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Öğe Correlation between intrahepatic hepatitis B virus cccDNA levels and other activity markers in patients with HBeAg-negative chronic hepatitis B infection(Lippincott Williams & Wilkins, 2011) Guner, Rahmet; Karahocagil, Mustafa; Buyukberber, Mehmet; Kandemir, Ozlem; Ural, Onur; Usluer, Gaye; Inan, Dilara; Koksal, Iftihar; Baykam, Nurcan; Hizel, Kenan; Yamazhan, Tansu; Esen, Saban; Tasyaran, Mehmet A.Objective The aim of this study was to demonstrate the relation between intrahepatic (IH) hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) levels and the other HBV replicative intermediates and hepatocyte expression of HBV antigens. Patients and methods Patients with hepatitis B surface antigen (HBsAg) positivity, hepatitis B early antigen negativity, serum HBV DNA levels 10(4) copies/ml or more, and constantly or intermittently increased alanine aminotransferase levels were included. Results Fifty-nine patients were included. There was a good correlation between the levels of IH HBV cccDNA and serum HBV DNA (P<0.001). Serum HBsAg levels were weakly correlated with IH HBV cccDNA levels and moderately correlated with serum HBV DNA (r=0.322, P=0.017; r=0.489, P=0.001, respectively). There were no significant correlation between serum HBsAg level and histologic activity index groups (P=0.691), but stage 0, 1, and greater than 2 fibrosis groups were positively correlated with serum HBsAg levels (P=0.019). IH cccDNA and serum HBV DNA were significantly different in hepatitis B core antigen staining groups (P=0.008 and <0.001, respectively) but there was no significant correlation between HBsAg staining groups and HBV replication markers. There was a weak correlation between serum HBsAg levels and IH HBsAg and hepatitis B core antigen levels (r=0.333, P=0.012; r=0.366, P=0.006, respectively). In multivariate analysis, alanine aminotransferase, age, fibrosis stage, and serum HBsAg quantitation were the most important factors predicting IH HBV cccDNA level. Conclusion Histopathologic damage, serum HBV DNA levels, and IH HBV replication markers have a more complex and dynamic process. However, both serum and IH HBV replication markers provide important knowledge about the activity of the disease. Eur J Gastroenterol Hepatol 23:1185-1191 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC)(Mosby-Elsevier, 2013) Leblebicioglu, Hakan; Ersoz, Gulden; Daniel Rosenthal, Victor; Nevzat-Yalcin, Ata; Akan, Ozay Arikan; Sirmatel, Fatma; Turgut, Huseyin; Ozdemir, Davut; Alp, Emine; Uzun, Cengiz; Ulusoy, Sercan; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Yilmaz, Hava; Kaya, Ali; Kuyucu, Necdet; Turhan, Ozge; Gunay, Nurgul; Gumus, Eylul; Dursun, Oguz; Tulunay, Melek; Oral, Mehmet; Unal, Necmettin; Cengiz, Mustafa; Yilmaz, Leyla; Sacar, Suzan; Sungurtekin, Hulya; Ugurcan, Dogac; Geyik, Mehmet Faruk; Sahin, Ahmet; Erdogan, Selvi; Aygen, Bilgehan; Arda, Bilgin; Bacakoglu, FezaBackground: We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey. Methods: A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods. Results: The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001). Conclusion: Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Öğe International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012(Bmc, 2014) Leblebicioglu, Hakan; Erben, Nurettin; Rosenthal, Victor Daniel; Atasay, Begum; Erbay, Ayse; Unal, Serhat; Senol, Gunes; Willke, Ayse; Ozgultekin, Asu; Altin, Nilgun; Bakir, Mehmet; Oncul, Oral; Ersoz, Gulden; Ozdemir, Davut; Yalcin, Ata