This study was undertaken to evaluate the diagnostic and prognostic values of pentraxin‐3 (PTX‐3) in patients with infected diabetic foot ulcers (IDFU) as well as to assess the association between PTX‐3 levels and IDFU severity. This study included 60 IDFU patients (Group 1), 45 diabetic patients without DFU (Group 2), and 45 healthy controls. Patients with IDFU were divided into mild, moderate, and severe subgroups based on classification of clinical severity. Patients who underwent amputation were also documented. Blood samples were collected to determine PTX‐3 levels. PTX‐3 levels in healthy controls, Group 1, and Group 2 were 5.83 (3.41‐20) ng/mL, 1.47 (0.61‐15.13) ng/mL, and 3.26 (0.67‐20) ng/mL, respectively. A negative correlation between plasma PTX‐3 and glucose levels was found. There were significant differences in terms of procalcitonin (PCT) and PTX‐3 levels in the subgroup analysis of Group 1. The PTX‐3 level in patients who did or did not undergo amputation was 4.1 (0.8‐13.7) and 1 (0.6‐15.1) ng/mL, respectively. Results suggest that PTX‐3 is a particularly effective marker in patients with IDFU, both in terms of predicting disease severity and assisting in the decision to perform amputation.

Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI,) and the hospitalacquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI,) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.

BackgroundBrucellosis is a zoonosis that affects several systems, especially with the osteoarticular involvement.ObjectivesThis study aims to compare the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), mean platelet volume (MPV) and red blood cell distribution (RDW) in patients with the osteoarticular involvement and those with non-localised brucellosis and evaluate their predictive value for the diagnosis of osteoarticular brucellosis.MethodsWe enrolled 140 patients with brucellosis, 70 with the osteoarticular involvement and 70 without any localised involvement. We collected patients' data retrospectively and compared haematological parameters between both groups. In patients with osteoarticular brucellosis, a correlation of the NLR with the ESR and CRP and correlation of the MLR with the ESR and CRP were assessed. Furthermore, the predictive performance of the ESR, CRP, NLR and MLR on the osteoarticular involvement was evaluated.ResultsThe NLR, MLR, ESR, CRP, neutrophil and monocyte levels were higher in the patient group than the control group.ConclusionThe NLR, MLR, ESR and CRP are useful parameters to estimate the clinical course of patients with brucellosis, and the NLR and MLR are alternative to inflammatory markers in the osteoarticular involvement.

Diabetes and associated complications still pose an important public health problem. Osteomyelitis as especially seen in patients with diabetes is associated with increased rates of morbidity and mortality. The present study aimed to investigate the clinical and diagnostic significance of inflammatory markers, including the systemic immune-inflammation index (SII) and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT) to differentiate osteomyelitis and cellulitis. The present study included 96 patients with osteomyelitis (Group 1) and 151 patients with cellulitis (Group 2). Inflammatory markers were significantly elevated in Group 1 compared to Group 2 patients ( p < 0.05). Furthermore, the correlation coefficients (rho) between SII and ESR, CRP, and PCT were 0.466 ( p < 0.001), 0.627 ( p < 0.001), and 0.501 ( p < 0.001), respectively, as a result of Spearman's Rho analysis. Accordingly, a moderately positive relationship was found between the variables. The area under the curve (AUC) values for SII, ESR, CRP, and PCT in diabetic foot infection patients with osteomyelitis were 0.687, 0.722, 0.692, and 0.641, respectively. As a result of the Likelhood Ratio (LR) test, the cut-off values were 2.182 for SII (sensitivity: 39.8% and specificity: 79.8%), 76.5 mm/h for ESR (sensitivity: 59.1% and specificity: 73.1%), 109.5 mg/mL for CRP (sensitivity: 40.9% and specificity: 79.8%), and 0.44 ng/mL for PCT (sensitivity: 26.1% and specificity: 88.2%). In conclusion, given that the patients with osteomyelitis had much higher ESR, CRP, PCT, and SII levels combined with the fact that SII is a low-cost and easy-to-measure index, suggests that the same may serve as an effective and novel marker alternative to other inflammatory markers for predicting diabetic foot osteomyelitis.

Objective: The present study aimed to evaluate Crimean-Congo Haemorrhagic Fever (CCHF) in patients hospitalized in our hospital. Methods: A total of 61 adult patients who were diagnosed as having CCHF between January 2011 and August 2018, in whom the diagnosis was confirmed by detecting virus-specific IgM by ELISA and/or by showing viral RNA by RT-PCR and who were managed at our clinic were evaluated retrospectively for their epidemiological and clinical findings, treatment and prognosis. Results: Of the 61 cases, 41 (67.2%) were male and 20 (32.8%) female. The mean age of the patients was 45.31±2.12 years. Sixty (98.4%) patients were living in rural area. Forty four patients (72.1 %) had a tick-bite history. According to months, most of the cases were seen in June, July and May, respectively. Fever, weakness and loss of appetite were the most common complaints of the patients. Treatment of ribavirin was started on the day of admission in all patients. One patient who was admitted in the late period died. The other 60 patients were discharged after being healed. Conclusions: Especially during summers when the disease is seen frequently, the history of tick contact should be questioned and tick should be searched in the examination in the patients with suspected clinical findings. A significant number of the patients do not have a known tick contact. Therefore, training meetings should be organized about the symptoms and findings of the disease in the endemic areas and awareness should be raised among the community and the doctors working in emergency services and primary care.