OBJECTIVE: This study aimed to determine the ratio of fluoroquinolone (FQ) exposure before the diagnosis of patients with a new case of active pulmonary tuberculosis (TB) and to investigate the correlation of this treatment with the emergence of FQ-resistant strains.MATERIAL AND METHODS: In this retrospective comparative case series study, a total of 132 patients, who had been diagnosed with adult, culture-positive, active pulmonary TB were reviewed. The FQ group had 30 patients who had had ≥1 time and ≥7 days of FQ exposure within 1 year before the diagnoses. The control group included an equal number of patients with TB with similar demographic characteristics (non-FQ group). Ofloxacin (OFX) and moxifloxacin (MFX) resistance were examined at 2 different concentrations (2 and 4 mg/L for OFX; 0.25 and 0.5 mg/L for MFX).RESULTS: Of the 132 patients, 30 (22%) had 7 days or longer of FQ monotherapy within 1 year of initiation of anti-TB treatment. FQ resistance was detected in 2 (3.3%) patients. In the FQ group, MFX resistance at 0.25 mg/L concentration was observed in 1 patient, whereas another patient had OFX and MFX resistance at 4 mg/L and 0.5 mg/L concentrations, respectively. In the non-FQ group, no FQ resistance was detected in any of the patients. No statistically significant difference in terms of development of FQ resistance was found between the ratios of FQ and non-FQ groups (p=0.492). Although there was no statistically significant difference, 2 patients, in whom resistance was detected, had FQ exposure before their diagnosis.CONCLUSION: The FQ exposure ratio before the diagnosis is high (22%) in this cohort that includes patients with new active pulmonary TB, and the presence of patients with FQ resistance (even if only a few) should be a noteworthy and cautionary result in terms of FQ exposure and resistance development.
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Ali Kadri ÇIRAK ,
Burçin HAKANOĞLU ,
Gülru POLAT ,
Yelda VAROL ,
Aysu AYRANCI ,
Gülistan KARADENİZ ,
Serir Aktoğu ÖZKAN ,
Aydan MERTOĞLU ,
Enver YALNIZ ,
Fevziye TUKSAVUL ,
Celalettin YILMAZ
Objective: There is currently no specific treatment for COVID-19. Favipiravir treatment has been shown to be effective in in-vitro and pre-clinical trials in the treatment of COVID-19. In this study, we aimed to present the characteristics and treatment results of our patients who were hospitalized with the diagnosis of COVID-19 pneumonia and received favipiravir treatment in the chest diseases clinics of our hospital. Method: The database created by the COVID-19 Study Group of our hospital consisting of the data of patients diagnosed with COVID-19 who applied to our hospital between March 11, 2020 and May 15, 2020 was examined. 471 patients enrolled in the database and 412 hospitalized patients were evaluated and included in 38 patients in whom favipiravir was used for treatment in the chest diseases clinic. Treatments, drug doses, initiation time of favipiravir, clinical and radiological responses to treatment were analyzed retrospectively. Fever control, improvement of respiratory failure, improvement in laboratory values, and absence of radiological deterioration were accepted as response criteria to treatment.Results: It was observed that 30 of 38 patients who were given favipiravir treatment in the chest diseases clinic were successfully discharged. Eight patients whose general condition deteriorated despite favipiravir treatment in the clinic and who had an indication for intensive care were transferred to intensive care. Three of these eight patients died and 5 of them were successfully discharged.Conclusion: Mortality rate was found to be 7.9% in COVID-19 cases who received favipiravir treatment in our chest diseases clinic. After the favipiravir treatment started to be used more effectively in our country, it was observed that transfers to intensive care units decreased and mortality decreased. Therefore, although favipiravir is thought to be effective in the treatment of COVID-19 infection, further prospective controlled studies are needed.
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Introduction: Patients with chronic obstructive pulmonary disease (COPD) hospitalized for an exacerbation are at risk of early readmission for any reason within 30 days of discharge. Understanding the frequency and risk factors related to readmission can provide valuable input for the development of readmission reduction strategies. The aim of this study was to investigate the frequency, specific risk factors and the cost analysis of early readmission for any reason within 30 days after discharge of the patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Materials and Methods: In a prospective comparative case series study, 110 patients over 40 years of age who were hospitalized with AECOPD were included. The frequency of readmissions within 30 days of discharge after hospitalization for AECOPD was investigated. Those who were admitted to any hospital for any reason within 30 days after discharge were classified as the readmission group. Whereas nonhospitalized patients were defined as the nonreadmission group. Demographic, clinical, therapeutic, laboratory and financial data of the groups were evaluated. Results: Thirty-four (30.9%) COPD patients were readmitted during the first 30 days post index hospitalization. In multivariate analysis, the best predictors of early readmission were the low forced expiratory volume in one second (FEV1) predicted % (FEV1%) (OR= 0.961, %95 CI 0.927-0.997 p= 0.034) and COPD diagnosis time (OR= 0.908, %95 CI 0.838-0.983 p= 0.017). Mean length of stay of the second hospitalization was longer than both the readmitted and nonreadmitted groups (8.3, 8.1 and 7.8 days respectively). While mean cost of second hospitalization was 1189$, mean cost of index hospitalization of the readmission group was 794$ and that of index hospitalization of nonreadmission group was 582$. Conclusion: The frequency of readmissions within 30 days after discharge of the patients hospitalized for AECOPD are common and costly. Low FEV1 percentage and lower diagnosis time were found to be significant predictors for readmission within 30 days of the index hospitalization.
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