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To describe the change in the epidemiology of health care–associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Introduction: The genito-urinary system is one of the most common areas of involvement in brucellosis. To present the epidemiological, clinical, and laboratory characteristics of patients with testicular involvement associated with brucellosis, together with the diagnostic and therapeutic approaches. Methodology: Patients followed up for brucellosis-related testicular involvement between January 2012 and November 2022 were included in the study. Brucellosis is defined as the production of Brucella spp. in cultures, or clinical symptoms together with the serum standard tube agglutination test titer of ≥ 1/160. Inflammation in scrotal Doppler ultrasonography was based on testicular involvement. Results: A retrospective evaluation was made of the data of 194 patients with brucellosis-related testicular involvement. The rate of determination of testicular involvement in brucellosis was 2.57%. The most affected patients were determined in the 16-30 years age range. On presentation, brucellosis was in the acute stage in 83.7% of patients. The most common symptoms on presentation were swelling and/or pain in the testes (86.6%). In the patients where a spermiogram could be performed, oligospermia was determined in 41.7%, and aspermia in 8.3%. When the testicular involvement of brucellosis was evaluated, epididymo-orchitis was present at the rate of 55.7%, epididymitis at 27.3%, and testis abscess at 5.1%. Conclusions: Although epididymo-orchitis was the most frequently determined form of involvement in this study, there was also seen to be a significant number of patients presenting with epididymitis. Male patients presented with the clinical status of brucellosis should be questioned about swelling and pain in the testes to avoid overlooking testicular involvement.

Background/Objectives: Potential drug–drug interaction (pDDI) refers to the co–administration of two or more drugs that interact with each other and may have therapeutic effects. Increasing rates of polypharmacy with age increase the risk of pDDIs in geriatric patients. This multicenter study aims to provide real–world data on the incidence of pDDI associated with antimicrobial therapy in hospitalized older adults. Methods: The study screened all hospitalized patients, including those aged 65 years and older. Using the Lexicomp® Drug Interaction Online Database, researchers screened for pDDIs among all medications taken by patients. Results: 663 (24.0%) aged 65 and over were included in the study. Polypharmacy was present in 64.9%, and hyperpolypharmacy was present in 10.0% of the cases. 480 (72.4%) of the cases used antimicrobial therapy. The mean total number of drugs and antimicrobials used per case was 5.86 and 1.02, respectively. A total of 372 antimicrobial–related pDDIs were detected, and at least one antimicrobial–related pDDI was identified in 202 (42%) patients receiving antimicrobials. Ciprofloxacin (73.3%), clarithromycin (58.3%), and colistin (26.3%) had the highest numbers of D–type pDDIs. The antimicrobials with the highest incidence of X–type pDDIs were metronidazole (23.6%) and clarithromycin (8.3%), respectively. The logistic analysis found a significant association between antimicrobial–related pDDIs and an increase in the number of drugs, length of hospital stays, and ID departments. Conclusions: PDDI rates associated with antimicrobials, like the high pDDI rates associated with all drugs, support the literature. Therefore, strategies should be developed to reduce the risk of pDDI when prescribing antimicrobials to geriatric patients.

Objectives:The aim of this study was to present the preliminary findings of real-world data of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) in treatment-naive chronic hepatitis C (CHC) patients, which was approved for the first time in treatment-naive patients in Turkey.Materials and Methods:This retrospective, cross-sectional, multicenter and national study comprised treatment-naive CHC patients receiving SOF/VEL/VOX between June-December 2022 in ten centers from Turkey. The sustained virological response (SVR) was defined as undetectable hepatitis C virus (HCV)-RNA after at least 12 weeks or more from the end of antiviral therapy.Results:Forty one patients initiating SOF/VEL/VOX were included in the study; median age 55 [interquartile range (IQR): 34.5-61 years], 63.4% males, and median HCV-RNA 521,644 IU/mL. Genotype distribution ranged from 1 to 4 in 28 patients who underwent genotype analysis, and genotype-1 was detected in 24 (85.7%) patients. The most common risk factor was substance abuse (n=10, 24.4%) and the most common comorbidity was hypertension (n=111, 26.8%). 3 (7.3%) patients had compensated cirrhosis and one (2.4%) had hepatocellular carcinoma. While in the 1st month of treatment, HCV-RNA was negative in all patients except one patient, at the end of treatment all patients’ viral load was negative. SVR12 results were available in 23 patients and SVR24 in 10 patients. SVR12 and SVR24 were achieved in all patients who could be evaluated (100%) (SVR12, 23/23; SVR24, 10/10). Adverse events were reported by two patients: Diarrhea (2.4%) and nausea (2.4%), but did not lead to a discontinuation of treatment.Conclusion:The preliminary results of our study corroborated the efficacy and well tolerateability of SOF/VEL/VOX in treatmentnaive CHC patients. High SVR rates were also observed across genotypes 1, 2, 3, 4 with the pangenotypic SOF/VEL/VOX.

