Although brucellosis is very common in the world and Türkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies.

Endocarditis is the most common cause of death from brucellosis. The information used to guide the management of cases with Brucella endocarditis has relied on case reports/series. Risk factors related to death and other adverse outcomes in patients with Brucella endocarditis were identified by an individual-patient data analysis of all reported Brucella endocarditis cases in the literature. The keywords “Bruce” and “endocard” were used to search articles published until July 2022 on PubMed and ULAKBIM databases. Case reports/series containing patients with endocarditis caused by Brucella spp., aged ≥17 years, and with data on antimicrobial or surgical treatment were included in the study. Epidemiological, clinical, laboratory, and treatment characteristics and outcomes of 273 cases from 86 eligible articles were recorded. It was found that male gender, a Wright serum tube agglutination (STA) titer of ≥1/1280 on admission, development of heart failure due to endocarditis were independent risk factors that increase mortality, while the usage of aminoglycoside and cardiac surgical intervention for endocarditis were factors reducing mortality. Including streptomycin or gentamicin in the treatment regimen may benefit patients with Brucella endocarditis. Valve surgery could be life-saving in patients with Brucella endocarditis. An STA titer of ≥1/1280, which probably reflects long-term and advanced disease, may be used as a marker for increased mortality. However, additional and more reliable studies are needed to define the most appropriate management approach in diagnosing and treating cases with Brucella endocarditis due to the low quality of the current evidence.

Background/aim: To have country-wide information about multidrug resistance (MDR) in isolates from community-acquired urinary tract infections (CAUTI) of Turkey, in terms of resistance rates and useful options. Materials and methods: We used a geocode standard, nomenclature of territorial units for statistics (NUTS), and a total of 1588 community-acquired isolates of 20 centres from 12 different NUTS regions between March 2019 and March 2020 were analysed. Results: Of the 1588 culture growths, 1269 (79. 9%) were Escherichia coli and 152 (9.6%) were Klebsiella spp. Male sex, advanced age, and having two or more risk factors showed a statistically significant relation with MDR existence (p < 0.001, p: 0.014, p < 0.001, respectively) that increasing number of risk factors or degree of advancing in age directly affects the number of antibiotic groups detected to have resistance by pathogens. In total, MDR isolates corresponded to 36.1% of our CAUTI samples; MDR existence was 35.7% in E. coli isolates and 57.2% in Klebsiella spp. isolates. Our results did not show an association between resistance or MDR occurrence rates and NUTS regions. Conclusion: The necessity of urine culture in outpatient clinics should be taken into consideration, at least after evaluating risk factors for antibacterial resistance individually. Community-acquired UTIs should be followed up time- and region-dependently. Antibiotic stewardship programmes should be more widely and effectively administrated.

Purpose: The current study aimed to evaluate the effects of the coronavirus disease 2019 (COVID-19) on choroidal thickness using enhanced depth imaging optical coherence tomography. Methods: This study evaluated the right eyes from 41 post-COVID-19 cases (Group 1) and 41 healthy subjects (Group 2). Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. Post-COVID-19 cases were evaluated within 1 month after a diagnosis of COVID-19. Two experienced ophthalmologists measured the choroidal thickness at the subfovea, temporal, and nasal quadrants at 500-mu m intervals up to 1500 mu m from the fovea at seven different points. Moreover, central macular thickness and ganglion cell layer thickness were measured via OCT, after which both two groups were compared. Results: Group 1 showed a significantly thicker choroid compared to Group 2 at the subfovea, 500 mu m temporal to the fovea, 500 and 1000 mu m nasal to the fovea (p=0.011, p=0.043, p=0.009, and p=0.019, respectively). Although other areas measured were also thicker in Group 1, the difference was not significant (p > 0.05). Moreover, no significant difference in the central macular thickness and ganglion cell layer thickness were observed between the groups (p>0.05). Conclusion: Choroidal thickness was increased in post-COVID-19 patients, which might be related to inflammation associated with the pathogenesis of COVID-19.

Direct-acting antiviral (DAA) drugs have increased the effectiveness of treatment in hepatitis C patients. With the developments in the world and DAA drugs coming into use in our country, the consensus report on the management of hepatitis C virus (HCV) infection has needed to be updated. It was first published in 2014 and updated in 2017 by the Viral Hepatitis Study Group of the Turkish Society of Clinical Microbiology and Infectious Diseases. Here, the Study Group has reviewed every aspect of chronic hepatitis C and revised the consensus report with the updated information. At the end of each topic, the agreed recommendations are summarized, considering the drugs reimbursed in our country.

Background/aim: Currently, hepatitis C virus (HCV) infection can be cured by direct-acting antivirals (DAAs). In this study, we aimed to find the rate of viremia among patients with a positive anti-HCV test and the rate of antiviral treatment given to viremic patients. We also aimed to reach patients with anti-HCV positivity but not tested for HCV-RNA, and patients, who were diagnosed with HCV-RNA positivity but received no treatment. Materials and methods: In this study, individuals tested for anti-HCV in Tokat Gaziosmanpaşa University Research and Application Hospital in the period between January 2010 and January 2020 were reviewed retrospectively. Anti-HCV positive patients, who were not tested for HCV-RNA, and HCV-RNA positive patients, who did not receive treatment, were called for a follow-up visit in the outpatient clinic. Results: The prevalences of anti-HCV positivity and viremia among patients were 2.24% and 0.67%, respectively. A HCV-RNA test was ordered in 71.7% of the anti-HCV positive patients. Antiviral treatment was not given to 44.4% of the viremic patients. Of the patients, who were called for a follow-up visit in the outpatient clinic, 3.9% attended the visit. Of these patients, 0.8% were HCV-RNA positive and 0.7% received treatment. Conclusion: Although the rate of HCV-RNA testing was relatively high in patients with anti-HCV positivity, almost half of them did not receive treatment. We could reach only one-third of the patients, who were called for a follow-up visit, and only a few patients received treatment. Individuals with anti-HCV positivity should be referred to a specialist without delay and HCV-RNA testing should be performed immediately to achieve HCV elimination targets. The likelihood of difficulties in reaching patients later should be considered.