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Introduction: Stenotrophomonas maltophilia is the only opportunistic human pathogen in the genus Stenotrophomonas. These bacteria can be isolated from healthcare settings, possibly resulting in bacterial colonization of medical devices, which cause nosocomial infections. S. maltophilia bacteremia results in high mortality and morbidity. This study aimed to determine the outcomes of S. maltophilia bacteremia and its associated mortality risk factors. Methodology: This was a retrospective study conducted at the University of Medical Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital (Istanbul, Turkey) from December 2015 to December 2022. Medical records, demographic information, clinical conditions, laboratory data, antimicrobial susceptibility, and clinical outcomes were retrospectively analyzed for the period between December 2015 and December 2022. Results: Data from 87 patients (median age 61 years) with bacteremia were included in this study. The most common underlying conditions were diabetes mellitus (DM; 32.2%), hypertension (29.9%), and malignancies (19.5%). The most common sources of bacteremia were central venous catheters (CVCs; 44%), primary blood infection (32%), respiratory tract infection (20.7%), and wound site/abscess infection (2.3%). Seventy-eight percent of the patients were admitted to the intensive care unit (ICU) when bacteremia was detected. The 28-day mortality rate was 55%. The mortality rate was significantly higher in the ICU (p < 0.001). Elevated values of procalcitonin and C-reactive protein, and the presence of CVC were significant risk factors for mortality in those with S. maltophilia bacteremia. Conclusions: S. maltophilia bacteremia should be carefully monitored in patients with CVCs. Timely removal of CVCs can result in decreased mortality.

ObjectivesTwo potent nucleoside analogues frequently used to treat chronic hepatitis B (CHB) are entecavir (ETV) and tenofovir disoproxil fumarate (TDF). The purpose of this study was to examine the virological and biochemical therapeutic responses to TDF and ETV in CHB patients and to assess their effects on renal function.Materials and MethodsThis was a single-center retrospective study. The study comprised patients diagnosed with CHB who had been treated with TDF or ETV for at least a year.ResultsA total of treatment-naive 269 patients were analyzed, of whom 29% were hepatitis B e antigen positive. Among the patients, 26% (n=70/269) received ETV, whereas 74% (n=199/269) received TDF treatment. Patients receiving TDF were younger than those treated with ETV. The TDF group had significantly higher baseline hepatitis B virus DNA levels (log10 IU/mL) than the ETV group. Complete virological response was achieved in 232 (86.2%) of patients. Antiviral efficacy was comparable between treatments; however, a greater decline in estimated glomerular filtration rate was observed among patients receiving TDF.ConclusionThis study showed that TDF and ETV had comparable antiviral effectiveness. These findings provide updated real-world evidence supporting individualized selection of first-line antiviral therapy based on patients’ renal profiles.

