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Öğe Are Soap, Paper Towel and Alcohol-based Disinfectants Easily Accessible in Intensive Care Units in Turkey?: Results of the Phokai Study(Galenos Yayincilik, 2018) Uyan, Ayse; Durmus, Gul; Sezak, Nurbanu; Ozdemir, Burcu; Kaygusuz, Turkkan; Oztoprak, Nefise; Ozdemir, Keyser; Aksoy, Firdevs; Ozgultekin, Asu; Koc, Meliha Meric; Oncul, Ahsen; Cagan Aktas, Sabahat; Isik, Burcu; Celebi, Giiven; Evik, Guliiz; Ozger, Selcuk; Harman, Rezan; Dindar Demiray, Emine Kubra; Ozkoren Calik, Sebnem; Alkan Ceviker, Sevil; Yildiz, Ilknur Esen; Isik, Mehmet Emirhan; Senol, Gunes; Sari, Sema; Dogan, Mustafa; Ugurlu, Kenan; Arslan, Mustafa; Akgul, Fethiye; Koc, Filiz; Kurekci, Yeim; Caglayan, Derya; Ucar, Mehmet; Gozukucuk, Ramazan; Elmaslar Mert, Habibe Tulin; Alay, Handan; Erdogan, Haluk; Demirel, Aslihan; Dogan, Nilgun; Kocak, Funda; Guven, Emre; Unsal, Guieser; Sipahi, Hilal; Yamazhan, Tansu; Arda, Bilgin; Ulusoy, Sercan; Sipahi, Oguz ResatIntroduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001). Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.Öğe Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study(Elsevier Science Inc, 2016) Hatipoglu, Mustafa; Mutluoglu, Mesut; Turhan, Vedat; Uzun, Gunalp; Lipsky, Benjamin A.; Sevim, Erol; Demiraslan, Hayati; Eryilmaz, Esma; Ozuguz, Cem; Memis, Ali; Ay, Hakan; Arda, Bilgin; Uysal, Serhat; Motor, Vicdan Koksaldi; Kader, Cigdem; Erturk, Ayse; Coskun, Omer; Duygu, Fazilet; Guler, Selma; Altay, Fatma Aybala; Ogutlu, Aziz; Bolukcu, Sibel; Yildiz, Senol; Kandemir, Ozlem; Aslaner, Halide; Polat, Arife; Karahocagil, Mustafa K.; Yasar, Kadriye Kart; Sehmen, Emine; Kilic, Sirri; Sunbul, Mustafa; Gencer, Serap; Bozkurt, Fatma; Yanik, Tugba; Oztoprak, Nefise; Batirel, Ayse; Sozen, Hamdi; Kilic, Inci; Celik, Ilhami; Ay, Bengisu; Tosun, Selma; Kadanali, Ayten; Comoglu, Senol; Denk, Affan; Hosoglu, Salih; Aydin, Ozlem; Elaldi, Nazif; Akalin, Serife; Kandemir, Bahar; Akbulut, Ayhan; Demirdal, Tuna; Balik, Recep; Azak, Emel; Sengoz, GonulAim: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. Methods: The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). Results: A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. Conclusions: Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions. (C) 2016 Elsevier Inc. All rights reserved.Öğe Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study(Springer Heidelberg, 2019) Sipahi, Oguz Resat; Kahraman, Hasip; Erdem, Huseyin Aytac; Yetkin, Funda; Kaya, Selcuk; Demirdal, Tuna; Tunccan, Ozlem Guzel; Karasahin, Omer; Oruc, Ebru; Cag, Yasemin; Kurtaran, Behice; Ulug, Mehmet; Kutlu, Murat; Avci, Meltem; Oztoprak, Nefise; Arda, Bilgin; Pullukcu, Husnu; Tasbakan, Meltem; Yamazhan, Tansu; Kandemir, Ozlem; Dizbay, Murat; Sipahi, Hilal; Ulusoy, SercanPurposeIn this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin).MethodsData and outcomes of adult (aged>18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status.ResultsOverall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72h antibiotic treatment (p=0.25). There was no significant difference in cured, improved and (cured+improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p>0.05). There was also no significant difference (p>0.05), in terms of persistent response in the (D) versus (G) cohorts,ConclusionsThese findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.