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1. Tetanus in adults: results of the multicenter ID-IRI study

Author

Tosun, S., Batirel, A., Oluk, A. I., Aksoy, F., Puca, E., Bénézit, F., Ural, S., Nayman-Alpat, S., Yamazhan, T., Koksaldi-Motor, V., Tekin, R., Parlak, E., Tattevin, P., Kart-Yasar, K., Guner, R., Bastug, A., Meric-Koc, M., Oncu, S., Sagmak-Tartar, A., Denk, A., Pehlivanoglu, F., Sengoz, G., Sørensen, S. M., Celebi, G., Baštáková, L., Gedik, H., Dirgen-Caylak, S., Esmaoglu, A., Erol, S., Cag, Y., Karagoz, E., Inan, A., and Erdem, H.

Published
2017
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2. Evaluation of tularaemia courses: a multicentre study from Turkey

Author

Erdem, H., Ozturk-Engin, D., Yesilyurt, M., Karabay, O., Elaldi, N., Celebi, G., Korkmaz, N., Guven, T., Sumer, S., Tulek, N., Ural, O., Yilmaz, G., Erdinc, S., Nayman-Alpat, S., Sehmen, E., Kader, C., Sari, N., Engin, A., Cicek-Senturk, G., Ertem-Tuncer, G., Gulen, G., Duygu, F., Ogutlu, A., Ayaslioglu, E., Karadenizli, A., Meric, M., Ulug, M., Ataman-Hatipoglu, C., Sirmatel, F., Cesur, S., Comoglu, S., Kadanali, A., Karakas, A., Asan, A., Gonen, I., Kurtoglu-Gul, Y., Altin, N., Ozkanli, S., Yilmaz-Karadag, F., Cabalak, M., Gencer, S., Umut Pekok, A., Yildirim, D., Seyman, D., Teker, B., Yilmaz, H., Yasar, K., Inanc Balkan, I., Turan, H., Uguz, M., Kilic, S., Akkoyunlu, Y., Kaya, S., Erdem, A., Inan, A., Cag, Y., Bolukcu, S., Ulu-Kilic, A., Ozgunes, N., Gorenek, L., Batirel, A., and Agalar, C.

Published
2014
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3. Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study

Author

Erdem, H., Kilic, S., Sener, B., Acikel, C., Alp, E., Karahocagil, M., Yetkin, F., Inan, A., Kecik-Bosnak, V., Gul, H.C., Tekin-Koruk, S., Ceran, N., Demirdal, T., Yilmaz, G., Ulu-Kilic, A., Ceylan, B., Dogan-Celik, A., Nayman-Alpat, S., Tekin, R., Yalci, A., Turban, V., Karaoglan, I., Yilmaz, H., Mete, B., Batirel, A., Ulcay, A., Dayan, S., Seza Inal, A., Ahmed, S.S., Tufan, Z.K., Karakas, A., Teker, B., Namiduru, M., Savasci, U., and Pappas, G.

Published
2013
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4. Central nervous system infections in the absence of cerebrospinal fluid pleocytosis

Author

Erdem, H., Ozturk-Engin, D., Cag, Y., Senbayrak, S., Inan, A., Kazak, E., Savasci, U., Elaldi, N., Vahaboglu, H., Hasbun, R., Nechifor, M., Tireli, H., Kilicoglu, G., Defres, S., Gulsun, S., Ceran, N., Crisan, A., Johansen, I.S., Namiduru, M., Dayan, S., Kayabas, U., Parlak, E., Khalifa, A., Kursun, E., Sipahi, O.R., Yemisen, M., Akbulut, A., Bitirgen, M., Popovic, N., Kandemir, B., Luca, C., Parlak, M., Stahl, J.P., Pehlivanoglu, F., Simeon, S., Ulu-Kilic, A., Yasar, K., Yilmaz, G., Yilmaz, E., Beovic, B., Catroux, M., Lakatos, B., Sunbul, M., Oncul, O., Alabay, S., Sahin-Horasan, E., Kose, S., Shehata, G., Andre, K., Dragovac, G., Gul, H.C., Karakas, A., Chadapaud, S., Hansmann, Y., Harxhi, A., Kirova, V., Masse-Chabredier, I., Oncu, S., Sener, A., Tekin, R., Deveci, O., Ozkaya, H.D., Karabay, O., Agalar, C., Gencer, S., Karahocagil, M.K., Karsen, H., Kaya, S., Pekok, A.U., Celen, M.K., Deniz, S., Ulug, M., Demirdal, T., Guven, T., Bolukcu, S., Avci, M., Nayman-Alpat, S., Yaşar, K., Pehlivanoʇlu, F., Ates-Guler, S., Mutlu-Yilmaz, E., Tosun, S., Sirmatel, F., Batirel, A., Öztoprak, N., Kadanali, A., Turgut, H., Baran, A.I., Karaahmetoglu, G., Sunnetcioglu, M., Haykir-Solay, A., Denk, A., Ayaz, C., Gorenek, L., Larsen, L., Poljak, M., Barsic, B., Argemi, X., Sørensen, S.M., Bohr, A.L., Tattevin, P., Gunst, J.D., Baštáková, L., Jereb, M., Chehri, M., Beraud, G., Del Vecchio, R.F., Maresca, M., Yilmaz, H., Sharif-Yakan, A., Kanj, S.S., Korkmaz, F., Komur, S., Coskuner, S.A., Ince, N., Akkoyunlu, Y., Halac, G., Nemli, S.A., Ak, O., Gunduz, A., Gozel, M.G., Hatipoglu, M., Cicek-Senturk, G., Akcam, F.Z., Inkaya, A.C., Sagmak-Tartar, A., Ersoy, Y., Tuncer-Ertem, G., Balkan, I.I., Cetin, B., Ersoz, G., Ozgunes, N., Yesilkaya, A., Erturk, A., Gundes, S., Turhan, V., Yalci, A., Aydin, E., Diktas, H., Ulcay, A., Seyman, D., and Leblebicioglu, H.

