Aim: This study aims to analyze the incidence of multidrug-resistant (MDR) retrospectively and extensively drug-resistant (XDR) infections, characteristics of patients with these infections, causative microorganisms, and mortality rates in a tertiary respiratory intensive care unit (ICU). Material and Method: Between 01.01.2022 and 31.12.2023, the data of patients treated in the third-level respiratory ICU were analyzed retrospectively. Adult patients over 18 years of age with MDR and XDR infections were included in the study. Demographic characteristics, age, gender, comorbid systemic diseases, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation support status, duration of ICU stay and prognosis of the patients were analyzed and recorded through the hospital information management system. Results: The study included 261 patients. Of these patients, 184 (70.5%) were male, 77 (29.5%) were female, and their ages were 65.54 ± 14.43 years. The majority of the patients had chronic diseases such as chronic obstructive pulmonary disease, hypertension, coronary artery disease, malignancy, and diabetes mellitus. There was no statistically significant difference between the resistance status of Klebsiella spp. Pseudomonas spp. and Acinetobacter spp. and the prognosis of the patients (p> 0.05). No statistically significant difference was found between MDR and XDR Klebsiella spp. Pseudomonas spp. and Acinetobacter spp. patients in terms of the need for invasive mechanical ventilation, non-invasive mechanical ventilation, respiratory support therapy with high flow, APACHE II score, SOFA score, length of stay in the ICU, and prognosis (p> 0.05). Conclusion: Early detection and close monitoring of MDR, XDR, and PDR bacterial strains are vital to combat antimicrobial resistance. This study shows that MDR and XDR infections are a major health problem in ICUs and that these infections have significant negative effects on patient prognosis.

Risk factors and the impact of vaccination on mortality in COVID-19 patients

Introduction: Stenotrophomonas maltophilia is the only opportunistic human pathogen in the genus Stenotrophomonas. These bacteria can be isolated from healthcare settings, possibly resulting in bacterial colonization of medical devices, which cause nosocomial infections. S. maltophilia bacteremia results in high mortality and morbidity. This study aimed to determine the outcomes of S. maltophilia bacteremia and its associated mortality risk factors. Methodology: This was a retrospective study conducted at the University of Medical Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital (Istanbul, Turkey) from December 2015 to December 2022. Medical records, demographic information, clinical conditions, laboratory data, antimicrobial susceptibility, and clinical outcomes were retrospectively analyzed for the period between December 2015 and December 2022. Results: Data from 87 patients (median age 61 years) with bacteremia were included in this study. The most common underlying conditions were diabetes mellitus (DM; 32.2%), hypertension (29.9%), and malignancies (19.5%). The most common sources of bacteremia were central venous catheters (CVCs; 44%), primary blood infection (32%), respiratory tract infection (20.7%), and wound site/abscess infection (2.3%). Seventy-eight percent of the patients were admitted to the intensive care unit (ICU) when bacteremia was detected. The 28-day mortality rate was 55%. The mortality rate was significantly higher in the ICU (p < 0.001). Elevated values of procalcitonin and C-reactive protein, and the presence of CVC were significant risk factors for mortality in those with S. maltophilia bacteremia. Conclusions: S. maltophilia bacteremia should be carefully monitored in patients with CVCs. Timely removal of CVCs can result in decreased mortality.

Background: Infective endocarditis (IE) is a serious and potentially life-threatening infection with high morbidity and mortality. Early risk identification is critical for enabling timely treatment and preventing adverse outcomes. Recently, several low-cost and accessible inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII), have gained attention for their potential prognostic value in infectious diseases. Methods: This retrospective study evaluated patients diagnosed with definite IE between May 2014 and May 2024 at Bakırköy Dr. Sadi Konuk Training and Research Hospital. Clinical characteristics, laboratory parameters, complications, and outcomes were compared between survivors and non-survivors. The predictive value of NLR, PNI, and SII for in-hospital mortality was assessed. Results: A total of 78 patients with IE were included, with an overall mortality rate of 52.5%. Non-survivors were significantly older (p = 0.001) and had higher rates of cardiac complications (p < 0.05). PNI values were significantly lower in non-survivors (p = 0.014). Undergoing cardiac surgery was associated with a lower mortality rate (p = 0.024). Conclusion: PNI, a simple, inexpensive, and readily available marker, may provide valuable prognostic information in patients with infective endocarditis. This index could help in early risk stratification and clinical decision.

Zika virus is a Flavivirus in the family Flaviviridae, and transmitted to humans by Aedes species mosquitoes. Zika virus infection is asymptomatic in 80% of cases and has a mild course when symptoms occur. These symptoms include headache, myalgia, mild fever, maculopapular rash and conjunctivitis. Zika virus has been associated with serious neurological complications such as Guillain-Barre syndrome in adults and microcephaly development in neonates. It has recently become a global public health problem as a result of increasing cases. As it is known that the vector of this disease is present in our country; entry of Zika virus infection in our country has a great importance. In this report the clinical and laboratory findings of two cases of Zika virus infection imported to Turkey by a couple returning from Cuba in October 2017 were presented. Newly married couple, both 29 years old, without a known chronic disease history, went on honeymoon to Cuba between 17-29 September and they visited Havana and Varadero. They reported that they were bitten repeatedly by the mosquitoes and did not use insect repellents during this time. Four days after returning to Turkey, they had headaches, back pain and myalgia followed by rash and joint pain. They reported having their symptoms started in the same day in a few hours difference. The symptoms for both patients disappeared in 10 days. Serum samples from the patients were sent to the Public Health General Directorate National Arboviruses and Viral Zoonoses Laboratory to be tested for Dengue, Chikungunya and Zika viruses. Nucleic acid testing yielded negative results. The Arbovirus Indirect Immunofluorescence test were positive both for IgM and IgG for Zika virus. No cross reactivity with Dengue virus was detected. Chikungunya antibodies were found as negative. At two months of the diagnosis, urine and semen samples of the male patient were tested by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). The result was negative for urine but positive for semen sample. This report is important to present the first cases of Zika virus infection published in Turkey. Zika virus infection should be suspected in patients with fever, headache, rash, myalgia and joint pain returning from an endemic areas. All travelers, especially pregnant women, have to take precautions for mosquitos during the trip.