Amaç: Koronavirüs hastalığı-2019 (COVİD-19) pandemisinin ilk dönemlerinde yoğun bakım ünitesinde (YBÜ) takip edilen hastalarda bakteriyel, fungal ve viral kaynaklı daha az sekonder enfeksiyonlar olduğu bildirilmiştir. COVİD-19’lu kritik hastalarda bakteriyel enfeksiyon deneyimi sınırlıdır. Bu çalışmanın amacı, COVİD-19 hastalarında YBÜ kaynaklı sekonder enfeksiyonların özelliklerini ve mortalite üzerine olan etkilerini değerlendirmektir. Gereç ve Yöntem: Çalışmamız, Mart ve Haziran 2020 tarihleri arasında YBÜ’de yatan ve şiddetli akut solunum yolu yetersizliği sendromu (SARS-CoV-2) pnömonisi olan 145 hastayı içeren tek merkezli retrospektif bir olgu-kontrol çalışması olarak planlandı. YBÜ kaynaklı enfeksiyonların epidemiyolojik, klinik ve mikrobiyolojik özellikleri ve sonuçları değerlendirildi. Bulgular: Hastaların ortalama yaşı 61,2 yıl ve vücut kitle indeksleri 28 kg/m2 olarak saptandı. Yüz kırk (%96,6) hastada en az bir komorbidite olduğu belirlendi. Çalışmadaki tüm COVİD-19 tanılı hastalardan 77’sinde (%53,1) ölüm gerçekleşti. Altmış iki (%42,75) hastada SARS-CoV-2’ye ek olarak farklı patojen üremesi saptandı. Kültürde ek mikroorganizma üreyen grupta ilk ölçülen lenfosit ve laktat düzeyleri ile kültür alındıktan sonra yapılan ölçümler arasında anlamlı bir artış belirlendi (p Objective: In the beginning of the coronavirus disease-2019 (COVID-19) pandemic, secondary bacterial, fungal and viral infections have been reported in the intensive care unit (ICU), but there is limited experience with infections in critically ill patients over time. The aim this study was to evaluate the characteristics of secondary infections related to ICU and their effects on mortality in COVID-19 patients. Materials and Methods: Our study was planned as a retrospective single-center case-control study involving 145 patients with severe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia hospitalized in the ICU between March and June 2020. The epidemiological, clinical and microbiological characteristics and results of ICU-related infections were evaluated. Results: The mean age of the patients was 61.2 years and mean body mass index was 28 kg/m2. At least one comorbidity was found in 140 patients (96.6%). Seventy seven of (53.1%) the patients diagnosed with COVID-19 included in the study died. In addition to SARS-CoV-2, the isolation of different pathogens was observed in 62 (42.75%) patients’ samples. In the group with secondary infections, a significant increase in lymphocyte and lactate levels was observed between the time of admission and time of sampling culture (p

Background Candida species are major causes of hospital-acquired bloodstream infections associated with high mortality in critically ill patients. This study aimed to evaluate temporal changes in species distribution, antifungal resistance, clinical outcomes, and mortality predictors in ICU patients with candidemia. Methods This retrospective study included 250 ICU patients with candidemia between January 2018 and January 2022. The study period was divided into two cohorts (2018–2020, n  = 80; 2020–2022, n  = 170). Clinical, laboratory, and microbiological characteristics were compared. Multivariable analysis was performed to identify independent predictors of mortality. Results The incidence density of candidemia significantly decreased from 4.32 to 3.10 per 1,000 ICU patient-days (IRR: 0.72; %95 CI: 0.55–0.94; p  = 0,014). A shift toward non-albicans Candida species was observed, while antifungal resistance rates remained stable. Candida score values and empirical antifungal therapy rates were lower in the later period. Despite increased central venous catheter use, catheter-related candidemia decreased. Overall mortality was similar between periods; however, during the second period, mortality was higher in patients with SARS-CoV-2 infection than in those without infection [100/105 (95.2%) vs. 43/65 (66.2%), p  < 0.001]. In multivariable analysis, SOFA score was independently associated with mortality in the early period (OR: 1.20, 95% CI: 1.01–1.43; p  = 0.043), whereas SARS-CoV-2 infection (OR: 20.43, 95% CI: 3.53–118.14; p  = 0.001), Candida score (OR: 0.19, 95% CI: 0.06–0.50; p  = 0.003), lactate level at ICU admission (OR: 5.23, 95% CI: 1.55–17.57; p  = 0.007), and urea level at ICU admission (OR: 1.01, 95% CI: 1.00–1.02; p  = 0.030) were independent predictors in the later period. Conclusion The high mortality observed among patients with SARS-CoV-2–associated candidemia underscores the need for heightened diagnostic awareness in deteriorating ICU patients. Early diagnostic work-up, timely initiation of antifungal therapy, and reassessment of treatment according to microbiological findings are important in this setting. Hospital-specific identification of preventable risk factors may also help optimize candidemia management and infection control strategies.