Subjects
protein cerebrospinal fluid level, Male, pleocytosis, Meningitis, Pneumococcal, Leukocytosis, herpes simplex encephalitis, CSF, Leukocyte, brucella meningitis, Article, cerebrospinal fluid, clinical feature, female, Central Nervous System Infections, tuberculous meningitis, Tuberculosis, Meningeal, central nervous system infection, middle aged, neurosyphilis, Encephalitis, Humans, pathology, Meningitis, human, pneumococcal meningitis
Abstract

Previous multicenter/multinational studies were evaluated to determine the frequency of the absence of cerebrospinal fluid pleocytosis in patients with central nervous system infections, as well as the clinical impact of this condition. It was found that 18% of neurosyphilis, 7.9% of herpetic meningoencephalitis, 3% of tuberculous meningitis, 1.7% of Brucella meningitis, and 0.2% of pneumococcal meningitis cases did not display cerebrospinal fluid pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had a high rate of unfavorable outcomes and thus this condition should not be underestimated. © 2017 The Author(s)

Published
2017

5. Tuberculous and brucellosis meningitis differential diagnosis

Author

Erdem H, Senbayrak S, Gencer S, Hasbun R, Karahocagil MK, Sengoz G, Karsen H, Kaya S, Civljak R, Inal AS, Pekok AU, Celen MK, Deniz S, Ulug M, Demirdal T, Namiduru M, Tekin R, Guven T, Parlak E, Bolukcu S, Avci M, Sipahi OR, Nayman-Alpat S, Yaşar K, Pehlivanoğlu F, Yilmaz E, Ates-Guler S, Mutlu-Yilmaz E, Tosun S, Sirmatel F, Şahin-Horasan E, Akbulut A, Johansen IS, Simeon S, Batirel A, Öztoprak N, Cag Y, Catroux M, Hansmann Y, Kadanali A, Turgut H, Baran AI, Gul HC, Karaahmetoglu G, and Sunnetcioglu

Subjects
Adult, Brucellosis/*diagnosis/epidemiology, Diagnosis, Differential, Female, Humans, Male, Meningitis, Bacterial/diagnosis/epidemiology, Middle Aged, Retrospective Studies, Tuberculosis, Meningeal/*diagnosis/epidemiology, Turkey, Young Adult, urologic and male genital diseases
Abstract

BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. METHOD: BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. RESULTS: The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. CONCLUSIONS: When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.

Published
2015

6. Neurobrucellosis: Results of the Istanbul Study

Author

Erdem, H, Ulu-Kilic, A, Kilic, S, Karahocagil, M, Shehata, G, Eren-Tulek, N, Yetkin, F, Celen, MK, Ceran, N, Gul, HC, Mert, G, Tekin-Koruk, S, Dizbay, M, Inal, AS, Nayman-Alpat, S, Bosilkovski, M, Inan, D, Saltoglu, N, Abdel-Baky, L, Adeva-Bartolome, MT, Ceylan, B, Sacar, S, Turhan, V, Yilmaz, E, Elaldi, N, Kocak-Tufan, Z, Ugurlu, K, Dokuzoguz, B, Yilmaz, H, Gundes, S, Guner, R, Ozgunes, N, Ulcay, A, Unal, S, Dayan, S, Gorenek, L, Karakas, A, Tasova, Y, Usluer, G, Bayindir, Y, Kurtaran, B, Sipahi, OR, and Leblebicioglu, H

Abstract

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 +/- 2.47 months in P1, 6.52 +/- 4.15 months in P2, and 5.18 +/- 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/ 117) and P3 (6.1%, n = 3/ 49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Published
2012

7. training under the pressure of consultation needs

Author

Erdem, H, Tekin-Koruk, S, Koruk, I, Tozlu-Keten, D, Ulu-Kilic, A, Oncul, O, Guner, R, Birengel, S, Mert, G, Nayman-Alpat, S, Eren-Tulek, N, Demirdal, T, Elaldi, N, Ataman-Hatipoglu, C, Yilmaz, E, Mete, B, Kurtaran, B, Ceran, N, Karabay, O, Inan, D, Cengiz, M, Sacar, S, Yucesoy-Dede, B, Yilmaz, S, Agalar, C, Bayindir, Y, Alpay, Y, Tosun, S, Yilmaz, H, Bodur, H, Erdem, HA, Dikici, N, Dizbay, M, Oncu, S, Sezak, N, Sari, T, Sipahi, OR, Uysal, S, Yeniiz, E, Kaya, S, Ulcay, A, Kurt, H, Besirbellioglu, BA, Vahaboglu, H, Tasova, Y, Usluer, G, Arman, D, Diktas, H, Ulusoy, S, and Leblebicioglu, H

