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    Antibiotic use and Influencing Factors Among Hospitalized Patients with COVID-19: A Multicenter Point-Prevalence Study from Turkey
    (Galenos Publ House, 2022) Sencan, Irfan; Cag, Yasemin; Karabay, Oguz; Kurtaran, Behice; Guclu, Ertugrul; Ogutlu, Aziz; Demirbas, Zehra
    Background: Broad-spectrum empirical antimicrobials arc frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims: We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design: The study was a national, multicenter, retrospective. and single-day point prevalence study. Methods: This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results: A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age +/- standard deviation of the patients was 65.0 +/- 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (372%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005). presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein >10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p <0.001) were found to be independent factors associated with increased antibiotic use. Conclusion: The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.
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    Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study"
    (Elsevier Science Inc, 2015) Erdem, Hakan; Elaldi, Nazif; Batirel, Ayse; Aliyu, Sani; Sengoz, Gonul; Pehlivanoglu, Filiz; Ramosaco, Ergys; Gulsun, Serda; Tekin, Recep; Mete, Birgul; Balkan, Ilker Inanc; Sevgi, Dilek Yildiz; Giannitsioti, Efthymia; Fragou, Archontoula; Kaya, Selcuk; Cetin, Birsen; Oktenoglu, Tune; DoganCelik, Aygul; Karaca, Banu; Horasan, Elif Sahin; Ulug, Mehmet; Man, Asuman; Kaya, Safak; Arslanalp, Esra; Ates-Guler, Selma; Willke, Ayse; Senol, Sebnem; Inan, Dilara; Guclu, Ertugrul; Tuncer-Ertem, Gunay; Meric-Koc, Meliha; Tasbakan, Meitem; Senbayrak, Seniha; Cicek-Senturk, Gonul; Sirmatel, Fatma; Ocal, Gulfem; Kocagoz, Sesin; Kusoglu, Hulya; Guven, Turner; Baran, Ali Irfan; Dede, Behiye; Yilmaz-Karadag, Fatma; Kose, Sukran; Yilmaz, Hava; Asian, Gonul; Algallad, D. Ashraf; Cesur, Salih; El-Sokkary, Rehab; Bekiroglu, Nural; Vahaboglu, Haluk
    BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available. (C) 2015 Elsevier Inc. All rights reserved.
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    Impact of antimicrobial drug restrictions on doctors' behaviors
    (Tubitak Scientific & Technical Research Council Turkey, 2016) Karabay, Oguz; Hosoglu, Salih; Guclu, Ertugrul; Akalin, Serife; Altay, Fatma Aybala; Aydin, Emsal; Ceylan, Bahadir; Celik, Aygul; Celik, Ilhami; Demirdal, Tuna; Demirli, Keziban; Erben, Nurettin; Erkorkmaz, Unal; Erol, Serpil; Evirgen, Omer; Gonen, Ibak; Guner, Ayse Ebru; Guven, Tumer; Kadanali, Ayten; Kocoglu, Mucahide Esra; Kokoglu, Omer Faruk; Kucukbayrak, Abdulkadir; Sargin, Fatma; Sunnetcioglu, Mahmut; Senol, Sebnem; Isikgoz Tasbakan, Meltem; Tekin, Recep; Turhan, Vedat; Yilmaz, Gurdal; Dede, Behiye
    Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had <= 5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.
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    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, Dogac
    Ventilator-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.