Multicentre studies from countries such as Spain, Australia, Japan, China, and Taiwan have revealed significant geographic variation in Nocardia species patterns, resistance profiles, and patient outcomes. In Türkiye, however, most available data originate from single-centre reports with limited species-level identification and antimicrobial resistance profiling, highlighting a significant gap in the current understanding of nocardiosis at the national level. Our aim was to evaluate the clinical and microbiological characteristics of Nocardia infections in Türkiye. In this multicentre, retrospective observational cohort study, adult patients (≥ 18 years) diagnosed with microbiologically confirmed nocardiosis between January 1, 2014, and December 31, 2024 from 18 tertiary care hospitals in Türkiye were examined. 109 microbiologically confirmed nocardiosis cases were identified, with a mean age of 55.9 years (median 59, range 18–80) and a predominance of male patients (66.1

Neurobrucellosis is a rare but clinically significant complication, accounting for approximately 3–5

We report the case of a woman with diabetes mellitus who developed a skin and soft tissue infection of the left thumb following trauma caused by a cactus thorn. Despite initial antibiotic therapy, no clinical improvement was observed. Broad-spectrum antimicrobial therapy was subsequently initiated, and wound cultures were obtained. Candida tropicalis was identified as the causative pathogen. Targeted antifungal therapy led to clinical improvement. The patient required repeated surgical debridement, and a skin graft was applied during the healing process. The patient ultimately recovered without recurrence.

Diabetic hand infections are uncommon but potentially severe complications of diabetes mellitus. Because of the complex anatomy and functional importance of the hand, these infections may progress rapidly and result in serious morbidity, including osteomyelitis and amputation. Clinical data on this condition remain limited. This case series included patients hospitalized with diabetic hand infection at a tertiary care center between 2020 and 2026. Patients, ≥ 18 year-old, with confirmed diabetes mellitus and clinical, microbiological, and/or radiological evidence of hand infection were included. Demographic data, comorbidities, HbA1c levels, laboratory findings, microbiological results, imaging findings, and treatment outcomes were reviewed from medical records. Seven patients were included. Osteomyelitis was identified in 57

Background/Aims:Despite the widespread use of direct-acting antivirals (DAAs), real-world data on treatment outcomes and predictors of response in hepatitis C virus (HCV) genotypes 2 and 3 remain limited, particularly in countries with heterogeneous patient populations such as Türkiye. This study evaluates the efficacy and safety of direct-acting antivirals (DAAs) in treating hepatitis C virus (HCV) genotype 2 (GT-2) and genotype 3 (GT-3) in Türkiye. Materials and Methods:This cohort is a multicenter, retrospective, and observational study. Data from 267 GT-2 or GT-3 patients treated with a DAA were analyzed. Treatment efficacy was assessed by sustained virological response at 12 weeks after the end of treatment (SVR), and baseline demographic, clinical, and laboratory parameters were evaluated to identify factors associated with treatment response. Results:An overall sustained virological response (SVR) rate of 95.9%, with no significant difference between GTs. The SVR rates were relatively lower in patients with cirrhosis. Prior pegylated interferon and ribavirin reduced SVR rates, particularly in males and patients with cirrhosis. The most common treatments were sofosbuvir-based regimens, which demonstrated comparable efficacy. No significant drug interactions were observed. The most commonly reported adverse events were fatigue and mild anemia, particularly in cirrhotic patients; however, these did not lead to treatment discontinuation. Conclusion:This study supports the efficacy and tolerability of DAA regimens for these HCV GTs, thereby reinforcing their role in HCV eradication.