Subjects
Infectious disease, clinical microbiology, training, consultation
Abstract

Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

Published
2011

10. Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

Author

Erdem Hakan, Tekin-Koruk Suda, Koruk Ibrahim, Tozlu-Keten Derya, Ulu-Kılıc Aysegul, Oncul Oral, Guner Rahmet, Birengel Serhat, Mert Gurkan, Nayman-Alpat Saygin, Eren-Tulek Necla, Demirdal Tuna, Elaldi Nazif, Ataman-Hatipoglu Cigdem, Yilmaz Emel, Mete Bilgul, Kurtaran Behice, Ceran Nurgul, Karabay Oguz, Inan Dilara, Cengiz Melahat, Sacar Suzan, Yucesoy-Dede Behiye, Yilmaz Sibel, Agalar Canan, Bayindir Yasar, Alpay Yesim, Tosun Selma, Yilmaz Hava, Bodur Hurrem, Erdem Huseyin A, Dikici Nebahat, Dizbay Murat, Oncu Serkan, Sezak Nurbanu, Sari Tuba, Sipahi Oguz R, Uysal Serhat, Yeniiz Esma, Kaya Selcuk, Ulcay Asim, Kurt Halil, Besirbellioglu Bulent A, Vahaboglu Haluk, Tasova Yesim, Usluer Gaye, Arman Dilek, Diktas Husrev, Ulusoy Sercan, and Leblebicioglu Hakan

Subjects
Infectious disease, clinical microbiology, training, consultation, Therapeutics. Pharmacology, RM1-950, Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract

Abstract Background Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.

Published
2011
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11. Efficacy And Tolerability Of Antibiotic Combinations In Neurobrucellosis: Results Of The Istanbul Study