Background: Brucellosis is one of the most common zoonotic infections. Although culture is the gold standard diagnostic method, bacterial growth in blood cultures may not always occur due to various factors. We aimed to investigate demographic, clinical, and laboratory findings that may have predictive significance for bacteremia in brucellosis. Methods: Patients older than 18 years of age followed up with a diagnosis of brucellosis between 2012 and 2022 were included in this retrospective multicenter study. They were divided into two main subgroups according to their Brucella species reproductive status as bacteremic and non-bacteremic. Results: A total of 743 patients, 370 (49.80%) bacteremic and 373 (50.20%) non-bacteremic brucellosis patients, were enrolled. The mean age of the bacteremic group (36.74 years) was lower than the non-bacteremic group (43.18 yr). High fever, chills/cold, sweating, nausea, vomiting, and weight loss were more common in the bacteremic group. In the bacteremic group, white blood cell count, platelet count, hemoglobin level, mean platelet volume, eosinophil, and neutrophil counts were lower, and lymphocyte, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and ferritin levels were higher. According to the receiver operating characteristic (ROC) analysis, when the cut-off value of ferritin was considered 67, it was the parameter with the strongest predictive significance in Brucella bacteremia. Conclusion: High ferritin level, low eosinophil count, and increased erythrocyte sedimentation rate were determined as the most critical laboratory findings in predicting bacteremia in brucellosis.  

In this multicenter, retrospective study involving 62 patients, we investigated whether switching from entecavir (ETV) or tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) represents a superior treatment strategy for patients with chronic hepatitis B (CHB) experiencing low-level viremia (LLV). The study determined that TAF significantly improved both virological and biochemical outcomes. At 48 weeks, the complete virological response (CVR) rate was 77.8% for those who switched from ETV and 81.8% for those who switched from TDF, with Hepatitis B virus deoxyribonucleic acid (HBV DNA) negativity reaching 81% by month 12. Additionally, significant normalization of liver enzymes, albumin, and platelet counts was observed across the cohort. While the switch from TDF was associated with a significant increase in triglycerides and high-density lipoprotein (HDL) and a decrease in estimated glomerular filtration rate (eGFR), no such changes were detected in the ETV group. This evidence suggests that TAF provides robust virological control in LLV patients and is associated with favorable biochemical improvements. However, due to the study’s limitations, the strong assertion that TAF promotes the regression of liver fibrosis and reduces the risk of hepatocellular carcinoma (HCC) must be interpreted with caution.

The combination of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is recommended as a salvage therapy for treatment-experienced chronic hepatitis C (CHC) patients. However, it is used in our country for treatment-naïve and treatment-experienced patients. This study aims to present real-world data from Türkiye on CHC patients treated with SOF/VEL/VOX. The present study was conducted by the Viral Hepatitis Study Group of the Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK). It was a multicenter, retrospective, observational study. The data were collected from patients receiving SOF/VEL/VOX therapy at 12 medical centers in Türkiye between 1 June 2022 and 31 December 2024. The patients had received the treatment for 8 to 12 weeks. Of the 139 patients enrolled, 63.3% (n = 88) were male, with a mean age of 54.4 years. Most patients were non-cirrhotic (94.2%, n = 131) and treatment-naïve (92%, n = 128); 49.6% (n = 69) were infected with genotype 1b. Early virologic response (EVR) could be assessed in 126 patients, with an EVR rate of 82.5% (n = 104). End-of-treatment data were available for 113 patients, all achieving an end-of-treatment response. Among the 80 patients for whom week-12 post-treatment data were available, 97.5% sustained virologic response at week 12 (SVR12). Significant improvements were observed in AST, ALT, and platelet levels, along with reductions in APRI and FIB-4 scores (p = 0.001).” No serious adverse events leading to treatment discontinuation were reported. Mild adverse events included pruritus (2.1%, n = 3), fatigue (2.1%, n = 3), and nausea (1.4%, n = 2). The SOF/VEL/VOX combination is a highly effective and well-tolerated treatment option in treatment-naïve CHC patients, achieving an SVR12 rate of 97.5%.