OBJECTIVE:Due to underrepresentation of carbapenemase-producing Enterobacterales infections in randomized controlled trials with ceftazidime-avibactam (CZA) and high cost of CZA therapy, other appropriate antimicrobial therapies (OAAT) are still being used for OXA-48- or KPC-producing Enterobacterales infections in Türkiye. METHODS:We conducted a multicentre retrospective 1:1 matched cohort study of patients who received ≥48 h of CZA or OAAT for documented OXA-48- or KPC-producing Enterobacterales infections. Patients were matched based on (1) the number of days (± 1 d) from the infection onset to the initiation of therapy, (2) INCREMENT-CPE score (± 1), (3) source of infection, (4) year of infectious episode, and (5) type of causative microorganism. RESULTS:From 5 Turkish university hospitals, 180 patients were enrolled. Baseline characteristics were all similar between treatment groups. At the time of treatment initiation, 63.9% of patients were in the intensive care unit, 35.6% had septic shock and 41.1% required mechanical ventilation support. Thirty-day mortality occurred in 35.6% (32/90) of patients treated with CZA and in 56.7% (51/90) of those receiving OAAT regimens (P = 0.004). Twenty-one-day clinical response was seen in 50% (45/90) and 26.7% (24/90) of patients receiving CZA and OAAT, respectively (P = 0.002). In multivariable logistic regression analyses, CZA treatment was associated with less likelihood of mortality (aOR = 0.37; 95% CI: 0.19-0.71; P = 0.003) and higher likelihood of 21-d clinical response (aOR = 3.32; 95% CI: 1.68-6.53; P < 0·001). CONCLUSIONS:Treatment with CZA is associated with more favourable clinical outcomes in treatment of OXA-48- or KPC-producing Enterobacterales infections. A randomized controlled trial is needed to confirm these results.

Cite this article as: Kaya SY, Fansa S, Asa S, Özdede A, Seyahi E, Tabak F. A case of fever of unknown origin: “the clinical case series of Cerrahpaşa”. Cerrahpaşa Med J. 2025; 49, 0026, doi: 10.5152/cjm.2025.24026.

Spondylodiscitis is a serious and potentially life-threatening infection that affects the vertebrae and intervertebral discs. Candida spp. is a fungus that normally exists as a commensal organism in the human body but can become an opportunistic pathogen in individuals with weakened immune systems. Risk factors such as immunodeficiency, prolonged antibiotic use, intravenous drug use, diabetes, and alcohol dependency can contribute to the development of fungal spondylodiscitis. Fungal spondylodiscitis has a more insidious onset and presents with more ambiguous symptoms compared to bacterial cases, which can lead to delays in diagnosis and treatment. Patients typically present to the clinic with non-specific symptoms such as back pain, limited mobility, and sometimes fever. Because laboratory findings are generally non-specific, magnetic resonance imaging is considered an effective method for diagnosis. Definitive diagnosis typically relies on biopsy and culture results; however, cultures may be negative, and situations where biopsy is not always feasible make diagnosis more challenging. Conservative treatment is the gold standard; however, surgery can be performed when necessary. A multidisciplinary approach and individualized treatment plans are critically important in enhancing the effectiveness of therapy. In conclusion, Candida spondylodiscitis is a rare but severe infection. Mortality and morbidity rates can be reduced with early diagnosis and appropriate treatment strategies. In clinical practice, the possibility of fungal infection should not be overlooked, especially in patients with risk factors and should be actively investigated during the diagnostic process. This article aims to contribute to a better understanding of spondylodiscitis caused by Candida spp. Cite this article as: Kılınç T, Yıldız Kaya S, Mete B, Tabak F. Candida spondylodiscitis: diagnostic dilemmas and treatment strategies. Cerrahpaşa Med J 2025; 49, 0071, doi: 10.5152/cjm.2025.24071.

Objective: This study aims to determine the prevalence and risk factors of sarcopenia in people living with human immunodeficiency virus (PLWH) aged 50 years and over. Materials and Methods: Ninety individuals who live with human immunodeficiency virus (HIV) aged 50 years and over, who were under followup in our outpatient clinic between May 2021 and October 2021, were included in the study. Demographic, clinical, laboratory data, and drug information of the patients, were reviewed from medical records. Sarcopenia tests were conducted, and fracture risk assessment tool scores of the patients were calculated. Results: In our study, the prevalence of sarcopenia in PLWH aged 50 years and over was found to be 40% (8.9% definite sarcopenia, 31.1% probable sarcopenia). No association was found between elapsed time since diagnosis of HIV infection, initial CD4 T lymphocyte count, rate of antiretroviral therapy (ART) usage, duration of ART usage, ART regimens with sarcopenia. In our study, 10-year probability of major osteoporotic fracture risk and hip fracture risk was significantly higher in the male group with sarcopenia compared to the non-sarcopenic group. Conclusion: The prevalence of sarcopenia in PLWH aged 50 years and over, was found to be higher compared to the general population. It was observed that individuals with sarcopenia had a higher risk of fractures. Since sarcopenia is associated with falls, fractures, disability, hospitalization, and mortality, screening for sarcopenia in PLWH aged 50 years and over may be beneficial in preventing adverse outcomes.