Author

Ayşe Seza Inal, Dilara Inan, Saim Dayan, Murat Dizbay, Gaye Usluer, Emel Yilmaz, Gürkan Mert, Nail Ozgunes, Başak Dokuzoğuz, Behice Kurtaran, Serhat Ünal, Mile Bosilkovski, Hakan Erdem, Sibel Gundes, Suzan Sacar, Maria Teresa Adeva-Bartolome, Ghaydaa A. Shehata, Hanefi Cem Gul, Mustafa Kasim Karahocagil, Suda Tekin-Koruk, Ahmet Karakaş, Bahadir Ceylan, Zeliha Kocak-Tufan, Levent Gorenek, Nazif Elaldi, Oğuz Reşat Sipahi, Hava Yilmaz, Nurgul Ceran, Yasar Bayindir, Asim Ulcay, Nese Saltoglu, Kenan Ugurlu, Yeşim Taşova, Funda Yetkin, Aysegul Ulu-Kilic, Rahmet Guner, Laila Abdel-Baky, Necla Eren-Tulek, Mustafa Kemal Çelen, Selim Kilic, Hakan Leblebicioglu, Saygin Nayman-Alpat, Vedat Turhan, İç Hastalıkları, Erdem, H., Kasimpasa Hospital, Department of Infectious Diseases and Clinical Microbiology (IDCM), Istanbul, Turkey -- Ulu-Kilic, A., Erciyes School of Medicine, Department of IDCM, Kayseri, Turkey -- Kilic, S., Gulhane Medical Academy, Department of Public Health, Ankara, Turkey -- Karahocagil, M., Yüzüncü Yil School of Medicine, Department of IDCM, Van, Turkey -- Shehata, G., Assiut University Hospital, Department of Neurology and Psychiatry, Assiut, Egypt -- Eren-Tulek, N., Ankara Training and Research Hospital, Ankara, Turkey -- Yetkin, F., Inonu School of Medicine, Department of IDCM, Malatya, Turkey -- Celen, M.K., Dicle School of Medicine, Department of IDCM, Diyarbakir, Turkey -- Ceran, N., Haydarpasa Numune Training and Research Hospital, Department of IDCM, Istanbul, Turkey -- Gul, H.C., Gulhane School of Medicine, Department of IDCM, Ankara, Turkey -- Mert, G., Gulhane School of Medicine, Department of IDCM, Ankara, Turkey -- Tekin-Koruk, S., Harran School of Medicine, Department of IDCM, Sanliurfa, Turkey -- Dizbay, M., Gazi School of Medicine, Department of IDCM, Ankara, Turkey -- Inal, A.S., Cukurova School of Medicine, Department of IDCM, Adana, Turkey -- Nayman-Alpat, S., Osmangazi School of Medicine, Department of IDCM, Eskisehir, Turkey -- Bosilkovski, M., Skopje Medical Faculty, Department of Infectious Diseases and Febrile Conditions, Skopje, Macedonia -- Inan, D., Akdeniz School of Medicine, Department of IDCM, Antalya, Turkey -- Saltoglu, N., Cerrahpasa School of Medicine, Department of IDCM, Istanbul, Turkey -- Abdel-Baky, L., Assiut University Hospital, Department of Tropical Medicine and Fever, Assiut, Egypt -- Adeva-Bartolome, M.T., Hospital Recoletas Zamora, Zamora, Spain -- Ceylan, B., Istanbul Training and Research Hospital, Department of IDCM, Istanbul, Turkey -- Sacar, S., Pamukkale School of Medicine, Department of IDCM, Denizli, Turkey -- Turhan, V., Haydarpasa Gulhane, Training and Research Hospital, Department of IDCM, Istanbul, Turkey -- Yilmaz, E., Uluda? School of Medicine, Department of IDCM, Bursa, Turkey -- Elaldi, N., Cumhuriyet School of Medicine, Department of IDCM, Sivas, Turkey -- Kocak-Tufan, Z., Ankara Training and Research Hospital, Ankara, Turkey -- U?urlu, K., Ankara Numune Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Dokuzo?uz, B., Ankara Ataturk Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Yilmaz, H., Ondokuz Mayis School of Medicine, Department of IDCM, Samsun, Turkey -- Gundes, S., Kocaeli School of Medicine, Department of IDCM, Kocaeli, Turkey -- Guner, R., Skopje Medical Faculty, Department of Infectious Diseases and Febrile Conditions, Skopje, Macedonia -- Ozgunes, N., Goztepe Training and Research Hospital, Department of IDCM, Istanbul, Turkey -- Ulcay, A., Kasimpasa Hospital, Department of Infectious Diseases and Clinical Microbiology (IDCM), Istanbul, Turkey -- Unal, S., Hacettepe University, Department of Internal Medicine, Ankara, Turkey -- Dayan, S., Dicle School of Medicine, Department of IDCM, Diyarbakir, Turkey -- Gorenek, L., Haydarpasa Gulhane, Training and Research Hospital, Department of IDCM, Istanbul, Turkey -- Karakas, A., Gulhane School of Medicine, Department of IDCM, Ankara, Turkey -- Tasova, Y., Cukurova School of Medicine, Department of IDCM, Adana, Turkey -- Usluer, G., Skopje Medical Faculty, Department of Infectious Diseases and Febrile Conditions, Skopje, Macedonia -- Bayindir, Y., Inonu School of Medicine, Department of IDCM, Malatya, Turkey -- Kurtaran, B., Cukurova School of Medicine, Department of IDCM, Adana, Turkey -- Sipahi, O.R., Ege School of Medicine, Department of IDCM, Izmir, Turkey -- Leblebiciogluz, H., Ondokuz Mayis School of Medicine, Department of IDCM, Samsun, Turkey, Ege Üniversitesi, OMÜ, Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı., and Yılmaz, Emel

Subjects
Nervous-system brucellosis, Male, Turkey, Antibiotics, Medical record review, Olfactory nerve disease, Meningoencephalitis, Esophagitis, Pharmacology (medical), Trimethoprim-sulfamethoxazole combination, Treatment outcome, Doxycycline, Depression, Vestibulocochlear nerve disease, Comparative effectiveness, Management, Retrospective study, Drug Therapy, Combination, Rifampin, Human, medicine.medical_specialty, Major clinical study, Side effect, Clinical Therapeutics, Oculomotor nerve disease, Microbiology, Article, Treatment duration, Brain ischemia, Drug substitution, Pharmacotherapy, Hypoglossal nerve disease, Brucellosis, Agglutination Tests, Zoonosis, Humans, Brain hematoma, Aged, Retrospective Studies, Pharmacology, Abducens nerve disease, Antibiotic therapy, medicine.disease, Brucella, Trimethoprim, Cotrimoxazole, Regimen, ComputingMethodologies_PATTERNRECOGNITION, Brucellar meningoencephalitis, Drug eruption, Bacterial meningitis, Administration, Oral, Turkey (republic), Recurrence, Nausea and vomiting, Diagnosis, Clinical protocol, Visual disorder, Treatment Failure, Pharmacology & Pharmacy, Relapse, Priority journal, Drug tolerability, Drug withdrawal, Ceftriaxone, Middle Aged, Anti-Bacterial Agents, Paresis, Brain abscess, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, Infectious Diseases, Tolerability, Gastritis, Injections, Intravenous, Female, InformationSystems_MISCELLANEOUS, Meningitis, Hydrocephalus, medicine.drug, Adult, Adolescent, medicine.drug_class, Optic nerve disease, Therapeutic features, Facial nerve disease, Bacterial-meningitis, Polyneuropathy, Internal medicine, Trimethoprim, Sulfamethoxazole Drug Combination, medicine, Subarachnoid hemorrhage, Rifampicin, business.industry, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, Brucellar meningitis, Thrombocytopenia, Surgery, Drug efficacy, Drug treatment failure, Aminotransferase blood level, business, Controlled study
Abstract

PubMed ID: 22155822, No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Published
2012

12. Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

Author

Tuba Sari, Aysegul Ulu-Kilic, İbrahim Koruk, Haluk Vahaboglu, Yasar Bayindir, Necla Eren-Tulek, Cigdem Ataman-Hatipoglu, Hakan Erdem, Bilgul Mete, Serhat Birengel, Selma Tosun, Yeşim Taşova, Bulent Ahmet Besirbellioglu, Nurbanu Sezak, Serhat Uysal, Yeşim Alpay, Hakan Leblebicioglu, Saygin Nayman-Alpat, Melahat Cengiz, Halil Kurt, Tuna Demirdal, Sibel Yilmaz, Oğuz Reşat Sipahi, Behiye Yucesoy-Dede, Hava Yilmaz, Esma Yeniiz, Sercan Ulusoy, Nurgul Ceran, Hurrem Bodur, Behice Kurtaran, Canan Agalar, Dilek Arman, Gaye Usluer, Rahmet Guner, Nazif Elaldi, Husrev Diktas, Gürkan Mert, Suzan Sacar, Nebahat Dikici, Dilara Inan, Asim Ulcay, Hüseyin Aytaç Erdem, Derya Tozlu-Keten, Serkan Oncu, Selçuk Kaya, Oral Oncul, Murat Dizbay, Emel Yilmaz, Suda Tekin-Koruk, Oguz Karabay, Erdem, H., Kasimpasa Hospital, Department of Infectious Diseases and Clinical Microbiology (IDCM), Istanbul, Turkey -- Tekin-Koruk, S., Harran University, School of Medicine, Department of IDCM, Sanliurfa, Turkey -- Koruk, I., Harran University, School of Medicine, Department of Public Health, Sanliurfa, Turkey -- Tozlu-Keten, D., Gazi University, School of Medicine, Department of IDCM, Ankara, Turkey -- Ulu-Kilic, A., Erciyes University, School of Medicine, Department of IDCM, Ankara, Turkey -- Oncul, O., Gulhane Haydarpasa Hospital, Department of IDCM, Istanbul, Turkey -- Guner, R., Ataturk Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Birengel, S., Ankara University, School of Medicine, Department of IDCM, Ankara, Turkey -- Mert, G., Gulhane Medical Academy, Department of IDCM, Ankara, Turkey -- Nayman-Alpat, S., Osmangazi School of Medicine, Department of IDCM, Eskisehir, Turkey -- Eren-Tulek, N., Ankara Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Demirdal, T., Kocatepe School of Medicine, Department of IDCM, Afyon, Turkey -- Elaldi, N., Cumhuriyet School of Medicine, Department of IDCM, Sivas, Turkey -- Ataman-Hatipoglu, C., Ankara Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Yilmaz, E., Uludag School of Medicine, Department of IDCM, Bursa, Turkey -- Mete, B., Cerrahpasa School of Medicine, Department of IDCM, Istanbul, Turkey -- Kurtaran, B., Cukurova School of Medicine, Department of IDCM, Adana, Turkey -- Ceran, N., Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey -- Karabay, O., Sakarya School of Medicine, Department of IDCM, Sakarya, Turkey -- Inan, D., Akdeniz School of Medicine, Department of IDCM, Antalya, Turkey -- Cengiz, M., Maltepe School of Medicine, Department of IDCM, Istanbul, Turkey -- Sacar, S., Pamukkale School of Medicine, Department of IDCM, Denizli, Turkey -- Yucesoy-Dede, B., Uskudar State Hospital, Department of IDCM, Istanbul, Turkey -- Yilmaz, S., Ataturk School of Medicine, Department of IDCM, Erzurum, Turkey -- Agalar, C., Kirikkale School of Medicine, Department of IDCM, Kirikkale, Turkey -- Bayindir, Y., Inonu School of Medicine, Department of IDCM, Malatya, Turkey -- Alpay, Y., Cengiz Gokcek State Hospital, Department of IDCM, Gaziantep, Turkey -- Tosun, S., Manisa State Hospital, Department of IDCM, Manisa, Turkey -- Yilmaz, H., Ondokuzmayis School of Medicine, Department of IDCM, Samsun, Turkey -- Bodur, H., Numune Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Erdem, H.A., Ege School of Medicine, Department of IDCM, Izmir, Turkey -- Dikici, N., Selcuklu School of Medicine, Department of IDCM, Konya, Turkey -- Dizbay, M., Gazi University, School of Medicine, Department of IDCM, Ankara, Turkey -- Oncu, S., Adnan Menderes School of Medicine, Department of IDCM, Aydin, Turkey -- Sezak, N., Manisa State Hospital, Department of IDCM, Manisa, Turkey -- Sari, T., Ankara Training and Research Hospital, Department of IDCM, Ankara, Turkey -- Sipahi, O.R., Ege School of Medicine, Department of IDCM, Izmir, Turkey -- Uysal, S., Ege School of Medicine, Department of IDCM, Izmir, Turkey -- Yeniiz, E., Girne Military Hospital, Department of IDCM, Girne, Turkey -- Kaya, S., Karadeniz School of Medicine, Department of IDCM, Trabzon, Turkey -- Ulcay, A., Kasimpasa Hospital, Department of Infectious Diseases and Clinical Microbiology (IDCM), Istanbul, Turkey -- Kurt, H., Ankara University, School of Medicine, Department of IDCM, Ankara, Turkey -- Besirbellioglu, B.A., Gulhane Medical Academy, Department of IDCM, Ankara, Turkey -- Vahaboglu, H., Kocaeli School of Medicine, Department of IDCM, Kocaeli, Turkey -- Tasova, Y., Cukurova School of Medicine, Department of IDCM, Adana, Turkey -- Usluer, G., Osmangazi School of Medicine, Department of IDCM, Eskisehir, Turkey -- Arman, D., Gazi University, School of Medicine, Department of IDCM, Ankara, Turkey -- Diktas, H., Gulhane Haydarpasa Hospital, Department of IDCM, Istanbul, Turkey -- Ulusoy, S., Ege School of Medicine, Department of IDCM, Izmir, Turkey -- Leblebicioglu, H., Ondokuzmayis School of Medicine, Department of IDCM, Samsun, Turkey, Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı., Yılmaz, Emel, Maltepe Üniversitesi, and Ege Üniversitesi

