Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among intensive care unit infections. Despite various preventive measures, the incidence of VAP remains high. This study aimed to explore the epidemiology and risk factors for VAP associated mortality in a secondary care hospital, comparing outcomes before and after implementing a VAP prevention bundle. This retrospective study was conducted from July 1, 2021, to June 30, 2023, at a secondary care hospital. Patients over 18 years old who underwent mechanical ventilation for more than 48 hours were included. The study compared the incidence, microbiological etiology, and outcomes of VAP before and after implementing the VAP prevention bundle and analyzed risk factors for mortality from VAP. A total of 83 patients diagnosed with VAP were included. Despite concerted efforts to implement the VAP prevention bundle, there was no significant decrease in the VAP rate per 1000 ventilator days, early-onset VAP, secondary bloodstream infections, acute respiratory distress syndrome, and 30-day mortality. The microbiological etiology of VAP remained consistent between the two periods. A decrease in lymphocyte count and albumin level were identified as independent risk factors for 30-day mortality. Concerted efforts to implement a VAP prevention bundle did not significantly reduce the incidence or improve outcomes of VAP in this secondary care hospital setting. The microbiological etiology remained unchanged. Monitoring lymphocyte count and albumin level may help identify patients at high mortality risk. Further research is needed to develop more effective VAP prevention and management strategies.

Candidemia ranks among the top causes of nosocomial bloodstream infections, significantly increasing hospital stays and costs. Rapid and effective empirical antifungal therapy is crucial. The Candida parapsilosis species complex, the second most common cause of candidemia, has shown rising fluconazole resistance globally and in our country. Additionally, echinocandins exhibit higher minimum inhibitory concentrations (MICs) for C. parapsilosis, complicating empirical treatment decisions. This retrospective study analyzed 173 C. parapsilosis candidemia cases over 22 years in a tertiary care hospital. We compared 88 fluconazole non-susceptible (minimum inhibitory concentration [MIC] = 4 µg/mL: susceptible dose dependent; MIC ≥ 8 µg/ml resistant) and 85 fluconazole susceptible cases, examining demographics, clinical characteristics, risk factors, and 28-day mortality. Independent risk factors for fluconazole non-susceptibilty included age ≥ 66 years (p = 0.016), central venous catheter use (p < 0.001), total parenteral nutrition (p = 0.003), and colostomy (p = 0.049). Fluconazole non-susceptible cases had lower microbiological cure rates and higher mortality. Mortality in this group was independently associated with microbiological cure failure (p < 0.001). This study highlights the importance of identifying risk factors to estimate the likelihood of resistant pathogens, initiating targeted antifungal therapy, and providing individualized management. Monitoring local resistance patterns is essential to guide empirical therapy. Further multicenter research is needed to validate findings and optimize treatment for fluconazole resistant candidemia. Clinical trial number: Not applicable.

OBJECTIVE: Urinary tract infections are common in older adults and associated with significant morbidity and mortality. This study aimed to characterize the clinical features, bacterial etiologies, antimicrobial resistance patterns, and risk factors for mortality in elderly patients hospitalized with urinary tract infection. MATERIAL AND METHODS: Data were retrospectively analyzed from 118 patients aged ≥65 years hospitalized with a diagnosis of urinary tract infection between January 2018 and December 2022. Urinary tract infections were defined according to Centers for Disease Control and Prevention criteria. Isolated microorganisms in urine cultures and antimicrobial resistance rates were determined. Risk factors associated with mortality were evaluated by logistic regression analysis. RESULTS: 50.8% of patients were female; the mean age was 72.5±7.0 years. The most common symptoms were dysuria (65.3%), anorexia (65.3%), and flank pain (57.6%). Forty-nine patients (41.5%) had nosocomial urinary tract infections. All cause in hospital mortality was observed in 48 patients (40.6%), and 22 patients (18.6%) had in-hospital mortality directly related to urinary tract infection. Urosepsis (OR: 13.518, 95% CI: 1.711-106.793, p=0.014), kidney stones (OR: 7.529, 95% CI: 1.596-35.525, p=0.011) and urinary tract infections caused by multidrug-resistant organisms (OR: 18. 612, 95% CI: 1.564-4.283, p<0.001) were independent risk factors for mortality, and appropriate treatment (OR: 0.090, 95% CI: -3.736--1.085, p<0.001) was an independent protective factor for mortality. CONCLUSIONS: Urinary tract infections in elderly adults present with a wide range of symptoms and are predominantly caused by drug-resistant Escherichia coli. Urosepsis and kidney stones are critical determinants of mortality, emphasizing the need for rapid and appropriate management strategies. Understanding the etiology, clinical features, and mortality risk factors of urinary tract infections in elderly adults is crucial for optimizing infection management in this vulnerable population.

