There are limited data on the long-term outcomes of COVID-19 from different parts of the world. To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Retrospective, observational cohort. Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO₂/FiO₂ ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Galactomannan (GM) assay is commonly used as an early diagnostic tool for invasive fungal infection (IFI) in high-risk hematology patients. False positivity is frequently observed in GM with the use of piperacillin/tazobactam. The usage of generic drugs over the original brand has a significant cost advantage. The aim of this study was to assess the performance of GM test among patients receiving original and generic piperacillin/tazobactam formulations. The study included 85 adult patients; 62.4% were male with hematological malignancy currently receiving piperacillin/tazobactam. The study group was divided into two groups: patients receiving original and generic piperacillin/tazobactam. Serum GM index was positive in one of 35 patients receiving original piperacillin/tazobactam, whereas it was positive in 46 out of 50 patients receiving generic piperacillin/tazobactam (P < .001). However, the patients receiving generic piperacillin/tazobactam underwent computed tomography (CT) scans more frequently than those receiving original piperacillin/tazobactam (P = .047). In addition, in vitro analysis of GM was performed in two generics and one original piperacillin/tazobactam vials. One generic piperacillin/tazobactam vial included high GM level. False positivity of serum GM with generic formulations of piperacillin/tazobactam is still an ongoing issue in hematology patients. A high rate of serum GM index false positivity may unexpectedly lead to a higher rate of CT scan. Selected piperacillin/tazobactam vials in each batch should be checked for GM to identify a false positivity of GM before purchase.

Candida auris is an emerging fungal pathogen that has become a critical global health concern due to its high antifungal resistance and potential to cause nosocomial outbreaks. Since its initial identification in Japan in 2009, C. auris has spread rapidly, posing significant treatment challenges across various healthcare settings worldwide. The biofilm formation ability of C. auris enhances its resilience against disinfectants and antifungal agents, complicating infection control in healthcare environments. This consensus report, developed with the collaboration of several Turkish medical specialty societies, including the Turkish Society of Infectious Diseases and Clinical Microbiology Specialty (EKMUD), the Turkish Society of Anesthesiology and Reanimation (TARD), the Turkish Intensive Care Society (TYBD), the Infectious Diseases – International Research Initiative (ID-IRI), the Clinical Microbiology Specialist Society (KLIMUD), the Turkish Microbiology Society (TMC), and the Public Health Institution of Türkiye (PHIT) under the Ministry of Health, provides a comprehensive overview of C. auris and its’ management. The report focuses on the epidemiology, antifungal resistance mechanisms, recommendations for diagnostic and therapeutic challenges, infection control and prevention measures and surveillance of C. auris. This consensus report aims to establish standardized diagnostic protocols, improve national surveillance systems, and promote effective infection control measures to mitigate C. auris related health risks in Türkiye. It also offers comprehensive national recommendations and addresses the need for inter-institutional collaboration, improve public health, and strengthen the healthcare response to this pathogens.

Eryilmaz-Eren E, et al. Infect Chemother. 2022 Jul;54:e59. https://doi.org/10.3947/ic.2022.0005

To evaluate risk factors affecting the prognosis of sepsis in elderly patients. The study was conducted retrospectively in a secondary healthcare institution between 2016 and 2023. Elderly patients (> 65 years) admitted with sepsis were included. Demographic data, laboratory parameters on the day of diagnosis, sepsis origin, causative microorganisms, and mortality on the 28th day were recorded. A total of 179 elderly patients were included. The median age was 82 and 44% were male. The mortality rate was 49% on the 28th day. Hypertension was more common in the non-survived patients. Blood urea nitrogen (OR 1.03 (1.00-1.05) p = 0.007), and albumin (OR 0.26 (0.10–0.62) p = 0.003), levels were a predictor of mortality at the time of the admission. In the non-survived patients, Systemic inflammatory response syndrome (SIRS) and quick sepsis-related organ failure assessment scores were higher at the time of sepsis diagnosis (p < 0.001). The rate of septic shock (79.5% vs. 33%), intensive care unit (99% vs. 90%), mechanical ventilation (87.5% vs. 55%), and vasopressor needs (55% vs. 27.5%) were significantly higher in the non-survived patients. The rate of bacteremia was found to be higher in the non-survived patient group (26%) than in the survivors (13.2%). The rate of Gram-negative microorganisms was significantly higher in the non-survived patient group than in the survivors (63% vs. 27%; p < 0.001). The most frequently isolated bacteria were Klebsiella pneumoniae (33%) in blood culture; it was Escherichia coli (35%) in urine cultures and Acinetobacter baumanii (40%) in sputum cultures. On the 3-5th day of treatment, the clinical response rate was lower in the non-survived patient group (29%) than in the surviving’s (53%) (p = 0.001). The most important determinants for the mortality were hypertension (OR 2.39 (1.25–4.95) p = 0.019), SIRS score (OR 1.86 (1.32–2.61) p < 0.001) and Gram-negative bacteria sepsis (OR 2.53 (1.22–5.22), p = 0.012). The number and the proportion of the elderly population is increasing worldwide, and sepsis is one of the most common causes of death in elderly patients. Knowing the poor prognostic factors is important for early treatment and to reduce mortality.