Background: The primary objective of this study was to report the incidence of bloodstream infections (BSIs) and clinically or microbiologically proven bacterial or fungal BSIs during neutropenic episodes in patients with hematological malignancies. Methods: In this retrospective observational study, all patients in the hematology department older than 14 years who developed febrile neutropenia during chemotherapy for hematological cancers were evaluated. Patients were included if they had experienced at least one neutropenic episode between November 2010 and November 2012 due to chemotherapy in the hematology ward. Results: During 282 febrile episodes in 126 patients, 66 (23%) episodes of bacteremia and 24 (8%) episodes of fungemia were recorded in 48 (38%) and 18 (14%) patients, respectively. Gram-negative bacteria caused 74% (n=49) of all bacteremic episodes. Carbapenem-resistant Gram-negative bacteria (n=6) caused 12% and 9% of Gram-negative bacteremia episodes and all bacteremia episodes, respectively. Carbapenem-resistant Gram-negative bacteria included Acinetobacter baumannii (n=4), Pseudomonas aeruginosa (n=1), and Serratia marcescens (n=1). Culture-proven invasive fungal infection occurred in 24 episodes in 18 cases during the study period, with 15 episodes in ten cases occurring in the first study year and nine episodes in eight cases in the second study year. In 13 of 18 cases (72%) with bloodstream yeast infections, previous azole exposure was recorded. Candida parapsilosis, C. glabrata, and C. albicans isolates were resistant to voriconazole and fluconazole. Conclusion: BSIs that occur during febrile neutropenic episodes in hematology patients due to Gram-negative bacteria should be treated initially with non-carbapenem-based antipseudomonal therapy taking into consideration antimicrobial stewardship. Non-azole antifungal drugs, including caspofungin and liposomal amphotericin B, should be preferred as empirical antifungal therapy in the events of possible or probable invasive fungal infections with an absence of pulmonary findings due to increase azole resistance.

Introduction: We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies. Methodology: All patients in the hematology department of the Ministry of Health Okmeydanı Training and Research Hospital, an 800-bed tertiary hospital in İstanbul, Turkey, older than 14 years of age and who developed febrile neutropenia during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated in this retrospective observational study. Results: A total of 282 neutropenic episodes in 126 patients who met the inclusion criteria were analyzed. The mean patient age was 51.73 ± 14.4 years (range: 17–82 years), and 66 cases occurred in male patients. The mean Multinational Association for Supportive Care in Cancer score of patients with hematological malignancies was 17.18 ± 8.27. Fifty (39.68%) patients were colonized with VRE, and the mean number of VRE colonization days per patient was 34.27 ± 13.12 days. Only two patients developed VRE bacteremia: a male patient with non-Hodgkin’s lymphoma who survived the infection, and a female patient with acute myeloid leukemia who died from VRE bacteremia. Conclusions: Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly.

Objective: The aim of this study is to evaluate the etiological causes of pancytopenia in patients who were admitted to the hematology ward due to pancytopenia. Materials and Methods: All patients who were admitted to the hematology ward of Ministry of Health Istanbul Training and Research Hospital due to pancytopenia between 2013 and 2015 were retrospectively evaluated regarding etiological causes. Results: A total of 137 patients was evaluated. The etiological causes of pancytopenia were recorded as Vitamin B12 deficiency (n: 24; 17%), chronic liver disease (n: 21; 15%), malignancy (n: 19; 13%), myelodysplastic syndrome (n: 18; 13%), aplastic anemia (n: 11; 8%), rheumatic diseases (n: 7; 5%), and endocrine causes (n: 3; 2%). Conclusion: The etiological causes of pancytopenia vary depends on patients' age, gender, country, and other conditions. Vitamin B12 deficiency is the most common treatable cause of pancytopenia. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imagings, without the need of a bone marrow examination.