Background The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic. Methods A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software. Results Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p  < 0.001) and depression (β = 0.135, p  < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p  < 0.001; β = 0.235, p  < 0.001, respectively) and depression (β = 0.365, p  < 0.001; β = 0.294, p  < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p  < 0.001) but not with depression (β = 0.066, p  = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p  < 0.001; β = 0.259, p  < 0.001, respectively) and depression (β = 0.400, p  < 0.001; β = 0.311, p  < 0.001, respectively). Conclusions The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.

Objectives: To evaluate the maternal and fetal clinical outcomes in SARS-CoV-2 infected pregnant women during the whole period of the pandemic in a single province in the southeast of Turkey. Methods: This retrospective study included patients who were screened from the medical registration system and found to be infected with SARS-CoV-2 virus during pregnancy. The demographic, clinical, laboratory, and radiological features of all the patients were obtained and compared between groups classified as severe-critical and mild-moderate disease severity. Results: The mean age of all the cases was 29.0 [+ or -] 5.3 years in the mild-moderate cases, and 30.1 [+ or -] 5.5 years in the severe-critical cases. The rates of 3rd trimester, cesarean and premature birth, high body mass index (BMI), symptoms of cough and dyspnea, the presence of comorbidities, and hypothyroidism were significantly higher in the severe-critical cases than in the mild-moderate group. In the univariate analyses, BMI, dyspnea, cough, maternal complication rate, the neutrophil/lymphocyte ratio, the values of white blood cells, procalcitonin, high-sensitive C-reactive protein, D-dimer, ferritin, aspartate aminotransferase, and alanine aminotransferase were detected as significant risk factors. In the multivariate analysis, only procalcitonin was a significant factor. Conclusion: In the 3rd trimester of pregnancy, obesity and hypothyroidism were found to be risk factors for severe-critical cases of COVID-19 infection, and the clinical course was more severe with a higher rate of mortality in the recent period of the pandemic. Keywords: COVID-19, pregnancy, SARS-CoV-2, trimester, COVID-19 vaccination [phrase omitted]

Background Surgical site infections (SSIs) are among the most significant concerns in healthcare settings, presenting challenges in patient management and healthcare outcomes. The emergence of the COVID-19 pandemic has further complicated the landscape of infectious disease epidemiology, impacting the distribution and resistance characteristics of pathogens responsible for SSIs. Understanding these dynamics is essential for improving infection prevention and treatment strategies. Methods This retrospective multi-center study included 17 hospitals in Turkey, analyzing SSI cases from January 2019 to January 2023. The study was divided into three phases: pre-pandemic (January 2019 - March 2020), early pandemic (March 2020 - January 2022), and late pandemic (January 2022 - January 2023). We assessed demographic and clinical characteristics, pathogen distributions, and resistance rates, focusing on multidrug-resistant (MDR) pathogens. Results A total of 2,058 patients with SSIs were included. The SSI rate increased from 0.79% in 2019 to 0.87% in 2020, then decreased to 0.46% in 2021 and 0.50% in 2022. The most prevalent pathogens were E. coli (21.9%) and K. pneumoniae (14.6%). Resistance to meropenem in K. pneumoniae rose from 23% pre-pandemic to 33% post-pandemic, while ceftazidime-avibactam resistance surged from 6 to 43%. P. aeruginosa showed increased quinolone resistance from 18 to 27%, with colistin resistance rising to 13% in the late pandemic phase. Conclusions This study highlights the significant impact of the COVID-19 pandemic on SSIs in Turkey, revealing concerning trends in antibiotic resistance among key pathogens. Ongoing surveillance and enhanced infection control measures are essential to address these challenges and improve patient outcomes in the post-pandemic era.