AIM:This study aimed to determine the important features and cut-off values after demonstrating the detectability of cirrhosis using routine laboratory test results of chronic hepatitis C (CHC) patients in machine learning (ML) algorithms. METHODS:This retrospective multicenter (37 referral centers) study included the data obtained from the Hepatitis C Turkey registry of 1164 patients with biopsy-proven CHC. Three different ML algorithms were used to classify the presence/absence of cirrhosis with the determined features. RESULTS:The highest performance in the prediction of cirrhosis (Accuracy = 0.89, AUC = 0.87) was obtained from the Random Forest (RF) method. The five most important features that contributed to the classification were platelet, αlpha-feto protein (AFP), age, gamma-glutamyl transferase (GGT), and prothrombin time (PT). The cut-off values of these features were obtained as platelet < 182.000/mm3, AFP > 5.49 ng/mL, age > 52 years, GGT > 39.9 U/L, and PT > 12.35 s. Using cut-off values, the risk coefficients were AOR = 4.82 for platelet, AOR = 3.49 for AFP, AOR = 4.32 for age, AOR = 3.04 for GGT, and AOR = 2.20 for PT. CONCLUSION:These findings indicated that the RF-based ML algorithm could classify cirrhosis with high accuracy. Thus, crucial features and cut-off values for physicians in the detection of cirrhosis were determined. In addition, although AFP is not included in non-invasive indexes, it had a remarkable contribution in predicting cirrhosis. TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT03145844.

People living with HIV (PLWH) continue to experience longer life expectancy due to effective antiretroviral therapy (ART). However, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Despite improved HIV care, major adverse cardiovascular events (MACE) remain prevalent, with limited data from long-term cohorts. This study aimed to determine the incidence, risk factors, and predictors of MACE in long-term ACTHIV-IST cohort of PLWH in Istanbul. We conducted a retrospective analysis of 1059 patients followed for at least 10 years. Patients with prior MACE or noncardiac mortality were excluded. Traditional CVD risk factors, HIV-related immunovirological parameters, ART, and comorbidities were analyzed using Cox proportional hazards regression. MACE incidence was 7.55% (80/1059) with a cumulative rate of 11.1%. The most frequent events were ischemic heart disease (30.4%), myocardial infarction (27.6%), and sudden cardiac death (18.6%). Among those without traditional CVD risk factors, a CD4+ count <200 cells/mm³ at diagnosis was associated with a 4.5-fold increased MACE risk. Hypertension (hazard ratio [HR]: 4.74), coronary artery disease (CAD) (HR: 8.49), and older age at HIV diagnosis (HR: 1.031/year) were the strongest independent predictors (p < 0.05). Patients who should have used statins but did not were at higher risk of developing MACE (34% vs. 17%) compared to those who did (p < 0.05). Twenty-one statin users of those who had MACE were before the event. A significantly higher MACE rate was observed in patients who used protease inhibitor (PI) compared to those who did not (p = 0.002). Low baseline CD4+ T-cell count, prolonged HIV duration, comorbidities (e.g., hypertension, CAD, and dyslipidemia), PI experienced, and older age at HIV diagnosis significantly increase MACE risk. Early diagnosis, continuous cardiovascular monitoring, start statins if indicated, and individualized ART strategies are essential to reduce MACE-related morbidity and mortality in PLWH.

