Background: The COVID-19 pandemic has introduced major disruptions in clinical practices, including infection management strategies and antibiotic prescribing habits. This study aimed to investigate changes in the distribution of respiratory pathogens and their antimicrobial resistance (AMR) patterns in intensive care units (ICUs) before and after the onset of COVID-19 pandemic. Methods: In this retrospective cross-sectional study, 1,662 respiratory tract samples (bronchoalveolar lavage, deep tracheal aspirate, and sputum) collected from ICU patients at a tertiary hospital in Turkey between January 1, 2016 and December 31, 2024 were analyzed. The study compared bacterial isolates and resistance profiles between the pre-pandemic (January 2016–Feb 2020) and post-pandemic (Mar 2020–December 2024) periods. Results: Acinetobacter baumannii and Klebsiella pneumoniae remained the most frequently isolated pathogens throughout the study. Post-pandemic, resistance rates increased significantly for several antibiotics, particularly against Acinetobacter baumannii (gentamicin: 70.9% to 91.3%, p < 0.001; colistin: 3.2% to 12.3%, p < 0.001) and Klebsiella pneumoniae (carbapenems: p < 0.001; colistin: 23% to 62.7%, p < 0.001). For Pseudomonas aeruginosa , meropenem, piperacillin-tazobactam, and ceftazidime resistance rates increased significantly after the post-pandemic period (33.9% to 52.0%, p = 0.003; 50.4% to 65.1%, p = 0.011; 27.9% to 56.4%, p < 0.001, respectively). The changes in resistance rates of Escherichia coli were not statistically significant and also showed a reduced isolation rate post-pandemic (11.4% to 7.0%, p < 0.05). Among Gram-positive isolates, only Enterococcus faecium showed a significant increase in vancomycin resistance (50.0% vs. 0%, p = 0.046). In contrast, no significant findings were observed for methicillin resistance in Staphylococcus aureus (MRSA) and vancomycin resistance in Enterococcus faecalis (31.3% vs. 28.0%, p = 0.823; and 25% vs. 0%, p = 0.285, respectively). Mortality also increased significantly during the post-pandemic period (70.5% to 74.9%, p = 0.048), alongside a higher prevalence of comorbidities such as hypertension and coronary artery disease. Conclusions: The findings highlight a marked escalation in AMR following the COVID-19 pandemic, likely driven by increased empirical antibiotic use, prolonged ICU stays, expanded use of invasive procedures, and broader steroid administration. This study underscores the deepening AMR crisis in ICUs and provides critical data from Turkey that may support global antimicrobial stewardship efforts.

Introduction: Long-term outcomes of smoking cessation treatments are crucial to optimize standards of cessation services, which are known to prevent excess morbidity and mortality. This study aimed to evaluate long-term outcomes of a smoking cessation program, to compare the success rates of...

OBJECTIVES: Patients being treated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents were reported to have better prognosis related to COVID-19. We evaluated the factors affecting the frequency, clinical course, and outcome of COVID-19 in patients treated with anti-TNF-alpha agents. METHODS: Patients with rheumatoid diseases and chronic inflammatory bowel diseases treated with anti-TNF-alpha agents were evaluated retrospectively. The laboratory data in routine visits, frequency of COVID-19, pneumonia, hospitalization and/or intensive care unit (ICU) follow-up and, mortality were recorded. The factors related to COVID-19 frequency and clinical outcome were evaluated. RESULTS: A total of 324 patients (177 males [54.6%] and 147 females [45.4%], mean age: 45.3 +/- 12.16 years) was included in the study. In all, 44 (13.6%) patients had COVID-19; of these, 11 (25%) developed pneumonia, 7 (15.9%) were hospitalized, and 1 (2.3%) was followed up in ICU. There was no mortality. The patients with COVID-19 pneumonia were older (mean age: 52 +/- 11 years versus 41 +/- 12 years, p=0.01), had hypertension and coronary artery disease more frequently (5 cases [55.6%] versus 4 cases [44.4], p=0.02 and 2 cases [100%] versus 0 cases [0%], p=0.014, respectively), and lower eosinophil % (1.35 +/- 1.79% versus 2.3 +/- 1.45%, p=0.016). The diabetes mellitus was more frequent (66.7 versus 33.3%, p=0.013), and mean eosinophil % was lower among inpatients compared with outpatients (1.29 +/- 2.22% versus 2.19 +/- 1.37%, p=0.02). CONCLUSIONS: We concluded that the patients treated with anti-TNF-alpha agents having COVID-19 might have mild clinical course and better prognosis.