This study aimed to describe the epidemiological and clinical features of patients admitted to non-intensive care hospital wards due to Staphylococcus aureus bacteremia (SAB) and to identify predictors of mortality to improve patient outcomes. This single-center retrospective study included hospitalized patients with SAB between 2016 and 2024. We retrieved clinical and microbiological data retrospectively from the electronic medical record system. The research comprised 356 patients with SAB. The 30-day and in-hospital mortality rates were 7.3% ( n  = 26) and 9.8% ( n  = 35), respectively. The multivariate analysis revealed neutrophil-to-lymphocyte ratio (NLR) (HR = 1.08; 95% CI = 1.02–1.13; p  = 0.002), CRP (HR = 1.01; 95% CI = 1-1.02 ; p  = 0.04), and albumin (HR = 0.83; 95% CI = 0.73-0.95; p  = 0.008) as predictors for 30-day mortality. Pneumonia (HR = 15.03; 95% CI = 2.05–109.71; p  = 0.008), leukemia (HR = 28.72; 95% CI = 1.56-525.92; p  = 0.002), and sepsis (HR = 7.06; 95% CI = 1.02–48.53; p  = 0.002) were identified as significant risk factors for mortality. Using the Cox regression analysis, age (HR: 1.05, CI:1.01–1.10, p  = 0.01), leukemia (HR: 0.80, CI:0.71–0.90, p  < 0.001), and low albumin level (HR: 11.76; CI:1.76–78.42, p  = 0.01) were identified as independent risk factors affecting in-hospital mortality. We used the receiver operating characteristic (ROC) curve to predict the30-day mortality. The area under the ROC curve values were 0.619 ( p  = 0.044) for NLR, 0.692 ( p  = 0.001) for CRP, and 0.791 ( p  < 0.001) for albumin. The highest sensitivity and specificity at 30-day mortality were obtained from CRP and albumin, with a sensitivity of 65.4% and a specificity of 78.5% for albumin. Elevated NLR and CRP levels, along with decreased albumin levels, may predict poor clinical outcomes and could assist clinicians in optimizing the management of this bacterial infection. As a result, early diagnosis and appropriate antibiotic treatments are crucial in reducing mortality in SAB.

Introduction: This study was planned to understand the continuity of the follow-up and treatment of people newly diagnosed with HIV infection during the COVID-19 pandemic. We compared the pre-pandemic to the pandemic period, focusing on factors such as diagnosis, accessing treatment, staying on treatment, and viral suppression, as the pandemic had the potential to disrupt HIV care. Methodology: The one-year follow-up data of patients diagnosed in 2018 (pre-pandemic era) and 2020 (pandemic era) were compared. Each patient’s age, gender, employment and educational status, sexual orientation, comorbidities, quantitative HIV RNA levels (qRT-PCR), and CD4+ cell counts during outpatient follow-up visits, regular use of the treatment, and regular visits to the outpatient clinic were investigated retrospectively. Results: We had 192 new patients during the pre-pandemic period in 2018 (Group A) and 118 new patients during the pandemic in 2020 (Group B). There was no difference between the two groups regarding patient age and gender. The number of newly diagnosed HIV patients during the pandemic period decreased compared to the previous period (p < 0.001). Compliance with treatment rates was similar in both periods. There was no statistical difference in HIV RNA between the two groups after one year of treatment. Conclusions: The COVID-19 pandemic has had the potential to disrupt the continuity of HIV care among individuals. Although the COVID pandemic had a statistically significant effect on attendance at HIV care programs, treatment compliance was not impaired due to rapid action on drug supply and correct policy implementation during the pandemic.