Nevzat; Ozdemir, Halil; Yildizdas, Dincer; Koksal, Iftihar; Aygun, Canan; Sirmatel, Fatma; Sener, Alper; Tuna, Nazan; Akan, OTzay Arikan; Turgut, Huseyin; Demiroz, A. Pekcan; Kendirli, Tanil; Alp, Emine; Uzun, Cengiz; Ulusoy, Sercan; Arman, Dilek; Ozgunes, Ilhan; Usluer, Gaye; Kilic, Atila; Arsan, Saadet; Cabadak, Hatice; Sen, Suha; Gelebek, Yasemin; Zengin, Humeyra; Topeli, Arzu; Alper, Yusuf; Meric, Meliha; Azak, Emel; Inan, Asuman; Turan, Guldem; Haznedaroglu, Tuncer; Gorenek, Levent; Acar, Ali; Cesur, Salih; Engin, Aynur; Kaya, Ali; Kuyucu, Necdet; Geyik, Mehmet Faruk; Aydin, Ozlem Cetinkaya; Erdogan, Nurse Selvi; Turhan, Ozge; Gunay, Nurgul; Gumus, Eylul; Dursun, Oguz; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Yilmaz, Hava; Sunbul, Mustafa; Gokmen, Zeynel; Ozdemir, Sonay Incesoy; Horoz, Ozden Ozgur; Yylmaz, Gurdal; Kaya, Selcuk; Ulusoy, Hulya; Kucukoduk, Sukru; Ustun, Cemal; Baysal, Abant Izzet; Otkun, Metin; Tulunay, Melek; Oral, Mehmet; Unal, Necmettin; Cengiz, Mustafa; Yilmaz, Leyla; Sacar, Suzan; Sungurtekin, Hulya; Ugurcan, Dogac; Yetkin, M. Arzu; Bulut, Cemal; Erdinc, F. Sebnem; Hatipoglu, Cigdem Ataman; Ince, Erdal; Ciftci, Ergin; Odek, Caglar; Yaman, Ayhan; Karbuz, Adem; Aldemir, Bilge; Kilic, Aysegul Ulu; Arda, Bilgin; Bacakoglu, Feza; Hizel, KenanBackground: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U. S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). Conclusions: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.Öğe Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)(Cambridge Univ Press, 2011) Rosenthal, V. D.; Udwadia, F. E.; Munoz, H. J.; Erben, N.; Higuera, F.; Abidi, K.; Medeiros, E. A.; Fernandez Maldonado, E.; Kanj, S. S.; Gikas, A.; Barnett, A. G.; Graves, N.; Guzman, Sandra; Flynn, Luis Pedro; Rausch, Diego; Spagnolo, Alejandro; Benchetrit, Guillermo; Bonaventura, Claudio; de los Angeles Caridi, Maria; Messina, Adriana; Ricci, Beatriz; Frias, Maria Laura; Churruarin, Griselda; Sztokhamer, Daniel; Soroka, Luisa C.; Forciniti, Silvia; Blasco, Marta; Lezcano, Carmen B.; Lastra, Carlos Esteban; Viegas, Monica; Di Nubila, Beatriz Marta Alicia; Lanzetta, Diana; Fernandez, Leonardo J.; Rossetti, Maria Adelaida; Romani, Adriana; Migazzi, Claudia; Barolin, Clarisa; Martinez, Estela; Kobylarz, Alicia; Grinberg, Gorki; Ferreira, Iselde Buchner; Cechinel, Raquel Bauer; Angelieri, Daniela Bicudo; Nouer, Simone; Vianna, Rosa; Machado, Ana Lucia; Gama, Elaine; Blanquet, Doris; Zanandrea, Bruna Boaria; Rohnkohl, Carolina; Regalin, Marcos; Salomao, Reinaldo; Maretti da Silva, Maria Angela; de Jesus Silva, Clelia Heloisa; Vilins, Margarete; Blecher, Sergio; Spessatto, Jamile Leda; Pasini, Ricardo Scopel; Ferla, Shaline; Grinberg, Gorki; Sussmann, Otto; Mojica, Beatriz Eugenia; Villamil Gomez, Wilmer; Ruiz Vergara, Guillermo; Arrieta, Patrick; Rojas, Catherine; Beltran, Humberto; Paez, Jerson; Sussmann, Otto; Torres Navarrete, Maria del Pilar; Dajud, Luis; Mendoza, Mariela; Arrieta, Patrick; Alvarez Moreno, Carlos; Linares, Claudia; Osorio, Laline; Barahona Guzman, Nayide; Rodriguez Ferrer, Marena; Sarmiento Villa, Guillermo; Lagares Guzman, Alfredo; Olarte, Narda; Valderrama, Alberto; Garzon Agudelo, Julio; Rodriguez Calderon, Maria Eugenia; Chaniotaki, Kalliopi; Tsioutis, Constantinos; Bampalis, Dimitris; Todi, Subhash