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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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    Mortality indicators in pneumococcal meningitis: therapeutic implications
    (Elsevier Sci Ltd, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, Asuman; Nayman-Alpat, Saygin; Ulu-Kilic, Aysegul; Pekok, Abdullah Umut; Gunduz, Alper; Gozel, Mustafa G.; Pehlivanoglu, Filiz; Yasar, Kadriye; Yilmaz, Hava; Hatipoglu, Mustafa; Cicek-Senturk, Gonul; Akcam, Fusun Z.; Inkaya, Ahmet C.; Kazak, Esra; Sagmak-Tartar, Ayse; Tekin, Recep; Ozturk-Engin, Derya; Ersoy, Yasemin; Sipahi, Oguz Resat; Guven, Tumer; Tuncer-Ertem, Gunay; Alabay, Selma; Akbulut, Ayhan; Balkan, Ilker I.; Oncul, Oral; Cetin, Birsen; Dayan, Saim; Ersoz, Gulden; Karakas, Ahmet; Ozgunes, Nail; Sener, Alper; Yesilkaya, Aysegul; Erturk, Ayse; Gundes, Sibel; Karabay, Oguz; Sirmatel, Fatma; Tosun, Selma; Turhan, Vedat; Yalci, Aysun; Akkoyunlu, Yasemin; Aydin, Emsal; Diktas, Husrev; Kose, Sukran; Ulcay, Asim; Seyman, Derya; Savasci, Umit; Leblebicioglu, Hakan; Vahaboglu, Haluk
    Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.
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    Risk factors for infection with colistin-resistant gram-negative microorganisms: a multicenter study
    (K Faisal Spec Hosp Res Centre, 2016) Yilmaz, Gul R.; Dizbay, Murat; Guven, Tumer; Pullukcu, Husnu; Tasbakan, Meltem; Guzel, Ozlem Tunccan; Tekce, Yasemin T.; Ozden, Mehmet; Turhan, Ozge; Guner, Rahmet; Cag, Yasemin; Bozkurt, Fatma; Karadag, Fatma Yilmaz; Kartal, Elif Doyuk; Gozel, Gokhan; Bulut, Cemal; Erdinc, Sebnem; Keske, Siran; Acikgoz, Ziya Cibali; Tasyaran, Mehmet A.
    BACKGROUND: Knowing risk factors for colistin resistance is important since colistin is the only remaining choice for the treatment of infections caused by multi-drug resistant microorganisms. OBJECTIVE: Evaluate risk factors associated with infection by colistin-resistant microorganisms. DESIGN: Retrospective study. SETTINGS: Tertiary healthcare centers. PATIENTS AND METHODS: An e-mail including the title and purpose of the study was sent to 1500 infectious disease specialists via a scientific and social web portal named "Infeksiyon Dunyasi (Infection World)". Demographic and clinical data was requested from respondents. MAIN OUTCOME MEASURE(S): Colistin-resistance. RESULTS: Eighteen infectious disease specialists from twelve tertiary care centers responded to the invitation. Data was collected on 165 patients, 56 cases (39.9%) and 109 (66.0%) age-and sex-matched controls. The colistin-resistant microorganisms isolated from cases were 29 Acinetobacter baumannii (51.8%), 18 Pseudomonas aeruginosa (32.1%) and 9 Klebsiella spp. Colistin, carbapenem, and quinolone use in the last three months were risk factors for colistin resistance in the univariate analysis. Previous quinolone use in the last three months (P=.003; RR: 3.2; 95% CI: 1.5-6,7) and previous colistin use in the last three months (P=.001; RR: 3.6; 95% CI: 1.63-7.99) were significant risk factors in the multivariate analysis. CONCLUSION: Clinicians should limit the use of quinolones and remain aware of the possibility of resistance developing during colistin use. LIMITATIONS: The lack of a heteroresistance analysis on the isolates. No data on use of a loading dose or the use of colistin in combination.
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    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, Serhat
    Background: 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.