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In addition to these advantages, it can detail the relationships between independent variables and provide easy-to-understand outputs in the form of trees even in the most complex models. Because of these advantages, CHAID analysis has a wide usage area in the literature [16-18].3 Result The remainder of the study was conducted with 489 patients after using the inclusion and exclusion criteria. According to these findings, as the age of the patients increases, the rate of mortality also increases. According to the findings, those who were 56 years old (χ2 = 12.82; p < 0.01), those between 56 and 77 years old (χ2 = 39.03; p < 0.01) and those over 77 years old (χ2 = 11.88; p < 0.01), the mortality rate of patients with a SI value above 0.93 was significantly higher than that of participants with a SI value of 0.93 and below. According to the findings, while the mortality rate of patients with SpO2 value of 95.0 and below was 15.9%, none of the patients with SpO2 values above 95.0 died.

Tuberculosis (TB) is one of the most common opportunistic infections in people living with HIV (PLHIV). Mycobacterium tuberculosis may cause more TB in all stages of HIV infection than in the general population, with the incidence of TB and the spread of pulmonary TB to other organs increasing as the CD4 count decreases. In this HIV cohort study, we aimed to evaluate the clinical features, diagnosis, and prognosis of TB among PLHIV in Türkiye. We conducted a retrospective cohort study to analyze clinical outcomes and identify determinants of mortality among people living with HIV (PLHIV) co-infected with tuberculosis. We included 264 patients diagnosed and treated for TB across six centers in Türkiye. We extracted clinical, demographic, laboratory, microbiological, and radiological data from patient medical records. To identify independent predictors of mortality, we performed multivariable logistic regression and reported the results as odds ratios (ORs) with 95% confidence intervals (CIs). Of the 9,687 PLHIV who were followed for 10 years, 2.7% (264 individuals) developed TB. The median age of these individuals was 40 years, and 89% were male. The prevalence of pulmonary TB only, extrapulmonary TB only, and the coexistence of pulmonary and extrapulmonary TB were 42.4%, 48.8%, and 8.7%, respectively. Opportunistic infections and cancers were found in 23% (62 out of 264) of patients with HIV/TB co-infection. Among patients with HIV/TB co-infection, 42% showed lymphadenopathy, with 70% of these cases being generalized. In patients who underwent chest CT scans (n=200), radiological patterns revealed post primary TB in 46%, primary TB in 36%, and miliary TB in 18%. The positivity rates of Ehrlich-Ziehl-Neelsen staining (EZN), polymerase chain reaction (PCR), and TB cultures in clinical samples were found to be 47.5%, 72.5%, and 53%, respectively. Most of our patients (95%) were given the standard TB treatment regimen (HRZE), with a paradoxical reaction observed in 11.6% of cases and hepatotoxicity occurring in 18% of cases. Age, CD4 count (<200 cells/mm3-late presenters), and thrombocytopenia were identified as independent risk factors for mortality in the 58 patients (22%) who died after diagnosis. Even today, more than one fifth of patients with HIV-TB co-infection in our cohort died. Mortality was higher among individuals who presented late with tuberculosis disease, especially those with advanced immunosuppression (CD4 <200 cells/μL). These findings underscore the urgent need for early HIV diagnosis and systematic TB screening to reduce co-infection-related mortality and improve clinical outcomes.

Polymyxin E is the main drug used in the treatment of microorganisms with multidrug resistance. The positively charged nature of colistin creates difficulties in susceptibility testing. As a result of the studies, the gold standard method to determine colistin susceptibility was determined as the broth microdilution method. However, this method has not yet entered the laboratory routine in many centers in our country. Our aim in this review was to examine methods that could detect colistin susceptibility, which was very important in treatment, in the light of current data. Disk diffusion method is not recommended due to the limited diffusion of the colistin molecule into the agar. While there are studies suggesting that E-test can be a reliable and suitable alternative when compared to the reference method, there are also studies that detect a very major error rate of over 3%. Automated methods have not been able to achieve the desired categorical agreement and very major error rates in many studies. Molecular-based methods are especially used to detect the mcr gene and are especially important in determining resistance transmission. The findings of newly developed rapid tests and methods such as colistin broth disk elution are encouraging, but more studies are needed in this area.