Kumar; Bhakta, Arpita; Bhattacharjee, Mahuya; Kumar, R. Krishna; Radhakrishnan, Kavitha; Ansari, Reshma; Poojary, Aruna; Koppikar, Geeta; Bhandarkar, Lata; Jadhav, Shital; Sen, Nagamani; Subramani, Kandasamy; Karlekar, Anil; Rodrigues, Camilla; Hegd, Ashit; Kapadia, Farahad; Sahu, Samir; Gopinath, Ramachadran; Ravindra, Nallagonda; Myatra, Sheila Nainan; Divatia, J. V.; Kelkar, Rohini; Biswas, Sanjay; Raut, Sandhya; Sampat, Sulochana; Kumar, Rishi; Chakravarthy, Murali; Gokul, B. N.; Sukanya, R.; Pushparaj, Leema; Dwivedy, Arpita; Shetty, Suvin; Binu, Sheena; Zahreddine, Nada; Sidani, Nisreen; Jurdi, Lamia Alamaddni; Kanafani, Zeina; Sanchez Lopez, Martha; Torres Hernandez, Hector; Chavez Gomez, Amalia; Morales, Jaime Rivera; Valero Rodriguez, Julian Enrique; Sobreyra Oropeza, Martha; Sigfrido Rangel-Frausto, Manuel; Martinez Soto, Jose; Armas Ruiz, Alberto; Campuzano, Roberto; Mena Brito, Jorge; Abouqal, Redouane; Madani, Naoufel; Zeggwagh, Amine Ali; Dendane, Tarek; Barkat, Amina; Bouazzaoui, Naima Lamdouar; Meryem, Kabiri; Cuellar, Luis; Rosales, Rosa; Castillo Bravo, Luis Isidro; Linares Caceres, Maria; Atencio Espinoza, Teodora; Sarmiento Lopez, Favio; Mayorga Espichan, Manuel Jesus; Echenique, Liliana; Castaneda Sabogal, Alex; Paredes Goicochea, Iliana; Arroyo Sanchez, Abel; Rios Alva, Guillermo; Garcia Ventura, Jorge; Ramrez Aguilar, Miguel; Segura Plasencia, Niler; Rodriguez, Teofilo; Yalcin, A. Nevzat; Turhan, Ozge; Keskin, Sevim; Gumus, Eylul; Dursun, Oguz; Ozdemir, Davut; Guclu, Ertugrul; Erdogan, Selvi; Ulusoy, Sercan; Arda, Bilgin; Bacakoglu, Feza; Alp, Emine; Aygen, Bilgehan; Arman, Dilek; Hizel, Kenan; Ozdemir, Kesver; Uzun, Cengiz; Sardan, Yesim Cetinkaya; Yildirim, Gonul; Topeli, Arzu; Sirmatel, Fatma; Cengiz, Mustafa; Yilmaz, Leyla; Ozgultekin, Asu; Turan, Guldem; Akgun, Nur; Ozturk, Recep; Dikmen, Yalim; Aygun, Gokhan; Akan, Ozay Arikan; Tulunay, Melek; Oral, Mehmet; Unal, Necmettin; Koksal, Iftihar; Yylmaz, Gurdal; Senel, A. C.; Sozen, Ebru Emel; Ersoz, Gulden; Kaya, Ali; Kandemir, Ozlem; Leblebicioglu, Hakan; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Aygun, Canan; Kucukoduk, Sukru; Ozgunes, Ilhan; Usluer, Gaye; Turgut, Huseyin; Sacar, Suzan; Sungurtekin, Hulya; Ugurcan, DogacVentilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity.Öğe Withdrawal of Staphylococcus aureus from intensive care units in Turkey(Mosby-Elsevier, 2013) Erdem, Hakan; Dizbay, Murat; Karabey, Selma; Kaya, Selcuk; Demirdal, Tuna; Koksal, Iftihar; Inan, Asuman; Erayman, Ibrahim; Ak, Oznur; Ulu-Kilic, Aysegul; Karasahin, Omer; Akbulut, Ayhan; Elaldi, Nazif; Yilmaz, Gulden; Candevir, Aslihan; Gul, Hanefi Cem; Gonen, Ibak; Oncul, Oral; Aslan, Turan; Azak, Emel; Tekin, Recep; Tufan, Zeliha Kocak; Yenilmez, Ercan; Arda, Bilgin; Gungor, Gokay; Cetin, Birsen; Kose, Sukran; Turan, Hale; Akalin, Halis; Karabay, Oguz; Dogan-Celik, Aygul; Albayrak, Adem; Guven, Tumer; Celebi, Guven; Ozgunes, Nail; Ersoy, Yasemin; Sirmatel, Fatma; Oztoprak, Nefise; Balkan, Ilker Inanc; Bayazit, Fatma Nurhayat; Ucmak, Hasan; Oncu, Serkan; Ozdemir, Davut; Ozturk-Engin, Derya; Bitirgen, Mehmet; Tabak, Fehmi; Akata, Filiz; Willke, Ayse; Gorenek, Levent; Ahmed, Salman Shaheer; Tasova, Yesim; Ulcay, Asim; Dayan, Saim; Esen, Saban; Leblebicioglu, Hakan; Altun, Begin; Unal, SerhatBackground: 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. Methods: 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. Results: 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). Conclusions: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