Subjects
Male, Pathology, Pulmonology, Turkey, Infectious disease, clinical microbiology, training, consultation, Resistance, lcsh:QR1-502, lcsh:Microbiology, Turkey (republic), Antimicrobial therapy, Medical microbiology, Endocrinology, Septic shock, Organization and management, Urologic surgery, Pulmonary Medicine, Medicine, Internal medicine, Referral and Consultation, Orthopedic surgery, Infectious Disease Medicine, Gastroenterology, General Medicine, Hematology, Patient referral, Clinical microbiology, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, Infectious Diseases, Neurology, Nephrology, Female, Education, Medical, Continuing, Medical emergency, InformationSystems_MISCELLANEOUS, Infection, Eye surgery, Needs Assessment, Human, Risk, Adult, Medical education, Microbiology (medical), medicine.medical_specialty, education, Cardiology, Neurosurgery, One Health Initiative, Curricula, University Teacher, Major clinical study, Dermatology, Microbiology, Article, lcsh:Infectious and parasitic diseases, Disease course, Education, Sepsis, otorhinolaryngologic diseases, Training, Humans, lcsh:RC109-216, Appropriateness, General surgery, Cross-sectional study, Consultation, business.industry, Research, lcsh:RM1-950, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, Methodology, medicine.disease, Professional knowledge, Specialists, stomatognathic diseases, lcsh:Therapeutics. Pharmacology, ComputingMethodologies_PATTERNRECOGNITION, Cross-Sectional Studies, Infectious disease (medical specialty), business, Clinical skills
Abstract

PubMed ID: 22177310, Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole. © 2011 Erdem et al; licensee BioMed Central Ltd.

Published
2011

13. A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model.

Author

Diktas H, Uysal S, Erdem H, Cag Y, Miftode E, Durmus G, Ulu-Kilic A, Alabay S, Szabo BG, Lakatos B, Fernandez R, Korkmaz P, Caliz MC, Argemi X, Kulzhanova S, Kormaz F, Yilmaz-Karadag F, Ergen P, Atilla A, Puca E, Dogan M, Mangani F, Sahin S, Grgić S, Grozdanovski K, Yilmaz GR, Del-Vecchio RF, Demirel A, Sirmatel F, Şener A, Sacar S, Aydin E, Batirel A, Dragovac G, El-Sokkary R, Alexandru C, Arslan-Ozel S, Bolukcu S, Ozkaya HD, Nayman-Alpat S, Inan A, Al-Majid F, Kaya-Ugur B, and Rello J

Subjects
Aged, Community-Acquired Infections diagnosis, Community-Acquired Infections mortality, Female, Hospitalization statistics & numerical data, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Prospective Studies, Risk Factors, Sepsis diagnosis, Severity of Illness Index, Hospital Mortality, Sepsis mortality
Abstract

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

Published
2020
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14. Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study.

Author

Ozturk-Engin D, Erdem H, Hasbun R, Wang SH, Tireli H, Tattevin P, Argemi X, Ouamara-Digue E, Gombos A, Lakatos B, Sırmatel F, Cag Y, Pekok AU, Senbayrak S, Balkan II, Gheno M, Uzun N, Kaya S, Cicek-Senturk G, Şengöz G, Tekin R, Çelen MK, Nayman-Alpat S, Ergen P, Şener A, Agalar C, Köse S, Inkaya AÇ, Kaptan F, Al-Majid F, Savasci U, and Vahaboglu H

Subjects
Adult, Anti-Bacterial Agents therapeutic use, Cohort Studies, Diplopia, Female, Headache, Humans, Length of Stay, Male, Middle Aged, Neurosyphilis diagnosis, Neurosyphilis drug therapy, Treatment Outcome, Neurosyphilis epidemiology, Neurosyphilis physiopathology
Abstract

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.

Published
2019
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15. Mortality indicators in pneumococcal meningitis: therapeutic implications.

