Earlier active treatment with colistin based regimens and microbiological and clinical response within 7 days are major predictors of survival in cases of BSIs due to CRE. Rectal screening offers the advantage of earlier recognition and prompt empirical treatment.

Objective: Polypharmacy, quite common in elderly patients, is an important issue, resulting in increased morbidity and mortality. This study aimed to examine polypharmacy rates and drug usage characteristics in elderly patients. Second aim of this study was to compare our results with other published studies. Methods:In a retrospective design, we reviewed hospital records of 1,205 patients (≥65 years) who presented to our geriatric clinic, which serves as a tertiary center at the University of Istanbul, Cerrahpasa School of Medicine, who were examined in detail in terms of polypharmacy between 2003 and 2012, and who had follow-up care for at least a year. Demographic characteristics, polypharmacy, drugs used at presentation and final evaluation, and comorbid conditions were recorded. The definition of ≥ 5 drugs usage for polypharmacy and ≥ 9 drugs usage for excessive polypharmacy were considered in this study.Multivariate binary logistic regression analysis was performed for independent predictive factors.Results: Of patients, 854 were females (70%). The average age was 75.2±6.9. The number of comorbidities was 2.46±1.30. The number of drugs used at first admission and final evaluation was 3.8±2.7 and 4.3±2.8 (p<0.001), polypharmacy rates of 40% and 45% (p<0.001). Also, the rate of excessive polypharmacy was found 8% at final assessments. The rates of patients using one drug, two drugs, three drugs and four drugs were 6%, 11%, 13% and 15%, respectively. Polypharmacy rate in females was statistically significant higher than males (33% vs. 12%; p=0.026). The most common prescribed drugs were found as anti-platelet therapies (70%), calcium channel blockers (68%), anti-osteoporotic drugs (57%), statins (53%), and beta-blockers (49%) in all patients respectively. The most common five comorbidities were hypertension (67%), diabetes mellitus (27%), osteoporosis (27%), hyperlipidemia (25%), and depression (20%). Depression was an independent predictive factor for polypharmacy than other comorbid diseases in the regression analysis (odds ratio (OR): 4.5; 95% confidence interval (CI): 3.2-6.5; p<0.001). Conclusions:The polypharmacy rate was found to be as high as 45% in elderly patients. Before starting an additional medication in elderly patients, particularly with depression, the indication should be clearly specified, and several aspects should be taken into consideration, including functional capacity of the patient, the drugs already used, and possible interactions of the new drug.

Aim Obesity is a disease complicating the course of COVID-19 and SARS-CoV-2 vaccine effectiveness in adults with obesity may be compromised. Our aim is to investigate the spike-protein receptor-binding domain antibody titers against BNT162b2 mRNA and inactivated SARS-CoV-2 (CoronaVac) vaccines in people with severe obesity. It is anticipated that the results to be obtained may provide invaluable information about future SARS-CoV-2 vaccination strategies in this vulnerable population. Methods A total of 124 consecutive patients with severe obesity (age > 18 years, BMI ≥ 40 kg/m 2 ) presenting between August and November 2021 were enrolled. The normal weight control group (age > 18, BMI 18.5-24.9 kg/m 2 ) was recruited from 166 subjects who visited the vaccination unit. SARS-CoV-2 spike-protein antibody titers were measured in patients with severe obesity and in normal weight controls who received two doses of BNT162b2, or CoronaVac vaccines. SARS-CoV-2 IgG Nucleocapsid Protein antibody (NCP Ab) testing was performed to discover prior SARS-CoV-2 infection. Blood samples were taken from individuals at 4th week and after 2nd dose of vaccination. SARS-CoV-2 IgG antibody titers were determined by quantitative serological methods. Results A total of 290 individuals (220 female, 70 male) who have received two doses of BNT162b2 or CoronaVac vaccines were enrolled in the study. Seventy had prior SARS-CoV-2 infection. In 220 subjects (non-prior infection) vaccinated with BNT162b2 or CoronaVac, the antibody titers against SARS-CoV-2 spike antigen of patients with severe obesity were significantly lower than normal weight controls (p = 0.001, p = 0.001 respectively). In seventy subjects with prior SARS-CoV-2 infection, spike antigen antibody titers in patients with severe obesity, vaccinated with BNT162b2 or CoronaVac, were not significantly different from normal weight controls (p = 0.1, p = 0.1 respectively). In patients with severe obesity, with and without prior SARS-CoV-2 infection, spike antigen antibody levels of those vaccinated with BNT162b2 were found to be significantly higher than those vaccinated with CoronaVac (p = 0.043, p < 0.001 respectively). Conclusion Patients with severe obesity generated significantly reduced antibody titers against SARS-CoV-2 spike antigen after CoronaVac and BNT162b2 vaccines compared to people with normal weight. Antibody levels in patients with severe obesity vaccinated with BNT162b2 were found to be significantly higher than those vaccinated with CoronaVac. People living with severe obesity should be prioritized for COVID-19 vaccination and BNT162b2 vaccine may be recommended for this vulnerable population. KeywordsSevere obesity • Vaccines • Antibody response Key Points • Individuals with severe obesity had low antibody responses to the BNT163b2 vaccine. • Individuals with severe obesity had low antibody responses to the CoronaVac vaccine. • BNT162b2 vaccine responses were better than CoronaVac in severely obese individuals. • BNT162b2 can be recommended for the COVID-19 vaccine to...