is one of the major concerns among bacterial diseases even when it shows a wild-type susceptibility pattern. In 2020, EUCAST reconsidered antibiogram interpretation shifting "I" from "intermediate" to "sensible, increased exposure" with possible significant impact on antibiotic prescription. The aim of this study was to evaluate mortality in patients with 

Bloodstream Infections Due to Wild-Type Pseudomonas Aeruginosa: Carbapenems and Ceftazidime/Avibactam Prescription Rate and Impact on Outcomes

Abstract Background Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV‐associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits. Methods Data collected from participants ( n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross‐sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30‐day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. Results The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA &lt; 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub‐score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory. Conclusions Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH. 

Moderate‐to‐severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with <scp>HIV</scp>: The New Orleans alcohol use in <scp>HIV</scp> (<scp>NOAH</scp>) study

Background: Bloodstream infections (BSIs) caused by Pseudomonas aeruginosa have high mortality rates and pose a significant threat to healthcare settings. Objectives: We aimed to investigate the clinical risk factors related to mortality and the development of P. aeruginosa with difficult-to-treat resistance (DTR-PA) BSI in the intensive care unit. Methods: This was a retrospective, single-center study that included patients with P. aeruginosa BSI who were hospitalized between 2020 and 2022. The risk factors affecting 30-day mortality and the development of DTR-PA were investigated using both univariate and multivariate analyses. Results: A total of 140 patients were analyzed. The mean age was (66 ± 17.5) years, and 48% of the patients were male. Previous meropenem use was an independent risk factor for DTR-PA BSI (odds ratio, 2.68; 95% CI, 1.24 to 5.80; P = 0.012). Multivariate analysis demonstrated that the requirement for inotropic support was an independent risk factor for 30-day mortality [hazard ratio, 2.50; 95% confidence interval (CI), 1.33 to 4.68; P = 0.004]. Conclusions: Prior meropenem use was an independent risk factor for DTR-PA development. Strict policies for Carbapenem use and infection control procedures are essential to combat infections caused by DTR-PA. 

Risk Factors and Outcomes of Patients with Pseudomonas aeruginosa Bloodstream Infection in the Intensive Care Unit

BACKGROUND
Managing Pseudomonas aeruginosa bloodstream infections (BSIs) is challenging due to increasing antimicrobial resistance, limited therapeutic options, and high mortality rates. In this study, we aimed to identify 30-day mortality risk factors and assess infectious diseases consultants' preferences for combination or monotherapy.


METHODS
The study was conducted in four hospitals in Istanbul, Turkey, involving 140 adult ICU beds and 336,780 ICU-bed-days between 1 January 2014, and 31 December 2021. A total of 157 patients were included in the study. Cox proportional hazard regression was performed to assess the factors on 30-day mortality.


RESULTS
The 30-day mortality rate was 44.6% (70/157). Higher Charlson Comorbidity Index (CCI) score, severe sepsis, primary bloodstream infection, being in COVID-19 pandemic period, and infection caused by MDR strain were associated with higher hazard of 30-day mortality. Combination therapy was more commonly used in patients with BSIs with MDR or DTR (difficult-to-treat) strains but did not significantly improve the hazard of 30-day mortality.


CONCLUSIONS
Targeted interventions and vigilant management strategies are crucial for patients with defined risk factors. While infectious disease consultants tended to favor combination therapy, particularly for drug-resistant strains, our analysis revealed no significant impact on 30-day mortality hazard. The increased incidence of P. aeruginosa BSIs during the pandemic emphasizes the need for infection control measures and appropriate antibiotic prescribing practices.

Registry-Based Retrospective Cohort Study of Mortality among Adults Admitted to Intensive Care Units in Istanbul with Hospital Acquired Pseudomonas aeruginosa Bloodstream-Infection between 2014-2021.

Objective: In the determination and monitoring of neurocognitive disorders in human immunodeficiency virus (HIV)-positive individuals, there is a need for significantly more practical methods which provide results in a shorter time than the tests that require challenging and specialized expertise. This study aimed to evaluate cognitive functions and the factors affecting them in naïve HIV-positive patients using by Montreal Cognitive Assessment (MoCA) test before and after the initiation of combination antiretroviral therapy. 

Cognitive Assessment of Young Adults Before and After Initiation of Combination Antiretroviral Therapy

Real life efficacy, renal and lipid profile data of tenofovir alafenamide in switched chronic hepatitis B patients

Human monkeypox (MPX) disease is a re-emerging zoonotic infection caused by the monkeypox virus belonging to the same family as vaccinia and variola. The European Center for Disease Prevention and Control (ECDC) has documented an outbreak of MPX with atypical transmission paths throughout Europe. In this report, male-to-male sexual intercourse was first defined as a means of close humanto-human contact. The Ministry of Health of the Republic of Turkey announced via social media on June 30, 2022 that the first case confirmed by polymerase chain reaction (PCR) for the MPX virus in Turkey was admitted and isolated in a hospital. Four days after this statement, a 24-year-old Turkish man was hospitalized in our clinic with a bacterial infection of the penis and scrotum following local radiofrequency ablation therapy. A week ago, lesions resembling warts were noted in his medical history, for which a local radiofrequency ablation procedure was conducted at an external center. One day after his hospitalization, skin lesions of different stages (from macules, papules to umbilical papules) and several eruptions were detected on his face, nose tip, body, arms, and fingers, which gradually became more evident. After evaluating the risk factors, the patient was isolated with a preliminary diagnosis of MPX disease and samples were collected and sent for MPX virus detection to the reference laboratory according to the Ministry of Health guidelines. MPX virus nucleic acid was detected by PCR in samples taken from the lesion. The patient was discharged after 21 days of isolation and treatment for a secondary bacterial infection. In this case report the significance of differential diagnosis and screening tests for sexually transmitted infections (STI), a previously unreported case of MPX disease in Turkey, and a soft tissue infection that developed after local ablation treatment which was administered to a patient with MPX disease were presented. To be prepared for new and re-emerging infectious diseases, it was emphasized that well-structured continuing education based on current epidemiological data is required. Sexual contact has recently been identified as a new mode of transmission for MPX disease, and symptoms and signs may resemble those of other ulcerative sexually transmitted infections (STIs), such as "molluscum contagiousum" or syphilis. ORF disease is also in the differential diagnosis of MPX disease in Turkey. In addition, patients admitted with unreported STIs are permitted to receive health services without additional screenings. For this reason, easily accessible sexually transmitted disease centers with a high diagnostic efficiency can provide greater control over these diseases.

/pdf/a-patient-presented-with-genital-eruptions-the-second-case-udgtm875.pdf

[A Patient Presented with Genital Eruptions: The Second Case of Monkeypox from Türkiye].

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Registry-Based Retrospective Cohort Study of Mortality among Adults Admitted to Intensive Care Units in Istanbul with Hospital Acquired Pseudomonas aeruginosa Bloodstream-Infection between 2014-2021.

Cognitive Assessment of Young Adults Before and After Initiation of Combination Antiretroviral Therapy

Real life efficacy, renal and lipid profile data of tenofovir alafenamide in switched chronic hepatitis B patients

[A Patient Presented with Genital Eruptions: The Second Case of Monkeypox from Türkiye].