Tıp Eğitimi Dünyası | Cilt: 23 Sayı: 69

Healthcare-associated bacterial conjunctivitis is an underrecognized yet preventable infection in neonatal intensive care units (NICUs). This study aimed to determine the incidence, risk factors, microbiological profile, and treatment approaches of healthcare-associated bacterial conjunctivitis in neonates. This descriptive, cross-sectional study included neonates diagnosed with bacterial conjunctivitis and followed in the NICU between January 2019 and January 2024. Pathogens were identified by MALDI-TOF MS and antimicrobial susceptibility determined using VITEK 2 according to EUCAST breakpoints. During the five-year period, 104 (2.5%) of 4107 neonates admitted to the NICU developed healthcare-associated bacterial conjunctivitis. Of the pathogens isolated in cultures, 70.2% were Gram-positive bacteria, with coagulase-negative staphylococci being the most common (52.9%), followed by Staphylococcus aureus, Klebsiella pneumoniae, and Serratia marcescens. Empirical treatment consisted of 0.3% topical gentamicin eye drops. In resistant cases, fortified vancomycin drops (32.7%), 0.5% moxifloxacin (4.8%), or 0.3% tobramycin (1.9%) eye drops were administered according to antibiogram results. Compared with Gram-positive infections, Gram-negative conjunctivitis was associated with longer durations of intubation, orogastric feeding, and hospitalization. These findings indicate a predominance of Gram-positive pathogens in NICU-acquired neonatal conjunctivitis, while Gram-negative infections confer greater clinical burden. Fortified antibiotic eye drops are an effective treatment option for resistant cases in high-risk newborns.

Objectives: To develop a scoring system to predict resistance to ceftolozane/tazobactam in Pseudomonas aeruginosa strains isolated from respiratory specimens. Methods: A case–control study was conducted to evaluate the risk factors associated with resistance to ceftolozane/tazobactam. Patients with P. aeruginosa were defined as cases if they had ceftolozane/tazobactam-resistant strains, whereas those with ceftolozane/tazobactam-susceptible strains were defined as test-negative controls. A predictive scoring system based on binary logistic regression coefficients was formulated to predict resistance to ceftolozane/tazobactam. The score’s performance was assessed using ROC curves and AUC. The sensitivity, specificity and predictive values of the score were determined on the basis of a cut-off point, using the Youden index. Results: Ceftolozane/tazobactam resistance was detected in 18.4% of P. aeruginosa isolates from 473 patients. In multivariate analysis, a history of bronchoscopy [OR (95% CI) = 2.1 (1.1–4.3), P = 0.035], invasive mechanical ventilation [OR (95% CI) = 2.4 (1.2–4.5), P = 0.009], colistin/polymyxin B use [OR (95% CI) = 3.2 (1.8–5.7), P < 0.001] and fluoroquinolone use [OR (95% CI) = 2.3 (1.1–4.8), P = 0.024] in the preceding month prior to P. aeruginosa isolation were significantly associated with ceftolozane/tazobactam resistance. The AUC (95% CI) of the score was 0.734 (0.675–0.794), with a sensitivity of 69%, specificity of 71.8%, positive predictive value of 35.5% and negative predictive value of 91.1% at the cut-off point of 2, out of a range of 0–5. Conclusions: In respiratory tract infections caused by P. aeruginosa, use of the proposed scoring system may reduce inappropriate use of ceftolozane/tazobactam in empirical treatment.

Objective: This study aims to assess the impact of hospital-specific guidelines on the optimal utilization of carbapenems and to examine their effects on patient outcomes. Design: Quasi-experimental study. Setting: Tertiary care hospital in Turkey where infectious diseases (IDs) consultation and antibiotic approval are mandatory for carbapenem use. Participants: All inpatients ≥18 years of age who received a carbapenem for at least 24 hours during the study periods were enrolled. Intervention: Hospital-specific treatment guidelines were introduced in April 2019. The control group was the year 2018, when there were no guidelines (pre-GP). The year 2020 was analyzed as the intervention period (post-GP). Results: A total of 678 patients were analyzed, 326 in the pre-GP period and 352 in the post-GP period. Following guideline implementation, there was a significant increase in appropriate carbapenem use (49.1% in pre-GP vs 71.9% in post-GP, P < .001). The duration of carbapenem use decreased significantly (P = .019). However, there was no significant change in the incidence of new infection episodes within the subsequent 30 days (27.6% in pre-GP vs 28.3% in post-GP), or in the length of hospitalization [median (25%–75%) = 28 (16–46) in pre-GP, 28 (15–47.5) in post-GP, P = .678]. Mortality rates were similar at day 7 post-GP (1.7%) compared to pre-GP (0.03%) (P = .125). Conclusions: The implementation of guidelines increased the appropriate utilization of carbapenems, without resulting in extended hospital stays or recurrent episodes. Despite an increased number of patients admitted to the ICU during the latter period, infection-related mortality rates remained comparable.

Objectives: Prevention and control of healthcare-associated infections are important for patients and personal safety and for fighting against antimicrobial resistance. In order to achieve the goal of zero infection, it is necessary to know and apply standard and transmission-based precautions. The aim of this study was to evaluate the knowledge of healthcare professionals working in the Adult Emergency Department of university hospital about isolation precautions. Methods: A cross-sectional study was conducted in the Emergency Department of Hacettepe University Hospital between May 16, 2023 to June 23, 2023. Data were collected electronically with a standardized data collection form specially prepared for this study to examine the knowledge about isolation precautions. Each correct answer was calculated as one point. Participants could receive a score between a minimum of 0 and a maximum of 20. Results: The 90 healthcare workers who agreed to participate in the study had a median age of 24 years and 40% were male. The median knowledge score was 13 (IQR = 4). The knowledge score of two pregnant healthcare workers was significantly higher than non-pregnant ones (p=0.04). 93.3% of the participants stated that they received education for isolation precautions. There was no significant difference in knowledge scores between those who received education and those who did not (p=0.02). Knowledge of isolation precautions to be followed in clinical scenarios (1.1% - 54.4%) and personal protective equipment to be used correctly (3.3% - 21.1%) was low. Conclusion: The knowledge of healthcare professionals working in the Adult Emergency Department of university hospital about isolation precautions is at a moderate level. Periodical education programs on clinical scenarios is important regarding raising awareness.

Timely selection of appropriate empirical treatment for carbapenem-resistant Enterobacterales (CRE) bacteremia remains challenging, especially when prior antibiotic exposure data is unavailable. We found that intensive care unit stay duration predicts CRE bacteremia—with ≥8 days showing 81% sensitivity and 96% PPV—providing a practical clue for empirical therapy decisions.