BACKGROUND/AIMS:Selecting the initial antiviral regimen for chronic hepatitis B (CHB) requires balancing patients' comorbidities and long-term safety. This study examines the differences in patient and disease-related factors that guide clinicians to prescribe either entecavir (ETV) or tenofovir disoproxil fumarate (TDF) as the initial treatment. MATERIALS AND METHODS:The study included treatment-naïve CHB patients aged 18 or older who had been diagnosed for at least 1 year since 2010 and initiated on antiviral therapy. The data included variables such as age, gender, body mass index (BMI), comorbidities, liver disease activity, biopsy results, cirrhosis, hepatic steatosis, hepatitis B e antigen status, hepatitis B virus DNA levels, triglycerides, cholesterol, renal function, and baseline bone mineral density (BMD), which were assessed by dual-energy x-ray absorptiometry (DEXA). RESULTS:Among 2259 patients (61.6% male), 1270 patients (56.22%) received TDF, while 989 patients (43.78%) received ETV as first line therapy. The TDF was more commonly prescribed to patients with a lower BMI (median 25.7 vs. 26.2, P = .001) and lower baseline creatinine (0.75 vs. 0.80 for ETV, P < .001). Clinicians preferred ETV among patients with an estimated glomerular filtration rate (eGFR) < 60 (n = 36), (P < .001). The BMD was evaluated in 365 patients (16.3%). The DEXA scans were performed for 116 patients (11.8%) in the ETV group and 249 patients (19.8%) in the TDF group (P < .001). CONCLUSIONS:This national multicenter study emphasizes that patient-related factors, including gender, age, baseline renal function, and liver disease severity, significantly influence the choice of first-line antiviral therapy for CHB, often outweighing disease-specific factors.   Cite this article as: Yamazhan T, Zerdali E, Önlen Y, et al. A national multicenter study on initial antiviral treatment preferences on chronic hepatitis B: Entecavir versus tenofovir disoproxil fumarate. Turk J Gastroenterol. 2026;37(2):179-185.

OBJECTIVE:Both vancomycin (VAN) and teicoplanin (TEI) augment the risk of acute kidney injury (AKI) when combined with piperacillin-tazobactam (TZP). We aimed to compare the risk of AKI among patients receiving TZP-VAN vs. TZP-TEI. METHODS:This was a prospective, multinational, multicentre cohort study conducted in 12 centres from Turkiye, Italy, and Spain between 1 June 2022, and 31 December 2023. The primary outcome was the occurrence of AKI between the first day of antibiotic treatment and the third day after completing therapy, according to the Kidney Disease Improving Global Outcomes criteria. Multivariable logistic regression and propensity-score match analyses were employed to adjust for confounding variables. Stratified Kaplan-Meier analysis was used to assess the time-to-AKI between the comparison groups. RESULTS:Of 187 patients (TZP-TEI, n = 102; TZP-VAN, n = 85), the AKI occurred in 21 patients (24.7%) who received TZP-VAN and in 15 patients (14.7%) with TZP-TEI (unadjusted odds ratio [OR], 1.90; 95% CI: 0.91-3.97; P = 0.087). After adjusting for confounding variables with multivariable analysis, TZP-VAN was not associated with increased odds of AKI compared with TZP-TEI; with an adjusted OR of 2.24 (95% CI: 0.78-6.42; P = 0.133). In propensity-score matched analysis (n = 49 pairs), the AKI risk was similar between the two groups (OR, 2.10; 95% CI: 0.67-6.50; P = 0.199). The stratified Kaplan-Meier analysis indicated no difference between the treatment groups in terms of time-to-AKI (log-rank test, P = 0.107). CONCLUSIONS:The risk of AKI in TZP-VAN was similar to that in TZP-TEI. These results should be confirmed in randomized controlled trials.

Fever of unknown origin (FUO) remains a significant diagnostic challenge. Changes in patient populations and diagnostic technologies may shift the spectrum of underlying etiologies. This study aimed to examine recent FUO cases at a single tertiary center to identify changes in etiology compared with previous reports and between the pre- and post-COVID-19 pandemic periods, assess the diagnostic value of laboratory and imaging findings, and examine FUO characteristics in underrepresented subpopulations, including people living with HIV (human immunodefficiency virus), those on immunosuppressive therapy, and individuals with recurrent fever, with the goal of informing a center-specific diagnostic approach. A retrospective analysis was performed on 100 patients hospitalized with FUO between 2017 and 2024, classified according to Durack and Street’s criteria. Subgroups included classical (n = 85), HIV-associated (n = 13), neutropenic (n = 1), and nosocomial FUO (n = 1). Clinical, laboratory, imaging, and biopsy findings were reviewed, and subgroup-specific analyses were conducted. Among 100 FUO patients (mean age 45.1 years; 52 males), recurrent fever was observed in 14 patients within the classical FUO group. The median fever duration at admission was 6 weeks. The average time to diagnosis was 14 days, and the mean hospital stay was 21 days. Final diagnoses were: collagen vascular diseases (CVD, 39

