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The aim of this study was to investigate the predictive factors which contribute to diagnosis of hantavirus infection. One hundred patients from rural areas hospitalized with a preliminary diagnosis of hantavirus infection from different... more
The aim of this study was to investigate the predictive factors which contribute to diagnosis of hantavirus infection. One hundred patients from rural areas hospitalized with a preliminary diagnosis of hantavirus infection from different hospitals in Turkey were investigated. Hantavirus infection was confirmed in 20 patients (Group 1) using immunofluorescence and immunoblot assays at the Refik Saydam National Public Health Agency. Hantaviruses were not detected in the serum of the remaining 80 patients, other infectious and non-infectious diseases being diagnosed in this group (Group 2). Patients' demographic characteristics and clinical and laboratory data on admission were examined and compared between the two groups. Fever, proteinuria, hematuria, lethargy-weakness, and nausea-vomiting were the most frequent symptoms and findings in Group 1, seen in almost all patients. Proteinuria, hematuria, muscle pain, diarrhea/abdominal pain, hypotension, shock, and sweating were observed at significantly higher levels in Group 1 compared to Group 2. Serum urea, creatinine, uric acid, lactate dehydrogenase (LDH), aspartate transaminase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) were significantly higher, but serum platelet counts were lower in Group 1 patients. Area beneath the receiver operating characteristics (ROC) curve analysis was used to calculate the discriminative ability of various laboratory values to identify patients with hantavirus infection. This analysis revealed that, serum CRP had a 100% negative predictive value, whilst, platelet, and creatinine had 75% and 70% positive predictive values for the diagnosis of hantavirus infection. In summary, laboratory markers used in clinical practice are of great importance predicting hantavirus infections.
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Microbiology, Gastroenterology, Medical Microbiology, Medicine, Humans, and 15 moreInternal Medicine, Clinical Medicine, Female, Male, Aged, Middle Aged, Adult, Medical virology, Hantavirus, Proteinuria, Predictive value of tests, Creatinine, Cohort Studies, Lethargy, and Decision Support Techniques
This study was intended to investigate the clinical significance and molecular epidemiology of Acinetobacter baumannii complex (ABC) isolated from cerebrospinal fluid (CSF) in neurosurgical intensive care unit (NSICU) patients,... more
This study was intended to investigate the clinical significance and molecular epidemiology of Acinetobacter baumannii complex (ABC) isolated from cerebrospinal fluid (CSF) in neurosurgical intensive care unit (NSICU) patients, particularly comparing isolates from healthcare workers' (HCW) hands. We retrospectively reviewed the medical records of 30 patients with CSF cultures positive for ABC seen at our NSICU from the date it first opened, January 2007, to September 2010. Pulsed-field gel electrophoresis (PFGE) typing was performed on 68 strains isolated from 32 patients' CSF and 36 HCWs' hands. ABC isolates were considered to be clinically significant in 21 (70.0%) patients but insignificant in the other nine (30.0%) patients. The prolonged (>7 days) use of cephalosporins was more common in patients with clinically significant ABC isolates (p = 0.049). Multiple drug resistance (MDR) was observed in 12 (57.1%) clinically significant isolates. Empirical antimicrobial therapies were not appropriate for nine of these 21 patients (42.8%). Mortality was significantly higher in the clinically significant group than in the clinically insignificant group (18/21 vs. 3/9; p = 0.008). Fifty-three isolates (77.9%) were grouped into 15 clusters, three of which contained possibly related isolates from patients' CSF and staff members' hands. The fact that ABC isolates grown from CSF cultures do not always exhibit infection and have high multiple antibiotic resistance, including to carbapenems, should be borne in mind when planning treatment for these patients. In addition, HCWs' hands may play a significant role in transmission to patients, and compliance with infection control procedures, especially hand washing, must be enhanced in order to avoid ABC infections.
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Epidemiology, Medical Microbiology, Medicine, Cerebrospinal Fluid, Humans, and 15 moreInternal Medicine, Infection Control, Female, Infection, Male, Clinical Sciences, Antibiotics, Intensive Care Unit, Aged, Adult, Hand, Acinetobacter baumannii, Intensive Care Units, Acinetobacter Infections, and Cross Infection
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Microbiology, Gastroenterology, Medical Microbiology, Infectious Diseases, Adolescent, and 15 moreMedicine, Humans, Internal Medicine, Female, Male, Aged, Middle Aged, C reactive protein, Biomarker, Adult, Biological markers, Febrile Neutropenia, Calcitonin, Case Control Studies, and Hematologic neoplasms
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Quality of life, Turkey, Medicine, Prospective studies, Hepatitis B, and 14 moreHumans, Internal Medicine, Female, Male, Aged, Middle Aged, Adult, Public health systems and services research, Cross Sectional Studies, chronic hepatitis B, Antiviral Agents, HBsAg, health status indicators, and Interviews as topic
The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed... more
The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.
