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    Identifying risk factors for blood culture negative infective endocarditis: An international ID-IRI study
    (Elsevier Sci Ltd, 2024) Filiz, Mine; Erdem, Hakan; Ankarali, Handan; Puca, Edmond; Ruch, Yvon; Santos, Lurdes; Fasciana, Teresa
    Background: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963-0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970-4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564-6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012-2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599-4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC +/- SE = 0.707 +/- 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. Conclusion: Caution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.
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    Managing adult patients with infectious diseases in emergency departments: international ID-IRI study
    (Taylor & Francis Ltd, 2020) Erdem, Hakan; Hargreaves, Sally; Ankarali, Handan; Caskurlu, Hulya; Ceviker, Sevil Alkan; Bahar-Kacmaz, Asiye; Alsalman, Jameela
    We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 +/- 0.74. Sepsis (qSOFA >= 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 +/- 0.963) compared to upper-middle (0.17 +/- 0.482) and high-income (0.36 +/- 0.714) countries ( P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.
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    The Predictors of COVID-19 Immunogenicity Elicited by Vaccines Against SARS-CoV-2 in Stem Cell Transplant Recipients
    (Bilimsel Tip Yayinevi, 2024) Elbahr, Umran; Erdem, Hakan; Ankarali, Handan; Reyes, Clark Steven Delos; Pastrana, Jennie; Vineeth, Chithra; Hejres, Suha
    Introduction: The literature falls short in providing thorough investigations into the influence of COVID-19 vaccination among those undergoing hematopoietic stem cell transplantation (HSCT). Materials and Methods: This prospective study evaluates COVID-19 antibody levels in HSCT recipients. The HSCT patients, having undergone transplantation at least three months prior, received BNT162b2 mRNA, Gam-COVID-Vac adenoviral, or BBIBP-CorV inactivated vaccines. Blood samples were taken 2-24 weeks post second dose. Results: The study involved 28 participants, comprising nine allogeneic-HSCT and 19 autologous-HSCT recipients. Among them, 18 (64.2%) exhibited positive results in SARS-CoV-2 neutralizing antibody tests, occurring at a median of 10.5 weeks (ranging from 2 to 24 weeks). In multivariate logistic regression analysis, age and a higher Charlson Comorbidity Index emerged as statistically significant variables linked with suboptimal antibody responses. Interestingly, no significant disparities surfaced in terms of anti-SARSCoV-2 spike, SARS-CoV-2 (IgG + neutralizing) antibodies, and SARS-CoV-2 (neutralizing) antibodies titers across various vaccine types and transplantation modes. However, the anti-SARS-CoV-2 nucleocapsid titers demonstrated a significant increase in patients who received the BBIBP-CorV inactivated vaccine (Sinopharm, China). Moreover, within the non -vaccinated BMT subgroup, a slightly higher yet insignificant incidence of COVID-19 was observed in comparison to the vaccinated subgroup (2/28-7.1% vs. 3/11-27.2%, p= 0.125). During the six-month post -vaccination follow-up, COVID-19 incidence was 144.9 per 1000 patient -years in the vaccinated group, contrasting with 545.4 per 1000 patient -years in the unvaccinated group. Hence, a substantial vaccination efficacy of 73.4% was noted. No fatalities were reported among either vaccinated or unvaccinated HSCT patients who contracted COVID-19 during the 30 -day follow-up period. Conclusion: The inactivated vaccine demonstrated antibody responses comparable to the Pfizer-BioNTech vaccine.
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    Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study
    (Elsevier, 2022) Cag, Yasemin; Erdem, Hakan; Gunduz, Mehmet; Komur, Suheyla; Ankarali, Handan; Ural, Serap; Tasbakan, Meltem
    Background: Mucormycosis is an emerging aggressive mold infection. This study aimed to assess the outcome of hospitalized adults with rhino-orbito-cerebral mucormycosis (ROCM). The secondary objective was to identify prognostic factors in this setting. Methods: This study was an international, retrospective, multicenter study. Patients' data were collected from 29 referral centers in 6 countries. All qualified as proven cases according to the EORTC/MSGERC criteria. Results: We included 74 consecutive adult patients hospitalized with ROCM. Rhino-orbito-cerebral type infection was the most common presentation (n = 43; 58.1%) followed by rhino-orbital type (n = 31; 41.9%). Twenty (27%) had acquired nosocomial bacterial infections. A total of 59 (79.7%) patients (16 in combination) received appropriate antifungal treatment with high-doses of liposomal amphotericin B. Fifty-six patients (75.7%) underwent curative surgery. Thirty-five (47.3%) required intensive care unit admission (27; 36.5% under mechanical ventilation). Hospital survival was 56.8%, being reduced to 7.4% in patients with invasive mechanical ventilation. A multivariate binary backward logistic regression model identified confusion at admission (OR 11.48), overlapping hospital-acquired infection (OR 10.27), use of antifungal treatment before diagnosis (OR 10.20), no surgical debridement (OR 5.92), and the absence of prior sinusitis (OR 6.32) were independently associated with increased risk for death. Conclusion: Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection.
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    Vector-borne and zoonotic infections and their relationships with regional and socioeconomic statuses: An ID-IRI survey in 24 countries of Europe, Africa and Asia
    (Elsevier Sci Ltd, 2021) Saydam, Fatma Nurhayat; Erdem, Hakan; Ankarali, Handan; Ramadan, Manar Ezz El-Arab; El-Sayed, Nagwa Mostafa; Civljak, Rok; Pshenichnaya, Natalia
    Background: In this cross-sectional, international study, we aimed to analyze vector-borne and zoonotic infections (VBZI), which are significant global threats. Method: VBZIs' data between May 20-28, 2018 was collected. The 24 Participatingcountries were classified as lower-middle, upper-middle, and high-income. Results: 382 patients were included. 175(45.8%) were hospitalized, most commonly in Croatia, Egypt, and Romania(P = 0.001). There was a significant difference between distributions of VBZIs according to geographical regions(P < 0.001). Amebiasis, Ancylostomiasis, Blastocystosis, Cryptosporidiosis, Giardiasis, Toxoplasmosis were significantly more common in the Middle-East while Bartonellosis, Borreliosis, Cat Scratch Disease, Hantavirus syndrome, Rickettsiosis, Campylobacteriosis, Salmonellosis in Central/East/South-East Europe; Brucellosis and Echinococcosis in Central/West Asia; Campylobacteriosis, Chikungunya, Tick-borne encephalitis, Visceral Leishmaniasis, Salmonellosis, Toxoplasmosis in the North-Mediterranean; CCHF, Cutaneous Leishmaniasis, Dengue, Malaria, Taeniasis, Salmonellosis in Indian Subcontinent; Lassa Fever in West Africa. There were significant regional differences for viral hemorrhagic fevers(P < 0.001) and tick-borne infections(P < 0.001), and according to economic status for VBZIs(P < 0.001). The prevalences of VBZIs were significantly higher in lower-middle income countries(P = 0.001). The most similar regions were the Indian Subcontinent and the Middle-East, the Indian Subcontinent and the North-Mediterranean, and the Middle-East and North Mediterranean regions. Conclusions: Regional and socioeconomic heterogeneity still exists for VBZIs. Control and eradication of VBZIs require evidence-based surveillance data, and multidisciplinary efforts.