Objectives:Ventilator-associated pneumonia (VAP) is a significant cause of hospital-related infections, one that must be prevented due to its high morbidity and mortality. The purpose of this study was to evaluate the incidence and risk factors in patients developing VAP in our intensive care units (ICUs).Methods:This retrospective cohort study involved in mechanically ventilated patients hospitalized for more than 48 hours. VAP diagnosed patients were divided into two groups, those developing pneumonia (VAP(+)) and those not (VAP(-)).\Results:We researched 1560 patients in adult ICUs, 1152 (73.8%) of whom were mechanically ventilated. The MV use rate was 52%. VAP developed in 15.4% of patients. The VAP rate was calculated as 15.7/1000 ventilator days. Mean length of stay in the ICU for VAP(+) and VAP(-) patients were (26.7±16.3 and 18.1±12.7 days (p<0.001)) and mean length of MV use was (23.5±10.3 and 12.6±7.4 days (p<0.001)). High APACHE II and Charlson co-morbidity index scores, extended length of hospitalization and MV time, previous history of hospitalization and antibiotherapy, reintubation, enteral nutrition, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus and organ failure were determined as significant risk factors for VAP. The mortality rate in the VAP(+) was 65.2%, with 23.6% being attributed to VAP.Conclusion:VAPs are prominent nosocomial infections that can cause considerable morbidity and mortality in ICUs. Patient care procedures for the early diagnosis of patients with a high risk of VAP and for the reduction of risk factors must be implemented by providing training concerning risk factors related to VAP for ICU personnel, and preventable risk factors must be reduced to a minimum.

Objectives: To determine the clinical and laboratory predictors of fatality among patients with Hantavirus infection. Materials and methods: A retrospective study was conducted on the patients with Hantavirus infection between April 2009and October 2011 at the Black Sea and the Mediterranean regions in Turkey. Demographic, clinical and laboratory findings of fatal cases and non-fatal cases at the admission were compared. Results:Twenty-two patients with confirmed Hantavirus infection were evaluated. Five patients died (22.7%). The cause of death was massive bleeding. The rate of hemorrhage was significantly higher in the fatal cases than non-fatal cases (p<0.001). Massive gastrointestinal hemorrhage was seen in four of these patients, cerebral hemorrhage in two and both gastrointestinal and pulmonary hemorrhage in one. Disseminated intravascular coagulation (DIC) was present in four of the fatal cases and a remarkable cause of the bleeding (p=0.02). White blood cell count (WBC) (p=0.002), creatine phosphokinase (CPK) (p=0.011), blood-urea-nitrogen (BUN) (p=0.014), C reactive protein (CRP) (p=0.005) and D-dimer levels (p=0.001), prothrombin time (PT) (p=0.023), activated partial thromboplastin time (aPTT) (p=0.001) and international normalized ratio (INR) (p=0.021) were significantly higher, and platelet counts (p=0.038) significantly lower in the fatal cases. Optimum diagnostic cut-off points for specific laboratory parameters which may be predictive of fatality were; WBC=16,000 µL-1, PLT=30000 µL-1, PT=19.7 s, aPTT=36 s, INR=1.2, D-dimer=9.3 µg/mL, CPK=600 U/L, BUN=47 mg/dL and CRP=13.4 mg/dL. Conclusions U Kostakoğlu et al. Predictors of fatality in patients with Hantavirus infection 156 J Microbiol Infect Dis

Background Crimean–Congo hemorrhagic fever (CCHF) is a potentially fatal disease caused by a tick-borne virus from the Bunyaviridae family. Cytokines plays an important role in the pathogenesis of viral, bacterial, and immunologic diseases. This study aimed to investigate the role of TNF-alpha, IL-6, IL-10, and IFN-gamma levels in the severity of infection and clinical outcome of patients with CCHF. Methods Patients with confirmed CCHF were divided into two groups (severe cases: Patients who exhibited hemorrhage during their hospital stay, and mild/moderate cases: Patients who displayed no hemorrhage during their hospital stay). Demographic characteristics, laboratory tests on admission of all patients with CCHF were investigated, and serum TNF-alpha, IL-6, IL-10, and IFN-gamma levels were measured. Results A total of 154 patients with confirmed CCHF were investigated. Forty-six (29.9%) of these patients were in the severe group. In patients with severe CCHF, significantly higher serum levels of TNF-alpha (68.2 ± 23.5; P = 0.008) and IL-6 (73.1 ± 41.6; P = 0.003) were detected, compared with cytokine levels in patients who mild/moderate CCHF (Table 1). No differences in serum IL-10 and IFN-gamma levels between patients who severe CCHF and those who mild/moderate CCHF were detected (P &gt; 0.05). Conclusion Cytokines, chemokines, and other inflammatory mediators function in a manner, acting on many different cell types to regulate the host’s immune response. When cytokines present in high concentrations, they might toxic or even lethal effects. In accordance with this view, we have detected increased serum TNF-alpha, IL-6 levels in the patients with severe CCHF. Disclosures All authors: No reported disclosures.

Abstract:Aim -The present study aimed to detect mecA and staphylococcal cassette chromosome mec (SCCmec) types in methicillinresistant Staphylococcus aureus (MRSA) isolates obtained from various clinical samples in two university hospitals. It was also aimed to make comparison amongst the isolates. Materials and Methods -A total of 99 MRSA strains isolated from various clinical samples between 2011-2015 were included in the study. Bacterial deoxyribonucleic acid (DNA) was extracted from Staphylococcus aureus strains using GF-1 DNA extraction Kit (Vivantis, Malaysia). mecA gene were detected, and SCCmec cassette types were determined by multiplex polymerase chain reaction (PCR) first, and following specific PCR. Specific MRSA strains such as COL type I, PER3 type Ia, and HU25 type IIIa were used as the quality control strains for optimization of multiplex PCR. The amplification products were electrophoresed using agarose gel electrophoresis in TAE buffer (mixture of tris base, acetic acid and ethylenediaminetetraacetic acid). Results -mecA gene was detected in 60 Staphylococcus aureus isolates, and these were identificated as MRSA. Amongst the MRSA strains, SCCmec type III was the most frequent cassette type (42 isolates, 70.0%). SCCmec type I was detected in 27 isolates (45.0%), type II was in 26 isolates (43.3%), and type V in 23 isolates (38.3%). Conclusion -In the present study, the most frequent cassette was detected as SCCmec type III in concordance with the studies conducted in Turkey and in some regions in the world. In conclusion, determination of epidemiological and molecular characteristics of MRSA strains has critical importance because of the difficulties in the treatment and of the nosocomial infections and epidemics they caused. The data obtained would contribute to the preventions in terms of epidemiology.

No abstract