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Author: Tulek, NeclaPublisher: Bilimsel Tip Yayinevi

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    Retrospective Evaluation of Potential Rabies Exposure Cases Over Nine Years: Single-Center Experience
    (Bilimsel Tip Yayinevi, 2024) Demircan, Serife Altun; Kilic, Esra Kaya; Tulek, Necla; Kinikli, Sami; Bulut, Cemal
    Introduction: T & uuml;rkiye is the only European country where suspected rabies exposure from animal contact is a significant public health concern. In this study, we evaluate cases investigated in our vaccination center, where individuals with suspected rabies exposure have been seeking consultation for many years. The evaluation encompasses demographic characteristics, distribution by years and seasons, the type of animal involved in the contact, the prevalence of stray animals, and the rabies vaccination status of owned animals. Materials and Methods: The study involves cases reported to the Public Health Center from those who sought consultation at our center between January 1, 2011, and December 31, 2019. Demographic characteristics, distribution by years and seasons, the type of animal involved in the contact, the prevalence of stray animals, and the rabies vaccination status of owned animals were retrospectively evaluated. Results: Over the nine years, there were a total of 39.731 cases, resulting in an average of 4414 cases per year. Of these cases, 61% were male, and 68.83% were between the ages of 15 and 64. The most cases occurred in summer and autumn. Of the suspected rabies contacts, 69% involved dogs, and 83.4% of these dogs were unowned. Forty-one point eight percent of the owned dogs were vaccinated. Eighty-nine point six percent of the cats were unowned, and the rate of vaccination among the owned cats was 28.2%. Over the years, there has been a decrease in the use of the 10 -day observation approach, while an increase in the administration of rabies vaccine and/or immunoglobulin has been observed. Conclusion: Seventy percent of all risky rabies contacts involve dogs, with a high rate of 84% of these dogs being unowned. To mitigate contact involving the risk of rabies, addressing the uncontrolled reproduction of stray animals, particularly dogs, and ensuring control and vaccination of the existing animal population appear to be primary measures. Improving the vaccination rate of owned animals, currently at only 30-40%, can prevent people from encountering risky rabies contacts, thereby potentially reducing the need for rabies prophylaxis significantly.
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    Risk Factors for Rectal Colonization with Carbapenemase Producing Enterobacteriaceae
    (Bilimsel Tip Yayinevi, 2021) Hekimoglu, Sirin; Ertem, Gunay; Yucel, Mihriban; Basar, Hulya; Kaya Kilic, Esra; Ozcan, Ayse; Tulek, Necla
    Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) is the most common pathogens acquired in intensive care units (ICU). Materials and Methods: This study was designed as prospective observational study at the Ankara Healthcare Application and Research Center of the University of Health Sciences. The study was conducted between September 2017 and May 2018 in the tertiary Anesthesiology and Reanimation ICU. Rectal swab samples were taken from each hospitalized patient during hospitalization and weekly thereafter. Sixty-five patients with CRE colonization were considered as the study group and 65 patients without CRE colonization were considered as the control group. Results: The 51% of the cases are male and 49% are females. The mean age of all cases was 69.1 +/- 17.6 and the median age was 73. The majority of bacteria grown in rectal swabs are constituted by Klebsiella pneumoniae (43-58.1%) and Escherichia colt (16-21.6%). Duration of hospitalization in the ICU was 19.6 +/- 15.8 in the control group and 48.5 +/- 38.2 in the study group. Duration of hospitalization in CRE-infected patients were longer than non-infected patients (p<0.001). The use of a central venous catheter and tracheostomy showed statistically significant difference between the groups (p< 0.05). Nineteen cases (29.2%) had CRE positivity at their admission to the ICU. Eighteen of these patients came from another clinical service or hospital (p< 0.005). In the control group, carbapenem was used in a mean of 11.9 +/- 9.9 days and in the study group a mean of 16.3 +/- 8.5 days (p= 0.002). In multivariate analysis of risk factors, duration of hospitalization in the ICU increases the risk of CRE positivity in rectal culture 1.04 (95%GA, 1,005-1,072, p= 0.024) times more. Conclusion: In our study, it can be said that it is important to question the indications of invasive procedures to be applied to the patients. We recommend that patients should be admitted to service follow-up when the ICU follow-up and treatment indications are terminated. Carbapenem treatment times should be shortened. As a result, it would be wise to take rectal surveillance cultures in ICUs to detect and control carbapenem-resistant strains.