Aspergillus spp. are ubiquitous, and people are frequently exposed to their spores in the environment and hospital settings. Despite frequent inhalation of the spores, Aspergillus infection is infrequent in humans, except in immunosuppressed hosts. Although amphotericin B (AmB) has been a first-line antifungal for invasive Aspergillus infections for 50 years, its success rate in these patients remains unsatisfactory. Resistance to AmB is sporadic, but the fungus can acquire resistance. Herein, we report two patients unresponsive to AmB, and eventually, we found that the fungi were resistant to AmB. The Aspergillus flavus species complex was recovered from endotracheal aspirate in one case. In the other case, the Aspergillus fumigatus species complex was recovered from a skin biopsy on liposomal amphotericin B (L-AmB) treatment. We used conventional methods for both Aspergillus spp. Initially, serum galactomannan tests were negative in the patients. The radiological results of two patients were compatible with invasive pulmonary aspergillosis, and later, the serum galactomannan levels in the cases increased rapidly during routine blood screening. Eventually, both patients died in intensive care.

We report a 52-year old man presenting with acute acalculous cholecystitis triggered by hepatitis B virus infection. The patient developed protective antibodies and cleared the infection. The relevant data is also discussed.

Background: Emerging carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae) (CRKP) bacteremias are presenting significant public health risks due to limited treatment options and increased mortality. K. pneumoniae isolates exhibit carbapenem resistance rates that vary from 25% to 50% throughout the European continent, including our country. Aims: To assess the characteristics of CRKP bacteremia, a condition that has recently demonstrated an increasing prevalence in our center. We sought to ascertain the resistance rates of isolated strains to antibiotics other than carbapenems, identify the responsible carbapenemase genes, evaluate the efficacy of antibiotics, determine mortality rates, explore clonality among strains, and investigate the influence of the COVID-19 pandemic on all these factors. Study Design: Retrospective observational study. Methods: This study included patients aged 18 and older who had experienced meropenem-resistant K. pneumoniae bacteremia. Meropenem resistance was confirmed by employing the Kirby-Bauer disk diffusion method. Meropenem minimum inhibitory concentration (MIC) levels were determined using the gradient test, while colistin MIC levels were ascertained using the disk elution technique. Carbapenemase genes were evaluated via colony polymerase chain reaction (PCR), and clonality analysis was performed using the arbitrarily primed PCR technique. Results: The study comprised 230 patients, with a mean age of 63.1 +/- 15.9 years, of whom 58.7% were male. Oxacillinase-48 (OXA-48) was detected in 74.8% of the patients, New Delhi metallo-beta-lactamase (NDM) in 12.6%, OXA-48 + NDM in 7.8%, and KPC in 4.8%. The 14-day and 30-day mortality rates were 57% and 69.6%, respectively. Multivariate analysis of the 30-day mortality revealed several crucial factors, including bacteremia development in the intensive care unit, the occurrence of bacteremia during the COVID-19 pandemic, polymicrobial bacteremia, the use of indwelling intravenous catheters, a platelet count of <= 140,000/ mu l, procalcitonin levels of >= 6 mu g/l, and a Charlson comorbidity score >= 3. Notably, the OXA-48 and KPC genes were upregulated significantly during the COVID-19 pandemic, while the NDM gene groups were downregulated. Additionally, both 14-day and 30-day mortality rates increased significantly. Conclusion: In this study, the most prevalent carbapenemase gene was OXA-48; however, there has been a recent increase in KPC genes. No dominant epidemic strain was identified through clonality analysis. The clustering rate was 68% before the pandemic, increasing to 85.7% during the pandemic. The significance of infection control measures is underscored by the rise in both clustering and mortality rates during the COVID-19 pandemic.