Outpatient parenteral antimicrobial therapy (OPAT) is a well-established, cost-effective treatment modality delivered through structured, multidisciplinary

Introduction: HIV and AIDS remain as significant global health issues, with misinformation and stigma surrounding the diseases still being prevalent. Accurate and reliable information is crucial for promoting prevention, early detection, and effective management of the disease. YouTube has emerged as a popular platform for sharing and consuming health-related content, but the quality and reliability of its videos on various health topics have been questioned. Objective: This study aims to systematically review and evaluate the quality and reliability of YouTube videos on HIV/AIDS. Methods: We searched for videos on YouTube using two search terms, “HIV” and “AIDS,” and evaluated the top 100 videos for each search term. We recorded video features such as length, likes, comments, views, and upload date. Two independent evaluators assessed the videos’ quality and reliability using the Global Quality Scale and the modified DISCERN tool. We classified the videos into two groups based on the source that uploaded the video, professional and non-professional, and analyzed the data using statistical methods. Results: Of the 159 videos evaluated, the most common content categories were HIV transmission routes, basic information and definition of HIV, and HIV/AIDS activism and awareness. Non-professional videos tended to be shorter, but there were no significant differences in views, likes, and likes per day counts. Comments were significantly higher in non-professional videos. Professional videos had higher quality and reliability scores than non-professional videos. Conclusion: Accurate and reliable information on HIV/AIDS is critical for promoting prevention, early detection, and effective management of the disease. YouTube has the potential to disseminate this information, but the quality and reliability of its videos must be improved. Our study highlights the need to prioritize professional, high-quality, and reliable video content on HIV/AIDS on YouTube to improve the public health outcome.

Background: Community-acquired urinary tract infection (CA-UTI) is a leading source of bacteremia and sepsis in adults, yet the determinants of bloodstream invasion and short-term mortality remain incompletely defined. In particular, the relative contributions of age, comorbidity, antimicrobial resistance, and acute organ dysfunction are uncertain. Methods: We conducted a retrospective cohort study of consecutive adults hospitalized with CA-UTI at a tertiary hospital in Türkiye between January 2023 and June 2025. Clinical, laboratory, microbiological, and outcome data were abstracted. Multivariable logistic regression was used to identify predictors of concomitant bacteremia and 30-day all-cause mortality in the overall cohort and in the bacteremic subgroup. An eight-item unweighted risk-factor count score (male sex, short symptom duration, prior extended-spectrum β-lactamase–producing and carbapenem-resistant organisms colonization or infection, Charlson Comorbidity Index (CCI) ≥ 2, diabetes mellitus, qSOFA ≥ 2, C-reactive protein > 100 mg/L, procalcitonin ≥ 0.5 ng/mL) was derived to predict bacteremia, and its discrimination was assessed with ROC analysis. Results: Among 358 adults with CA-UTI, 117 (32.7%) had concomitant bacteremia. In the multivariable model, independent predictors of bacteremia included male sex, shorter symptom duration, prior extended-spectrum β-lactamase–producing and carbapenem-resistant organisms colonization or infection, CCI ≥ 2, diabetes mellitus, qSOFA ≥ 2, C-reactive protein > 100 mg/L, and procalcitonin ≥ 0.5 ng/mL. The eight-item risk-factor count showed a strong gradient in bacteremia prevalence (3.8% with 0–1 factors, 24.7% with 2–3, and 75.0% with ≥ 4) and good discrimination (AUROC 0.83 for the full model and 0.80 for the simplified score; DeLong p ≈ 0.3). Overall, 30-day mortality was 6.1% (22/358) and higher in bacteremic than non-bacteremic CA-UTI (9.4% vs. 4.6%). In the whole cohort, both bacteremia and qSOFA score ≥ 2 were independent predictors of 30-day mortality. Within the bacteremic subgroup, qSOFA score ≥ 2 was identified as the sole independent predictor. Conclusion: In adults hospitalized with CA-UTI, bacteremia identifies a high-risk clinical phenotype but is not the sole determinant of prognosis. Bacteremia is a marker of severity, whereas organ dysfunction, as captured by qSOFA, is the main driver of mortality. A simple eight-item bedside score demonstrated promising performance in predicting bacteremia but requires external validation before its routine use in clinical triage.