Aim Influenza vaccination is the most effective method in prevention of influenza disease and its complications. Our study aimed to investigate the rates of vaccination and the behaviors and attitudes against the vaccine in healthcare workers in Turkey. Methods This multicenter national survey is a descriptive study in which 12475 healthcare workers. Healthcare workers were asked to answer the questionnaire consisting of 12 questions via the survey. Results It was found that 6.7% of the healthcare workers regularly got vaccinated each year and that 55% had never had the influenza vaccine before. The biggest obstacle against getting vaccinated was determined as not believing in the necessity of the vaccine (53.1%). Conclusion The rates of influenza vaccination in healthcare workers in Turkey are quite low. False knowledge and attitudes on the vaccine and disease are seen as the most important reasons to decline vaccination. It is important to detect reasons for anti‐vaccination and set a course in order to increase the rates of vaccination.

Background/Aims: Tumor necrosis factor-α (TNF-α) inhibitors and ustekunimab are widely used in autoimmune diseases. It is known that these biological agents cause the reactivation of hepatitis B virus (HBV). There is no standardized strategy to prevent the reactivation in patients with evidence of a previous HBV infection. In our study, anti-HBc IgG-positive patients who received a biological agent were evaluated in terms of HBV reactivation. Materials and Methods: Patients who were followed up for the use of biological agents in our clinic were evaluated retrospectively. Patients with isolated anti-HBc IgG positivity were included in the study. The HBV reactivation data were recorded from the patients’ files retrospectively. Results: Two hundred and seventy-eight patients who received biological treatment were evaluated. Twenty-nine patients with isolated anti-HBc IgG positivity or resolved HBV infection were included in the study. The HBV reactivation was seen in 5 patients (17.2%). Of these patients, 3 were using adalimumab, 1 infliximab, and 1 ustekunimab. It was controlled by antiviral therapy that was started in the early period. Conclusion: Drugs that block TNF-α and ustekunimab cause an increase in viral replication. In literature, the HBV reactivation rate was approximately 1% in HBsAg-negative, anti-HBC IgG-positive cases, whereas it was found to be as high as 17.2% in our study. Patients receiving the immunomodulator therapy should be evaluated for HBV serology before treatment and carefully monitored for HBV reactivation during and after treatment. Cite this article as: Solay AH, Acar A, Eser F, et al. Reactivation rates in patients using biological agents, with resolved HBV infection or isolated anti-HBc IgG positivity. Turk J Gastroenterol 2018; 29: 561-5.

Broad-spectrum empirical antimicrobials are frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. The study was a national, multicenter, retrospective, and single-day point prevalence study. This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age ± standard deviation of the patients was 65.0 ± 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (37.2%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005), presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein > 10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p < 0.001) were found to be independent factors associated with increased antibiotic use. The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.

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.

AIM: To measure cytokine and lactate levels in the cerebrospinal fluid (CSF) of patients with suspected post-neurosurgical meningitis. MATERIAL and METHODS: Interleukin (IL)-8,-12, and -13, interferon (IFN) gamma, and lactate concentrations were determined in the CSF of patients diagnosed with meningitis, who were undergoing follow-up after neurosurgical procedures at the Neurosurgery Clinic between May 2016 and November 2017. The demographic, clinical, biochemical, CSF cell count, CSF biochemistry, and CSF culture results of 119 patients were recorded. RESULTS: The study group consisted of 39 patients diagnosed with post-neurosurgical meningitis. The control group comprised of 80 patients without pleocytosis, who had undergone lumbar puncture due to various indications. In the study group, 59% of the patients had fever, 66.7% had deterioration in the level of consciousness, and 35.9% had neck stiffness. The levels of IL-8 (96.5 ng/L vs. 86.6 ng/L, p<0.001), IL-12 (10.1 ng/L vs. 3 ng/L, p<0.001), and lactate (5.9 mmol/L vs. 2.1 mmol/L, p<0.001) were higher in the CSF of the patient group compared to the control group. However, IL-13 (32.7 ng/L vs. 42.5 ng/L, p=0.003) and IFN gamma (73.3 ng/L vs. 260.4 ng/L, p<0.001) levels were lower in patients compared to controls. The mortality rate in post-neurosurgical meningitis patients was estimated to be 35.9%. CONCLUSION: Post-neurosurgical meningitis prolongs the duration of hospital stay and causes long-term sequelae. Therefore, measurement of CSF cytokine and lactate levels alongside meningitis diagnostic processes may facilitate early and accurate diagnosis. Measuring CSF lactate is inexpensive and cost effective, particularly in post-neurosurgical patients.

Objective: This study aimed to investigate the knowledge, attitude and behaviors of people about human papillomavirus (HPV) infection and HPV vaccine. Material and Method: In this cross-sectional study, a detailed questionnaire was completed by participants who were admitted to the outpatient clinics of a secondary care hospital between June 2019 and December 2019 and the knowledge, attitude and behaviors of these participants about HPV infection and HPV vaccine were assessed. Results: A total of 836 participants who were admitted to different outpatient clinics of a secondary care hospital between June 2019 and December 2019 were included in the study. Mean age of the participants was 36.29±9.03 and 86.36% of them were female. While 44.26% of the participants were university graduates 44.98% had a master’s degree. Of the participants, 73.09% (n=611) stated that they had never had gynecological exam. While 73.32% (n=613) of the participants answered the question how HPV is transmitted as “yes, it is sexually transmitted” 67.58% (n=565) knew the relationship between HPV and cervical cancer. Of the participants, 71.05% (n=594) knew that cervical cancer was a disease that could be prevented with HPV vaccine. While 56.57% (n=336) stated that they heard HPV vaccine from their physicians 8.85% knew that HPV vaccine was not in the vaccination program of the Ministry of Health. Of the participants, 43.66% (n=365) stated that they had no intention of having HPV vaccine for themselves, their wife/husband or their children. While 11.48% (n=96) of the patients stated that they would not have the vaccine even if it was covered free of charge by the government 31.57% (n=264) stated that they would have the vaccine if it was provided free of charge by the state. Conclusion: People have insufficient knowledge on that cervical cancer is a disease that can be prevented by HPV vaccine, how HPV virus is transmitted and which measures must be taken. Main reason is that the vaccine is not included in the routine vaccination schedule in our country, that healthcare workers do not sufficiently inform patients about HPV vaccine and infection and that the vaccine is expensive in conditions of our country. Underlying reasons why institutions or workers who provide healthcare insufficiently inform people about HPV vaccine can be questioned in detail.