Background/Objectives: The accurate evaluation of the fibrosis stage is critical for improving chronic hepatitis B (CHB) management and patient outcomes. This study aimed to compare the diagnostic accuracy of non-invasive fibrosis markers with liver biopsy for detecting significant, advanced fibrosis and cirrhosis. We further investigated the diagnostic performance of non-invasive markers according to HBeAg status to provide further insight into their clinical utility across patient subgroups. Methods: This single-center retrospective study included 536 treatment-naive patients with CHB who underwent liver biopsy. Patients were categorized into four groups according to the fibrosis stage: “no significant fibrosis” (F0–F2), “significant fibrosis” (F3–F6), “advanced fibrosis” (F4–F6), and “cirrhosis” (F5–F6). AAR, AAPRI, APRI, API, FIB-4, GPR, and S–index were compared among these groups. Results: In total, 536 treatment-naïve patients were analyzed (63.2% male; mean age 44.8 ± 12.9 years), of whom 25.4% were HBeAg-positive. API, FIB 4, GPR, and S-Index showed good performance (area under the curve [AUC] ≥ 0.8–0.9) in defining advanced fibrosis (≥F4), AAPRI, AAR, API, and APRI showed good performance ([AUC] < 0.700) in defining cirrhosis. The analysis showed that GPR had the highest AUC for ≥F3 (0.719) and ≥F4 (0.838), while FIB 4 had the highest AUC for cirrhosis (0.865). Conclusions: These findings highlight the value of non-invasive markers as inexpensive and easily applicable methods for clinicians in assessing the stage of liver fibrosis. The integration of these scores into the routine monitoring of chronic hepatitis B patients is expected to expand, enhancing clinical decision-making and reducing the necessity for liver biopsies.

Introduction: We aimed to evaluate the prevalence and clinical outcomes of COVID-19 in healthcare workers (HCWs) in the pre-vaccination and post-vaccination periods. In addition, we determined factors associated with the development of COVID-19 after vaccination. Methodology: In this analytical cross-sectional epidemiological study, HCWs who were vaccinated between January 14, 2021, and March 21, 2021, were included. HCWs were followed up for 105 days after the 2 doses of CoronaVac. Pre-vaccination and post-vaccination periods were compared. Results: A total of 1,000 HCWs were included, 576 patients (57.6%) were male, and the mean age was 33.2 ± 9.6 years. In the last 3 months during the pre-vaccination period, 187 patients had COVID-19, and the cumulative incidence of COVID-19 was 18.7%. Six of these patients were hospitalized. Severe disease was observed in three patients. In the first 3 months post-vaccination period, COVID-19 was detected in 50 patients, and the cumulative incidence of the disease was determined to be 6.1%. Hospitalization and severe disease were not detected. Age (p = 0.29), sex (OR = 1.5, p = 0.16), smoking (OR = 1.29, p = 0.43), and underlying diseases (OR = 1.6, p = 0.26) were not associated with post-vaccination COVID-19. A history of COVID-19 significantly reduced the likelihood of the development of post-vaccination COVID-19 in multivariate analysis (p = 0.002, OR = 0.16, 95% CI = 0.05-0.51). Conclusions: CoronaVac significantly reduces the risk of SARS-CoV-2 infection and alleviates the severity of COVID-19 in the early period. Additionally, HCWs who have been infected and vaccinated with CoronaVac are less likely to be reinfected with COVID-19.

Toxoplasmosis is a common opportunistic infection in patients with HIV/AIDS and may cause life-threatening clinical courses, such as encephalitis and pneumonia. Patients admitted between January 2006 and August 2017 with anti-HIV positivity confirmed by Western blotting were included in the study. Demographic data, CD4+ T-lymphocyte counts, and Toxoplasma gondii IgG/IgM levels were retrospectively obtained from patient records. T. gondii IgM positivity was not detected in patients, whereas T. gondii IgG positivity was detected in 267 (43.5%) patients. The T. gondii IgG positivity rate was 37.6% in men who had sex with men (MSM) and 48.4% in heterosexual patients. Furthermore, 42.6% of MSM and 21% of heterosexual patients were university graduates, of which T. gondii IgG positivity was detected in only 33.6% of MSM patients and 42.3% of heterosexual patients. In our study, high seronegativity was remarkable in MSM patients, particularly those who were highly educated, thus emphasizing the importance of prevention of primary infection in seronegative patients; necessity of prophylaxis in appropriate patients due to encephalitis, which has a high mortality rate and almost always develops after a latent infection; and necessity of screening for toxoplasmosis seropositivity at the time of diagnosis.

Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.