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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... more
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...
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Quality of life, Turkey, Medicine, Prospective studies, Hepatitis B, and 14 moreHumans, Internal Medicine, Female, Male, Aged, Middle Aged, Adult, Public health systems and services research, Cross Sectional Studies, chronic hepatitis B, Antiviral Agents, HBsAg, health status indicators, and Interviews as topic
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The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed... more
The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.
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Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME... more
Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combi...
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Microbiology, Medical Microbiology, Treatment Outcome, Medicine, Herpes Simplex, and 15 moreHumans, Internal Medicine, Female, Male, Confidence intervals, Glasgow Coma Scale, Middle Aged, Adult, Odds ratio, Retrospective Studies, Encephalitis, Meningoencephalitis, Confidence Interval, Antiviral Agents, and Pharmacology and pharmaceutical sciences
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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... more
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 resu...
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Microbiology, Neurology, Pulmonology, Consultation, Medical Microbiology, and 14 moreTraining, Turkey, Dermatology, Medicine, Clinical Microbiology, Continuing Medical Education, Humans, Internal Medicine, Needs Assessment, Infectious Disease, Clinical Sciences, Pulmonary Medicine, Cross Sectional Studies, and Referral and consultation
In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of... more
In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant. Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs.
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Epidemiology, Medical Microbiology, Turkey, Communicable Diseases, Medicine, and 15 moreFrance, Biological Sciences, Humans, Infection Control, Female, TURKISH, Male, Aged, Middle Aged, Anti-Bacterial Agents, Adult, Patient Care, Cross sectional Study, Cross Sectional Studies, and Medical and Health Sciences
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To determine predictive fatality criteria based on clinical and laboratory findings on admission to hospital in patients diagnosed with pandemic influenza A (H1N1) virus infection. The study was conducted at the School of Medicine,... more
To determine predictive fatality criteria based on clinical and laboratory findings on admission to hospital in patients diagnosed with pandemic influenza A (H1N1) virus infection. The study was conducted at the School of Medicine, Karadeniz Technical University, Trabzon, Turkey. Demographic, clinical, and laboratory data for hospitalized cases with a diagnosis of A (H1N1) virus infection between October 2009 and May 2010 were analyzed retrospectively. Patients were divided into 2 groups: fatal (group I) and non-fatal (group II). The 2 group's demographic, clinical, and laboratory data were compared on admission. Ten (20%) of the 50 patients included in the study died. The average age of group I was significantly higher than that of the group II. No significant difference was observed between the groups in terms of underlying chronic diseases and pregnancy. Fever, phlegm, shortness of breath, tachypnea, cyanosis were observed at significantly higher levels in group I compared to group II. Serum hemoglobin, glucose, albumin levels, arterial oxygen saturation were significantly lower in group I compared to group II; aspartate transaminase, alanine aminotransferase, C-reactive protein, procalcitonin, blood urea nitrogen levels, time between onset of symptoms and commencement of antiviral treatment were all significantly higher in group I. This study shows that in addition to demographic characteristics and clinical findings, prognosis of patients with A (H1N1) virus infection can be determined beforehand with various laboratory tests. But these parameters, which can guide the clinician in the prior identification of potentially fatal A (H1N1) cases will contribute to the provision of supporting treatment and, when necessary, intensive care services for such patients.
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Obstetrics, Adolescent, Medicine, Humans, Female, and 15 moreCandidiasis, Hygiene, Reproductive Tract Infections, Prevalence, Middle Aged, Questionnaires, Gynecology, Adult, Risk Factors, Cross Sectional Studies, Logistic Models, IntraUterine Devices, Escherichia Coli Infections, Interviews as topic, and Paediatrics and reproductive medicine
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Africa, Developing Countries, Adolescent, Antibiotic Resistance, Child, and 15 moreDeveloping Country, Bacterial resistance, Europe, Clinical Medicine, Asia, Bacteria, American, Data Collection, Clinical Sciences, Aged, Adult, Bacterial infections, Basic Medicine, Dynamic Networks, and Cross Infection
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Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin... more
Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin involvements are less frequent. In this case report, a 36-years-old female patient with fever, arthralgia, disseminated macular rash at the extremities and body and peripheral polineuropathy has been presented. The patient, living at a rural area, had a history of consumption of raw milk products. Polyneuropathy of the patient presenting as glove-sock type paresthesia was evaluated with electromyography and reported as mild demyelinated sensorial polyneuropathy and radiculopathy compatible with right L(4-5) involvement. Brucella agglutination test was found to be positive at a titer of 1/1280 in the serum sample. Other bacterial and viral agents presenting with maculopapular rash were ruled out by serological tests. Bacterial growth was detected in ...
