This study aimed to describe the effect of initial antifungal therapy on patient mortality and to detail the current distribution and resistance patterns of Candida spp. among patients with candidaemia. A prospective observational study was performed among consecutive patients with candidaemia from 10 Turkish medical centres between January 2015 and November 2018. The primary outcome was 10-day mortality. Species were identified using MALDI-TOF/MS. A total of 342 patients with candidaemia were included, of which 175 (51.2%) were male and 68 (19.9%) were aged < 18 years. The most common species were Candida albicans (47.4%), Candida parapsilosis (26.6%), Candida tropicalis (9.6%) and Candida glabrata (7.6%). Among all Candida spp., the 10-day case fatality rate (CFR) was 32.2%. The CFR was highest in patients with C. albicans (57.3%) and lowest in patients with C. parapsilosis (21.8%). The resistance rate to fluconazole was 13% in C. parapsilosis , with no significant effect on mortality. No resistance to echinocandins was detected. In the multivariate analysis, being in the ICU [OR = 2.1 (95% CI 1.32-3.57); P = 0.002], renal failure [OR = 2.4 (1.41-3.97); P = 0.001], total parenteral nutrition [OR = 2 (1.22-3.47); P = 0.006], C. albicans infection [OR = 1.7 (1.06-2.82); P = 0.027] and echinocandin as primary agent [OR = 0.6 (0.36-0.99); P = 0.047] were significantly associated with mortality. Candidaemia is a deadly infection. Fluconazole resistance is emerging, although it was not significantly related to mortality. Using an echinocandin as the primary agent could be life-saving.
Objective: The aim was to determine vitamin D status in the general population in Turkey between 2011 and 2016, and to evaluate the effectiveness of the national vitamin D supplementation programme. Methods: Serum 25-hydroxyvitamin D (25-OHD) measurement data were retrieved from an internationally accredited laboratory, operating nationwide. A total of 108,742 measurements of 25-OHD were analyzed using the cut-off values of 0-11 ng/mL, 12-19 ng/mL, 20-49 ng/mL, 50-70 ng/mL and >70 ng/mL for vitamin D deficiency, insufficiency, sufficiency, possibly harmful and excess respectively. Results: The mean±standard deviation 25-OHD level was 21.6±13.3 ng/mL. Mean 25-OHD concentrations by age groups were: 37.3 ng/mL, 30.1 ng/mL and 23.7 ng/mL for <1, 1-10 and 11-18 year old groups, respectively. Mean 25-OHD levels of children <1 year and 1-3 years of age were significantly higher than those found in other age groups. The prevalence of vitamin D deficiency (<12 ng/mL) was lowest in children at 1-3 years of age (5%). In subjects older than 18 years of age, mean 25-OHD levels were 18.2 ng/mL, 20.1 ng/mL, 21.9 ng/mL and 21.1 ng/mL for age groups 19-30, 31-50, 51-70 and >70 years, respectively. Conclusion: Successful implementation of the national vitamin D supplementation programme, appears to have nearly eliminated vitamin D deficiency for children under 1-years of age. However, the positive impact of the vitamin D supplementation diminishes as children get older suggesting that supplementation may be required in the older children and adults. In addition, improved awareness of the benefits and risks of excess vitamin D should prevent unnecessary and excessive use of vitamin D supplements.
What is known -Recently, extra-skeletal effects of vitamin D have caused an increase of interest in vitamin D. This interest has leaded the phsycians to check serum 25OHD levels more oftenly.-Furthermore, high dose vitamin D treatment have been prescribed by physicians even in cases with normal 25OHD levels in order to achieve extra-skeletal effects of vitamin D. What is new -This study, which has a very large sample size, aimed to assess vitamin D status in Turkey. Despite the previous trials demonstrating a high prevalence of vitamin D deficiency our data do not justify the presence of a vitamin D deficiency pandemic in Turkey. -With successful implementation of the vitamin D supplementation program, Turkey seems to have overcome vitamin D deficiency for those under 1-year of age. AbstractObjective: This population-based study aimed to determine the vitamin D status in Turkey between 2011 and 2016, evaluate the effectiveness of the national vitamin D supplementation program. Methods: Data on serum 25-hydroxyvitamin D (25-OHD) measurements were retrieved from an internationally accredited laboratory operating nationwide. A total of 108,742 measurements of 25-OHD were analyzed using the cut-off values of 0-11 ng/ml, 12-19 ng/ml, 20-49 ng/ml, 50-70 ng/ml and >70 ng/ml. Results: Overall, the mean 25-OHD level was 21.6±13.3 ng/ml. The mean 25-OHD levels according to age brackets were as follows: 37.3 ng/ml for <1 year of age, 30.1 ng/ml for 1-10 years of age, 23.7 ng/ml for 11-18 years of age. The mean 25-OHD levels among children <1 year and 1-3 years of age were significantly higher compared with those found for the other age groups. The prevalence of vitamin D deficiency (<12 ng/ml) was lowest in children at 1-3 years of age (5%). Conclusion: With successful implementation of the vitamin D supplementation program, Turkey seems to have overcome vitamin D deficiency for those under 1-years of age. However, the positive impact of the program does not continue over 1 year of age, indicating that vitamin D supplementation may be required in the older children and adults. On the other hand, increased awareness about vitamin D should be continued to prevent unnecessary and excessive use of vitamin D supplements.
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