Introduction: The aim of this national, multicenter, cross-sectional, retrospective chart review study was to determine the proportion of patients in Turkey who received hepatitis C virus (HCV) treatment after receiving positive anti-HCV results during HCV screening. Methodology: Data related to patients’ demographics, laboratory results, time interval from obtaining a positive anti-HCV result to treatment initiation, specialty of the physician requesting anti-HCV screening, and type of hospital were analyzed. Results: Among 1,000 patients who received a positive anti-HCV result, 50.3% were male and 78.5% were screened for HCV-RNA. Among HCV-RNA screened patients, 54.8% (n = 430) had a positive result. Among patients who tested positive for HCV-RNA, 72.8% received HCV treatment in line with their positive anti-HCV results. The median time from obtaining a positive anti-HCV result to initiation of HCV treatment was 91.0 days (interquartile range 42.0 to 178.5). Non-surgical branches requested HCV-RNA testing more frequently than surgical branches (p < 0.001). The rate of access to HCV treatment was higher among patients screened in university hospitals than among patients screened in training and research hospitals (p < 0.001). Conclusions: Our results indicate a higher rate of treatment initiation among patients with HCV infection than is described in the published literature. Furthermore, the time from screening to treatment initiation was considerably shorter compared with other international studies. However, since HCV-RNA testing was not requested in a significant portion of patients with a positive anti-HCV test result, there might be a large patient population with HCV who do not receive treatment.

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.

The characteristics, diagnosis, and treatment stages of malaria in Turkey in the last ten years are not known except few case reports. We aimed to describe the details of the diagnosis and treatment practices of malaria cases in various hospitals across Turkey between 2012 and 2023 after the declaration of the elimination of malaria. We collected the patient data from 30 centers by using Qualtrics Survey Software. The patients were categorized according to the WHO Malaria Severe Disease Symptoms guidelines. We detected 299 malaria cases. Of these patients, 23.7 % experienced misdiagnosis, with 77.5 % of misdiagnosed cases receiving antibiotics. Among the patients, 9 (3 %) had no travel history. Additionally, 28 (9.4 %) patients required admission to the intensive care unit (ICU) during hospitalization. There is a significant association between misdiagnosis and subsequent ICU admissions. Additionally, the duration between malaria diagnosis and the initiation of treatment significantly affected ICU admissions. Furthermore, the number of cases with severe malaria (according to WHO criteria) and ICU admissions increased after the COVID-19 period. In multivariate analysis, initial misdiagnosis was found to be associated with ICU admission (OR: 2.8, p < 0.05), while each day's treatment delays post-diagnosis increased ICU admissions (OR: 1.26, p < 0.05). Misdiagnosis is common which delays the treatment and is correlated with higher admissions to ICUs. Post-COVID-19, there was a notable increase in both ICU admissions and cases of severe malaria, suggesting an escalation in disease severity that warrants further investigation. The resurgence of rare malaria cases with no travel history to abroad highlights the necessity of continued vigilance for new malaria cases. Efforts to promptly treat upon diagnosis and improve diagnostic accuracy in Turkey, where malaria is uncommon, are crucial. Enhancing diagnostic methods and treatment strategies remains essential, especially in significant events like COVID-19.

ObjectivesPatients diagnosed with chronic hepatitis B virus (HBV) should be tested for hepatitis A virus (HAV) and vaccinated if they are seronegative. However, this test is often neglected. This study aims to investigate the status of HAV testing in chronic HBV patients.Materials and MethodsA multicenter study is being conducted by the Viral Hepatitis Combat Association with 16 centers across the country, including patients who have been receiving treatment for chronic HBV for at least 14 years. The anti-HAV immunoglobulin G (IgG) testing and vaccination status of the patients in this study were evaluated retrospectively. The patients’ data recorded in a web-based program were transferred to an Excel form, and the necessary analyses were performed. Statistical analysis was performed using SPSS for Windows, version 22.0 (IBM Corp., Armonk, NY, USA). Categorical measurements were summarized as numbers and percentages, continuous measurements as mean and standard deviation, and chi-square or Fisher’s exact test statistics were used to compare categorical variables.ResultsThe study group included 2966 individuals, 1832 of whom were male (61.8%) and 1134 of whom were female (38.2%). Of these patients, 1819 individuals (61.3%) were tested for anti-HAV IgG, while 1147 individuals (38.7%) were not. Of the 1819 individuals tested for anti-HAV IgG, 1688 (92.8%) were seropositive, and 131 (7.2%) were seronegative. It was determined that seropositivity increased significantly with age, and seronegativity was 23% among those aged 18-26 and 21% among those aged 27-33 (p=0.00001). According to the obtained data, HAV seronegativity was detected in one-fourth of individuals younger than 26 years and one-fifth of individuals aged 27-33. At 40 and above, seronegativity decreases significantly, falling to 5% and below.ConclusionDue to the changes observed in HAV epidemiology in our country in recent years, HAV seronegativity is high in young adults. According to our study data, anti-HAV IgG should be tested once in all chronic HBV patients, especially patients under the age of 35, and vaccination of seronegative individuals should not be neglected.

Background Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010–2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality. Conclusions The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.