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Hantaviruses which are the members of Bunyaviridae, differ from other members of this family since they are transmitted to humans by rodents. More than 200.000 cases of hantavirus infections are reported annually worldwide. Hantaviruses... more
Hantaviruses which are the members of Bunyaviridae, differ from other members of this family since they are transmitted to humans by rodents. More than 200.000 cases of hantavirus infections are reported annually worldwide. Hantaviruses can lead to two different types of infection in humans, namely, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). HFRS is the most common type of hantavirus infection in Europe and Asia and the most common virus types are Dobrava, Puumala, Hantaan and Seoul. A total of 25 hantavirus suspected cases have been reported from the Western Black Sea region of Turkey and 12 of these were confirmed serologically as "Puumala" subtype. Serological tests such as indirect immunofluorescence assay (IFA), are used for diagnosis and typing of the hantaviruses, however, since cross-reactions are common between the subtypes, the results of these tests should be confirmed by other methods. In this report two cases with han...
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Amac: Bu calismada hematolojik malignitesi olan ve flukonazol (FLU) veya posakonazol (POS) proflaksisi uygulanan hastalarda gorulen fungal enfeksiyon sikligi ve mortalite oranlari karsilasildi. Yontemler: Bu retrospektif, gozlemsel... more
Amac: Bu calismada hematolojik malignitesi olan ve flukonazol (FLU) veya posakonazol (POS) proflaksisi uygulanan hastalarda gorulen fungal enfeksiyon sikligi ve mortalite oranlari karsilasildi. Yontemler: Bu retrospektif, gozlemsel calismada 01 Ocak 2011-01 Ocak 2013 tarihleri arasinda hastanemiz hematoloji kliniginde hematolojik malignite tanisiyla izlenmekte olan hastalara verilen antifungal profilaksiler degerlendirildi. Birer yillik 2 donemin ilkinde, hastalara proflaktik olarak FLU, 2.donemde ise POS uygulandi. Bulgular: FLU proflaksisi alan hastalarda gorulen fungal enfeksiyon sikligi 22/70 (31%) iken, POS alan hastalarda 13/35 (37%) oldugu goruldu. Invaziv pulmoner aspergilloz (IPA) gorulme sikligi FLU kolunda 21/70 (31%) bulunurken, POS kolunda bu oran 9/35 (%26) bulundu. FLU proflaksisi alan gruptan 17 hasta oldu (%24), POS alan gruptan ise 4 (%11) hasta oldu. Bu farkin fungal enfeksiyon disi nedenlerden kaynaklandigi dusunuldu. AML icin yapilan subgrup analizinde fungal enfeksiyon sikligi ve mortalite oranlari bakimindan sonuclar, genel sonuclarla benzerdi. Coklu varyasyon analizinde hastalardaki ortalama notropeni suresinin uzunluguyla fungal proflaksi basarisizligi arasinda iliski bulundu.Sonuc: Her iki ajanin da yuksek riskli hastalardaki fungal enfeksiyon proflaksisinde basariyla kullanilabilecegi sonucuna varildi
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This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic... more
This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic factors, he was discharged in a healthy condition after 17 days of hospitalization with close monitoring and supportive care. Tranexamic acid was successfully used together with other supportive treatments.
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Abstract: Objective: In this study, epidemiological characteristics, clinical and laboratory findings of HIV/AIDS cases were analyzed. Methods: Thirty-six cases with HIV/AIDS who applied to our department between 1999 and 2009 were... more
Abstract: Objective: In this study, epidemiological characteristics, clinical and laboratory findings of HIV/AIDS cases were analyzed. Methods: Thirty-six cases with HIV/AIDS who applied to our department between 1999 and 2009 were examined retrospectively. ...
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Developing Countries, Medicine, Critical Care Medicine, Cities, Humans, and 15 moreInfection Control, Hospitalization, Female, Infection, Male, Clinical Sciences, Aged, Middle Aged, Adult, Intensive Care Units, Communicable disease control, Cohort Studies, Health Personnel, Guideline Adherence, and Cross Infection
Background.The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance... more
Background.The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line–associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership.Methods.Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line–days). Process surveillance results at baseline were compared with intervention period data.Results.During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line–days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line–days; relative risk, 0.46 [95% confidence interval, 0.33–0.63];P