Author

Erdem H, Elaldi N, Öztoprak N, Sengoz G, Ak O, Kaya S, Inan A, Nayman-Alpat S, Ulu-Kilic A, Pekok AU, Gunduz A, Gozel MG, Pehlivanoglu F, Yasar K, Yılmaz H, Hatipoglu M, Cicek-Senturk G, Akcam FZ, Inkaya AC, Kazak E, Sagmak-Tartar A, Tekin R, Ozturk-Engin D, Ersoy Y, Sipahi OR, Guven T, Tuncer-Ertem G, Alabay S, Akbulut A, Balkan II, Oncul O, Cetin B, Dayan S, Ersoz G, Karakas A, Ozgunes N, Sener A, Yesilkaya A, Erturk A, Gundes S, Karabay O, Sirmatel F, Tosun S, Turhan V, Yalci A, Akkoyunlu Y, Aydın E, Diktas H, Kose S, Ulcay A, Seyman D, Savasci U, Leblebicioglu H, and Vahaboglu H

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Drug Therapy, Combination, Female, Humans, Male, Meningitis, Pneumococcal mortality, Microbial Sensitivity Tests, Middle Aged, Penicillins pharmacology, Retrospective Studies, Treatment Outcome, Turkey epidemiology, Young Adult, Anti-Bacterial Agents therapeutic use, Ceftriaxone therapeutic use, Cephalosporins therapeutic use, Meningitis, Pneumococcal drug therapy, Penicillin Resistance, Vancomycin therapeutic use
Abstract

Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications., Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers., Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912)., Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment., (Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2014
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16. Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study.

Author

Erdem H, Ulu-Kilic A, Kilic S, Karahocagil M, Shehata G, Eren-Tulek N, Yetkin F, Celen MK, Ceran N, Gul HC, Mert G, Tekin-Koruk S, Dizbay M, Inal AS, Nayman-Alpat S, Bosilkovski M, Inan D, Saltoglu N, Abdel-Baky L, Adeva-Bartolome MT, Ceylan B, Sacar S, Turhan V, Yilmaz E, Elaldi N, Kocak-Tufan Z, Ugurlu K, Dokuzoguz B, Yilmaz H, Gundes S, Guner R, Ozgunes N, Ulcay A, Unal S, Dayan S, Gorenek L, Karakas A, Tasova Y, Usluer G, Bayindir Y, Kurtaran B, Sipahi OR, and Leblebicioglu H

Subjects
Administration, Oral, Adolescent, Adult, Aged, Anti-Bacterial Agents therapeutic use, Brucella growth & development, Brucellosis microbiology, Ceftriaxone administration & dosage, Ceftriaxone therapeutic use, Doxycycline administration & dosage, Doxycycline therapeutic use, Drug Therapy, Combination, Female, Humans, Injections, Intravenous, Male, Meningitis microbiology, Meningoencephalitis drug therapy, Meningoencephalitis microbiology, Middle Aged, Recurrence, Retrospective Studies, Rifampin administration & dosage, Rifampin therapeutic use, Treatment Failure, Trimethoprim, Sulfamethoxazole Drug Combination administration & dosage, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Turkey, Anti-Bacterial Agents administration & dosage, Brucella drug effects, Brucellosis drug therapy, Meningitis drug therapy
Abstract

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Published
2012
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17. Clinical and Epidemiologic Characteristics of Hospitalized Patients with 2009 H1N1 Influenza Infection.

Author

Nayman Alpat S, Usluer G, Ozgunes I, Doyuk Kartal E, and Erben N

Abstract

Objective. 2009 H1N1 virus is a new virus that was firstly detected in April 2009. This virus spreads from human to human and causes a worldwide disease. This paper aimed to review the clinical and epidemiological properties of patients with 2009 H1N1 influenza who were hospitalized and monitored at Eskisehir Osmangazi University Faculty of Medicine Hospital. Setting. A 1000-bed teaching hospital in Eskisehir, Turkey. Patients-Methods. Between 05 November 2009-01 February 2010, 106 patients with 2009 H1N1 influenza, who were hospitalized, were prospectively evaluated. Results. Out of 106 patients who were hospitalized and monitored, 99 (93.4%) had fever, 86 (81.1%) had cough, 48 (45.3%) had shortness of breath, 47 (44.3%) had sore throat, 38 (35.8%) had body pain, 30 (28.3%) had rhinorrhea, 17 (16%) had vomiting, 15 (14.2%) had headache, and 14 (13.2%) had diarrhea. When the patients were examined in terms of risk factors for severe disease, 83 (78.3%) patients had at least one risk factor. During clinical monitoring, pneumonia was the most frequent complication with a rate of 66%. While 47.2% of the patients were monitored in intensive care unit, 34% of them required mechanical ventilation support. Conclusion. Patients with 2009 H1N1 influenza, who were hospitalized and monitored, should be carefully monitored and treated.

Published
2012
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18. [Evaluation of risk factors in patients with candiduria].

