept under control by stopping mutual flights to countries with cases, intermittent curfews, transportation restrictions, closure of schools, filiation, social isolation, use of PPE, social media communication, and intensive work of healthcare workers. Softwares were developed for analysis and data reporting, case and contact tracing. Various mobile applications were developed providing a safe social life in social areas and enabling filiation teams to intervene in the necessary areas in the fastest way and to record data instantly in the system. Prior to normalization process, "COVID-19 Epidemic Management and Working Guide" was prepared including epidemic measures for social life, institutions, organizations, and businesses. Variants of concern, recommended by WHO to be monitored, led to an increase in the number of cases around the world. In our country, the number of laboratories and tests were expanded to monitor variant viruses. Vaccination activities continue in line with the National Vaccine Administration Strategy. In the fight against pandemic, it will be possible to maintain and increase our country's acquisitions so far, owing to the strong health infrastructure both in terms of manpower and institutions, free health care, success in the production of PPE and medical devices, and finally, rapid acceleration of the vaccination.

COVID-19 outbreak control, example of ministry of health of Turkey

Our first COVID-19 case in Turkey was a 44-year-old male who referred to the hospital on March 9, 2020. The first related death occurred on March 17, 2020. Preparedness for the pandemic has been ongoing before the first case was detected. The National Pandemic Plan was published in 2006. The Pandemic Influenza National Preparedness Plan was available after being updated in light of experiences gained during the 2009 Influenza A pandemic. Accordingly, Pandemic Coordination Boards and Operation Centers have been established on the national and provincial levels. This was an adaptable plan to the Novel Coronavirus Disease (COVID-19). We formed teams to work on a 24/7 basis and established a Scientific Committee at the Public Health Emergency Operation Center within the General Directorate of Public Health. "COVID-19 Risk Assessment", "COVID-19 Guideline" and "Case Report Form", regulations of personal protective equipment along with need-based guidelines, treatment algorithms, brochures and related documents have been released. For the case-based follow-up, Public Health Management System (HSYS) is being used. PCR and rapid diagnostic kits are being used to analyze the samples at the central Microbiology Reference Laboratory and the authorized laboratories in several provinces. Various preventive measures were implemented including flight restrictions to certain countries, gradually expanded to suspending all flights and prohibiting the entry of foreign nationals, 14-day isolation and symptom monitoring for those that came from countries under risk. Persons with chronic diseases have been granted an administrative leave, on campus education at schools and activities of public rest and entertainment areas were temporarily suspended. The measures have been implemented for penitentiary institutions, dormitories, nursing homes, public transport and intercity buses, and also weekend curfews are implemented. In accordance with the pandemic plan, actions have been carried out with a multi-sectoral approach, and preventive measures have been implemented to cover the society as a whole.