To compare the effects of high- and low-intensity Inspiratory Muscle Training (IMT) combined with standard pulmonary rehabilitation on respiratory muscle function, exercise capacity,dyspnea and quality of life in asthmatic patients. Forty asthmatic patients were randomized into high-intensity IMT (H-IMT,n = 20) and low-intensity IMT (L-IMT,n = 20) groups.The H-IMT group trained at 80% of maximal inspiratory pressure and the L-IMT group at 30%, with 5% weekly load increases.Both groups followed an 8-week exercise program including breathing, strengthening and walking exercises.Respiratory functions, pulmonary function test, respiratory muscle strength, maximum inspiratory and expiratory pressure measurement, peripheral muscle strength, 6-minute walk test (6MWT), modified Medical Research Council (mMRC) dyspnea and Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), Saint George Respiratory Quality of Life Questionnaire (SGRQ) and International Physical Activity Questionnaire (IPAQ) scores were assessed pre- and post-intervention. Baseline characteristics were similar.Both groups improved in most outcomes except spirometric values.The L-IMT group showed significant gains in IPAQ-SF walking (p = .03) and total scores (p = .02).6MWT distance, mMRC and ACT scores improved significantly more in the H-IMT group compared to the L-IMT group.There was no statistically significant difference between the groups (p > 0.05).Similarly, when the groups were compared, AQLQ-Environmental, AQLQ-Total, SGRQ-Impact, SGRQ-Total scores showed more improvement in the H-IMT group. Both IMT intensities improved respiratory function, exercise capacity, and quality of life. High-intensity IMT was more effective for asthma control, while low-intensity IMT enhanced physical activity. Tailoring IMT intensity may optimize outcomes for asthmatic patients.

OBJECTIVE: The aim of this studywas to ascertain the long-term respiratory effects of COVID-19 pneumonia through pulmonary function tests in follow-ups at 1 and 6 months. METHODS: Our studywas conducted between August 1, 2020 and April 30, 2021. At 1 month after discharge, follow-up evaluations, PFTs, and lung imaging were performed on patients aged above 18 years who had been diagnosed with COVID-19 pneumonia. In the 6th month, the PFTs were repeated for those with pulmonary dysfunction. RESULTS: A total of 219 patients (mean age, 49 +/- 11.9 years) were included. Pathological PFT results were noted in the 1st month for 80 patients and in the 6th month for 46 (7 had obstructive disorder, 15 had restrictive disorder, and 28 had small airwayobstruction) patients.A significant difference was found between abnormal PFT results and patient-described dyspnea in the 1st month of follow-up. The 6-month PFT values (especially those for forced vital capacity) were statistically significantly lower in the patients for whom imaging did not indicate complete radiological improvement at the 1-month follow-up. No statistically significant difference was found between the severity of the first computed tomography findings or clinical condition on emergency admission and pulmonary dysfunction (Pearson's chi-square test, P=0.904; Fisher's exact test, P=0.727). CONCLUSION: It is important that patients with COVID-19 pneumonia be followed up for at least 1 month after discharge to be monitored for potential long-term lung damage. PFTs should be administered to those in whom ongoing dyspnea,which started with COVID-19, and/or full recovery were not identified in pulmonary imaging.

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.