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Öğe ANKYLOSING SPONDYLITIS HEALTH CARE COSTS AND ASSOCIATED DISEASE ACTIVITY SCORES IN TURKEY(Elsevier Science Inc, 2013) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Baser, O.; Hamuryudan, VÖğe The burden and epidemiology of community-acquired central nervous system infections: a multinational study(Springer, 2017) Erdem, H.; Inan, A.; Guven, E.; Hargreaves, S.; Larsen, L.; Shehata, G.; Pernicova, E.; Khan, E.; Bastakova, L.; Namani, S.; Harxhi, A.; Roganovic, T.; Lakatos, B.; Uysal, S.; Sipahi, O. R.; Crisan, A.; Miftode, E.; Stebel, R.; Jegorovic, B.; Feher, Z.; Jekkel, C.; Pandak, N.; Moravveji, A.; Yilmaz, H.; Khalifa, A.; Musabak, U.; Yilmaz, S.; Jouhar, A.; Oztoprak, N.; Argemi, X.; Baldeyrou, M.; Bellaud, G.; Moroti, R. V.; Hasbun, R.; Salazar, L.; Tekin, R.; Canestri, A.; Calkic, L.; Pratico, L.; Yilmaz-Karadag, F.; Santos, L.; Pinto, A.; Kaptan, F.; Bossi, P.; Aron, J.; Duissenova, A.; Shopayeva, G.; Utaganov, B.; Grgic, S.; Ersoz, G.; Wu, A. K. L.; Lung, K. C.; Bruzsa, A.; Radic, L. B.; Kahraman, H.; Momen-Heravi, M.; Kulzhanova, S.; Rigo, F.; Konkayeva, M.; Smagulova, Z.; Tang, T.; Chan, P.; Ahmetagic, S.; Porobic-Jahic, H.; Moradi, F.; Kaya, S.; Cag, Y.; Bohr, A.; Artuk, C.; Celik, I.; Amsilli, M.; Gul, H. C.; Cascio, A.; Lanzafame, M.; Nassar, M.Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.Öğe Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study(Springer Science and Business Media Deutschland GmbH, 2023) Tanoglu, A.; Erdem, H.; Friedland, J.S.; Ankaralı, H.; Garcia-Goez, J.F.; Albayrak, A.; El-Kholy, A.Existing literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 ± 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.Öğe The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study(Springer, 2014) Erdem, H.; Stahl, J. P.; Inan, A.; Kilic, S.; Akova, M.; Rioux, C.; Pierre, I.; Canestri, A.; Haustraete, E.; Engin, D. O.; Parlak, E.; Argemi, X.; Bruley, D.; Alp, E.; Greffe, S.; Hosoglu, S.; Patrat-Delon, S.; Heper, Y.; Tasbakan, M.; Corbin, V.; Hopoglu, M.; Balkan, I. I.; Mutlu, B.; Demonchy, E.; Yilmaz, H.; Fourcade, C.; Toko-Tchuindzie, L.; Kaya, S.; Engin, A.; Yalci, A.; Bernigaud, C.; Vahaboglu, H.; Curlier, E.; Akduman, D.; Barrelet, A.; Oncu, S.; Korten, V.; Usluer, G.; Turgut, H.; Sener, A.; Evirgen, O.; Elaldi, N.; Gorenek, L.The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.Öğe Genitourinary brucellosis: results of a multicentric study(Wiley-Blackwell, 2014) Erdem, H.; Elaldi, N.; Ak, O.; Gulsun, S.; Tekin, R.; Ulug, M.; Duygu, F.; Sunnetcioglu, M.; Tulek, N.; Guler, S.; Cag, Y.; Kaya, S.; Turker, N.; Parlak, E.; Demirdal, T.; Hatipoglu, C. Ataman; Avci, A.; Bulut, C.; Avci, M.; Pekok, A.; Savasci, U.; Kaya, S.; Sozen, H.; Tasbakan, M.; Guven, T.; Bolukcu, S.; Cesur, S.; Sahin-Horasan, E.; Kazak, E.; Denk, A.; Gonen, I.; Karagoz, G.; Solay, A. Haykir; Alici, O.; Kader, C.; Senturk, G.; Tosun, S.; Turan, H.; Baran, A. I.; Ozturk-Engin, D.; Bozkurt, F.; Deveci, O.; Inan, A.; Kadanali, A.; Sayar, M. S.; Cetin, B.; Yemisen, M.; Naz, H.; Gorenek, L.; Agalar, C.This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530 +/- 3115/mm(3). Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.Öğe INDIRECT COSTS ASSOCIATED WITH ANKYLOSING SPONDYLITIS IN TURKEY(Elsevier Science Inc, 2012) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Baser, O.; Hamuryudan, VÖğe INDIRECT COSTS ASSOCIATED WITH ANKYLOSING SPONDYLITIS IN TURKEY(Bmj Publishing Group, 2013) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Baser, O.; Hamuryudan, V.Öğe Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study(Springer, 2016) Erdem, H.; Ak, O.; Elaldi, N.; Demirdal, T.; Hargreaves, S.; Nemli, S. A.; Cag, Y.; Ulug, M.; Naz, H.; Gunal, O.; Sirmatel, F.; Sipahi, O. R.; Alpat, S. N.; Ertem-Tuncer, G.; Sozen, H.; Evlice, O.; Meric-Koc, M.; Dogru, A.; Koksaldi-Motor, V.; Tekin, R.; Ozdemir, D.; Ozturk-Engin, D.; Savasci, U.; Karagoz, E.; Cekli, Y.; Inan, A.Mass gatherings pooling people from different parts of the world-the largest of which is to Mecca, Saudi Arabia, for Hajj-may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were a parts per thousand yen 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3-7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.Öğe Liver involvement in patients with brucellosis: results of the Marmara study(Springer, 2014) Ozturk-Engin, D.; Erdem, H.; Gencer, S.; Kaya, S.; Baran, A. I.; Batirel, A.; Tekin, R.; Celen, M. K.; Denk, A.; Guler, S.; Ulug, M.; Turan, H.; Pekok, A. U.; Mermut, G.; Kaya, S.; Tasbakan, M.; Tulek, N.; Cag, Y.; Inan, A.; Yalci, A.; Ataman-Hatipoglu, C.; Gonen, I.; Dogan-Celik, A.; Bozkurt, F.; Gulsun, S.; Sunnetcioglu, M.; Guven, T.; Duygu, F.; Parlak, E.; Sozen, H.; Tosun, S.; Demirdal, T.; Guclu, E.; Karabay, O.; Uzun, N.; Gunal, O.; Diktas, H.; Haykir-Solay, A.; Erbay, A.; Kader, C.; Aydin, O.; Erdem, A.; Elaldi, N.; Kadanali, A.; Yulugkural, Z.; Gorenek, L.; Altindis, M.; Bolukcu, S.; Agalar, C.; Ormeci, N.Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with a parts per thousand yen5 times of the upper limit of normal for aminotransferases, total bilirubin level a parts per thousand yen2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.Öğe Managing atypical and typical herpetic central nervous system infections: results of a multinational study(Elsevier Sci Ltd, 2016) Cag, Y.; Erdem, H.; Leib, S.; Defres, S.; Kaya, S.; Larsen, L.; Poljak, M.; Ozturk-Engin, D.; Barsic, B.; Argemi, X.; Sorensen, S. M.; Bohr, A. L.; Tattevin, P.; Gunst, J. D.; Bastakova, L.; Jereb, M.; Johansen, I. S.; Karabay, O.; Pekok, A. U.; Sipahi, O. R.; Chehri, M.; Beraud, G.; Shehata, G.; Fontana, R.; Maresca, M.; Karsen, H.; Sengoz, G.; Sunbul, M.; Yilmaz, G.; Yilmaz, H.; Sharif-Yakan, A.; Kanj, S.; Parlak, E.; Pehlivanoglu, F.; Korkmaz, F.; Komur, S.; Kose, S.; Ulug, M.; Bolukcu, S.; Coskuner, S. A.; Stahl, J. P.; Ince, N.; Akkoyunlu, Y.; Halac, G.; Sahin-Horasan, E.; Tireli, H.; Kilicoglu, G.; Al-Mahdawi, A.; Nemli, S. A.; Inan, A.; Senbayrak, S.; Vahaboglu, H.; Elaldi, N.There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection. (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study(Elsevier