Author

Nayman Alpat S, Özguneş I, Ertem OT, Erben N, Doyuk Kartal E, Tözun M, and Usluer G

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents therapeutic use, Candidiasis etiology, Case-Control Studies, Cross Infection etiology, Female, Humans, Immunosuppression Therapy adverse effects, Length of Stay, Male, Middle Aged, Risk Factors, Urinary Catheterization adverse effects, Urinary Tract Infections etiology, Young Adult, Candida classification, Candidiasis epidemiology, Cross Infection epidemiology, Urinary Tract Infections epidemiology
Abstract

Urinary system infections are usually bacterial, however, fungal etiology, particularly Candida spp. are encountered in about 10% of these infections. C.albicans is still the most frequently isolated species in candiduria. This study was aimed to identify the risk factors of candiduria and to determine species distribution of Candida which cause candiduria in hospitalized patients. The study was carried out in a total of 93 hospitalized patients (68 female, 25 male; age range: 17-84 yrs, mean age: 59.5 ± 1.7 yrs) of which 50 presented with candiduria (case group) and 43 with bacteriuria (control group), between January 2009 to December 2009. The most frequently isolated species was C.albicans (n= 32; 64%), followed by C.glabrata (n= 13; 26%), C.tropicalis (n= 4; 8%) and C.krusei (n= 1; 2%). All of the isolates except one, were found susceptible to fluconazole and voriconazole by E-test (AB Biodisk, Sweden), however, C.krusei isolate was resistant to fluconazole and susceptible to voriconazole. The mean hospitalization period and the period of stay in intensive care unit (ICU) of the case group (9.56 ± 9.09 and 4.12 ± 7.05 days, respectively) were found statistically significant compared to control group (4.42 ± 3.71 and 0.53 ± 1.78, respectively) (p< 0.005). Nosocomial origin of infection was higher in control group (n= 45, 90%) than the case group (n= 30, 69.8%), (p= 0.014). The rate of antibiotic use prior to candiduria in the case group was detected significantly higher (n= 43; 86%) than the controls (n= 14; 32.6%) (p= 0.000). The most frequently used antibiotic prior to candiduria/bacteriuria was the quinolone group of agents both in case and control groups (42% and 21%, respectively). The other risk factors for candiduria found to be higher in the case group than the controls were as follows; presence of urinary system intervention (32% and 0, respectively; p= 0.000), catheter use (76% and 46.5%, respectively; p= 0.003) and immunosuppression history (24% and 9.3%, respectively; p= 0.041). However, there was no significant relationship between candiduria and history of surgical intervention, diabetes mellitus and renal failure (p> 0.05). In conclusion, rate of candiduria might be reduced by judicious antibiotic use, by implementation of guidelines for urinary catheter use, care and maintenance, and shortening the duration of ICU and hospital stay.

Published
2011

19. [In vitro tigecycline and carbapenem susceptibilities of clinical Acinetobacter baumannii isolates].

Author

Nayman Alpat S, Aybey AD, Akşit F, Ozgüneş I, Kiremitçi A, and Usluer G

Subjects
Acinetobacter Infections drug therapy, Acinetobacter baumannii isolation & purification, Anti-Bacterial Agents therapeutic use, Carbapenems therapeutic use, Cross Infection drug therapy, Humans, Microbial Sensitivity Tests, Minocycline pharmacology, Minocycline therapeutic use, Tigecycline, Acinetobacter Infections microbiology, Acinetobacter baumannii drug effects, Anti-Bacterial Agents pharmacology, Carbapenems pharmacology, Cross Infection microbiology, Minocycline analogs & derivatives
Abstract

Acinetobacter baumannii is a frequent cause of nosocomial infections in most hospitals. Management of infections caused by these strains is difficult, as the strains often display multiple drug resistance, including carbapenem. Tigecycline which is a glycylcycline derivative has antimicrobial activity against many gram-positive and gram-negative organisms. In this study, in vitro activity of tigecycline and carbapenems against clinical isolates of A.baumannii strains were investigated. A total of 100 A.baumannii isolates were collected from hospitalized patients with documented nosocomial infections [pneumonia (n = 39), surgical wound infection (n = 32), bacteremia (n = 16), catheter infection (n = 6), urinary tract infection (n = 5), peritonitis (n = 1), eye infection (n = 1)] between October 2006 and June 2007. Only one isolate per patient was included to the study. Minimum inhibitory concentrations (MIC) of tigecycline were determined by E-test (AB Biodisk, Sweden). Carbapenem resistance of A.baumannii strains were determined by disk diffusion method. All of the 100 A.baumannii isolates (100%) were found susceptible to tigecycline (MIC values ≤ 2 µg/ml; MIC ranges: 0.032-1.5 µg/ml). Imipenem susceptibility test was performed for 95 strains, and 36 (37.9%) were found sensitive, 18 (18.9%) were intermediate sensitive, and 41 (43.2%) were resistant. Meropenem susceptibility test was performed for 87 strains, and 22 (25.3%) were found sensitive, 9 (10.3%) were intermediate sensitive, and 56 (64.4%) were resistant. Since tigecycline is found quite effective on nosocomial A.baumannii isolates, it may be considered as a treatment alternative in infections caused by carbapenem-resistant Acinetobacter spp.

Published
2010

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