Introduction: Bloodstream infection (BSI) caused by Enterobacteriaceae is associated with mortality in cancer patients receiving chemotherapy. The aim of this study is to identify the risk factors and outcomes related to BSIs caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in cancer patients. Methodology: Hematology/oncology patients, who were diagnosed with BSIs caused by Enterobacteriaceae by positive blood cultures were evaluated retrospectively. Patients were divided into two groups by ESBL-positive and ESBL-negative Enterobacteriaceae bacteremia. Patients' demographic features, underlying conditions, comorbidity, neutrophil count, duration of neutropenia, antibiotic use in the previous three months before infection, mechanical ventilation, steroid use, central venous catheter implementation, total parenteral nutrition (TPN), hospitalization in the past three months, stay in intensive care unit, quinolone prophylaxis, and history of infection with ESBL-producing Enterobactericeae were evaluated. Risk factors related to BSIs caused by ESBL-producing Enterobacteriaceae and mortality were assessed. Results: A total of 122 patients were evaluated retrospectively. Quinolone propyhlaxis, TPN, infection with Extended Spectrum Beta-Lactamase positive ESBL-P Enterobacteriaceae during the previous three months, treatment with piperasillin-tazobactam or carbapenems in the previous three months were found to be independent risk factors for ESBL-P BSIs. Longer duration of neutropenia before BSI and complication at the beginning of BSI were found to be independent risk factors for mortality related to infection. Conclusions: ESBL-producing Enterobacteriacea should be treated with an appropriate antibiotic that is associated with better outcomes in hematology/oncology patients with BSIs. History of broad-spectrum antibiotic use and stay in hospital in the previous three months should be taken into consideration upon commencing antibiotic therapy.

Most frequently, empirical antibiotic therapy is immediately administered for patients with febrile neutropenia (FN). In this study, its aim was to assess the antibiotic resistance status and the cost of antibacterial agents in FN patients associated with hematological malignancies.The cost of antibacterial agents used in FN episodes in patients with hematologic neoplasms followed-up at the Department of Hematology from November 2010 to November 2012 were analyzed retrospectively.In the study period, 15 of 141 patients who were admitted to the hematology ward and ineligible for the study criteria were excluded. In total, 282 febrile episodes of 126 consecutive patients with neutropenia were retrospectively investigated. Imipenem was found to be the most commonly used among the antibacterial drugs as 1.16 patient daily dose (PDD)/100 patient-days, 117.16 is the mean defined daily dose (DDD) per month and US $73264.66 total cost per year, followed by meropenem, cefoperazone-sulbactam, and linezolid.Choosing noncarbapenem-based antibacterial therapy for empirical treatment of FN until the growth of microorganisms and switching to carbapenem therapy subsequent to new radiological, or microbiological, or/ and clinical findings, the appropriate vancomycin use may decrease the cost of antibacterial agents in the treatment of FN episodes in patients with hematologic malignancies contributing to antimicrobial stewardship.

The aim of this study was to retrospectively evaluate the characteristics, treatment, and prognosis of patients with intracranial suppurative infection (ISI) by review of clinical, radiological, and laboratory findings. The data collected from all patients who had been diagnosed with ISI and followed up at the Infectious Diseases and Clinical Microbiology Department of the study site between 1998 and 2013 were reviewed. Of the 23 ISI patients identified, the mean age was 38.21 ± 12.61 years (range: 19-67 years, median: 34) and mean symptom duration was 22.25 ± 20.22 days. Headache was the most common symptom, the frontal lobe the most common localization of ISI, and mastoiditis due to chronic suppurative otitis media the most common source of infection causing ISI. Proteus mirabilis, Pseudomonas spp., Peptostreptococcus spp., Enterococcus avium, Mycobacterium tuberculosis complex, and Toxoplasma gondii were isolated from the specimens collected from 6 (37.5%) of the 16 patients who underwent invasive procedures. Of these 16 patients, 2 underwent craniotomy, 12 burr hole aspiration, and 2 stereotactic biopsy. The rate of recurrence was 0% and the rates of sequelae and fatality were both 8%. ISI should be considered in male patients presenting with headache and neurological signs and symptoms, whether with or without fever, on admission for early diagnosis and provision of timely, adequate therapy and, if required, surgical intervention to reduce mortality and sequelae rates.