Sci Ltd, 2014) Erdem, H.; Ozturk-Engin, D.; Elaldi, N.; Gulsun, S.; Sengoz, G.; Crisan, A.; Johansen, I. S.; Inan, A.; Nechifor, M.; Al-Mahdawi, A.; Civljak, R.; Ozguler, M.; Savic, B.; Ceran, N.; Cacopardo, B.; Inal, A. S.; Namiduru, M.; Dayan, S.; Kayabas, U.; Parlak, E.; Khalifa, A.; Kursun, E.; Sipahi, O. R.; Yemisen, M.; Akbulut, A.; Bitirgen, M.; Dulovic, O.; 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.; Alp, A.; Cosic, G.; Gul, H. Cem; Karakas, A.; Chadapaud, S.; Hansmann, Y.; Harxhi, A.; Kirova, V.; Masse-Chabredier, I.; Oncu, S.; Sener, A.; Tekin, R.; Deveci, O.; Karabay, O.; Agalar, C.We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (=-0.189); ACS and L-J culture (=-0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (=-0.299, p<0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.Öğe Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study(Springer, 2018) Hakyemez, I. N.; Erdem, H.; Beraud, G.; Lurdes, M.; Silva-Pinto, A.; Alexandru, C.; Bishop, B.; Mangani, F.; Argemi, X.; Poinot, M.; Hasbun, R.; Sunbul, M.; Akcaer, M.; Alp, S.; Demirdal, T.; Angamuthu, K.; Amer, F.; Ragab, E.; Shehata, G. A.; Ozturk-Engin, D.; Ozgunes, N.; Larsen, L.; Zimmerli, S.; Sipahi, O. R.; Tigen, E. Tukenmez; Celebi, G.; Oztoprak, N.; Yardimci, A. C.; Cag, Y.Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.Öğe Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study (vol 37, pg 1231, 2018)(Springer, 2018) Hakyemez, I. N.; Erdem, H.; Beraud, G.; Lurdes, M.; Silva-Pinto, A.; Alexandru, C.; Bishop, B.; Mangani, F.; Argemi, X.; Poinot, M.; Hasbun, R.; Sunbul, M.; Akcaer, M.; Alp, S.; Demirdal, T.; Angamuthu, K.; Amer, F.; Ragab, E.; Shehata, G. A.; Ozturk-Engin, D.; Ozgunes, N.; Larsen, L.; Zimmerli, S.; Sipahi, O. R.; Tigen, E. Tukenmez; Celebi, G.; Oztoprak, N.; Yardimci, A. C.; Cag, Y.In the original version of this article, Mustafa Sunbul was not included in the list of authors for this article. The name has been added accordingly.Öğe PRODUCTIVITY LOSS DUE TO SICK LEAVE IN PATIENTS WITH ANKYLOSING SPONDYLITIS(Bmj Publishing Group, 2013) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Hamuryudan, V.Öğe Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study(NLM (Medline), 2023) Erdem, H.; Kocoglu, E.; Ankaralı, H.; El-Sokkary, R.; Hakamifard, A.; Karaali, R.; Kulzhanova, S.OBJECTIVES: Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS: The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS: A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS: Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance. Copyright © 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.Öğe Tetanus in adults: results of the multicenter ID-IRI study(Springer, 2017) Tosun, S.; Batirel, A.; Oluk, A. I.; Aksoy, F.; Puca, E.; Benezit, 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.; Sorensen, S. M.; Celebi, G.; Bastakova, L.; Gedik, H.; Dirgen-Caylak, S.; Esmaoglu, A.; Erol, S.; Cag, Y.; Karagoz, E.; Inan, A.; Erdem, H.Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.