Öğe Is Nurse Workforce Sufficient in Intensive Care Units in Turkey. Results of the Multicenter Karia Study(Galenos Yayincilik, 2017) Uyan, Ayse; Durmus, Gul; Sezak, Nurbanu; Pepe, Fatmanur; Kaygusuz, Turkkan; Oztoprak, Nefise; Ozdemir, Kevser; Aksoy, Firdevs; Erol, Serpil; Koc, Meliha Meric; Oncul, Ahsen; Cagan Aktas, Sabahat; Caskurlu, Hulya; Celebi, Guven; Kandemir, Ozlem; Ozger, Selcuk; Harman, Rezan; Demiray, Kubra; Ari, Alpay; Alkan Ceviker, Sevil; Esen Yildiz, Ilknur; Menekse, Sirin; Senol, Gunes; Sari, Sema; Dogan, Mustafa; Ugurlu, Kenan; Arslan, Mustafa; Akdemir, Irem; Firat, Pinar; Kurekci, Yesim; Caglayan, Derya; Ucar, Mehmet; Gozukucuk, Ramazan; Elmaslar Mert, Habibe Tulin; Alay, Handan; Erdogan, Haluk; Demirel, Aslihan; Dogan, Nilgun; Kocak, Funda; Guven, Emre; Unsal, Guleser; Sipahi, Hilal; Isikgoz Tasbakan, Meltem; Arda, Bilgin; Ulusoy, Sercan; Sipahi, Oguz ResatIntroduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was <1 year, was; 19% in level 1 ICUs, 25% in level 2 ICUs and 24% in level 3 ICUs. The number of patients per nurse was mostly <5 in level 1 ICUs whereas the number of patients per nurse in level 3 ICUs was generally >2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was <0.0001 at all time points except summer weekend night shift (p=0.002). Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing.Öğe 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, HalukBackground: 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.Öğe Portraying infective endocarditis: results of multinational ID-IRI study(Springer, 2019) Erdem, Hakan; Puca, Edmond; Ruch, Yvon; Santos, Lurdes; Ghanem-Zoubi, Nesrin; Argemi, Xavier; Hansmann, Yves; Guner, Rahmet; Tonziello, Gilda; Mazzucotelli, Jean-Philippe; Como, Najada; Kose, Sukran; Batirel, Ayse; Inan, Asuman; Tulek, Necla; Pekok, Abdullah Umut; Khan, Ejaz Ahmed; Iyisoy, Atilla; Meric-Koc, Meliha; Kaya-Kalem, Ayse; Martins, Pedro Palma; Hasanoglu, Imran; Silva-Pinto, Andre; Oztoprak, Nefise; Duro, Raquel; Almajid, Fahad; Dogan, Mustafa; Dauby, Nicolas; Gunst, Jesper Damsgaard; Tekin, Recep; Konopnicki, Deborah; Petrosillo, Nicola; Bozkurt, Ilkay; Wadi, Jamal; Popescu, Corneliu; Balkan, Ilker Inanc; Ozer-Balin, Safak; Zupanc, Tatjana Lejko; Cascio, Antonio; Dumitru, Irina Magdalena; Erdem, Aysegul; Ersoz, Gulden; Tasbakan, Meltem; Ajamieh, Oday Abu; Sirmatel, Fatma; Florescu, Simin; Gulsun, Serda; Ozkaya, Hacer Deniz; Sari, Sema; Tosun, Selma; Avci, Meltem; Cag, Yasemin; Celebi, Guven; Sagmak-Tartar, Ayse; Karakus, Sumeyra; Sener, Alper; Dedej, Arjeta; Oncu, Serkan; Del Vecchio, Rosa Fontana; Ozturk-Engin, Derya; Agalar, CananInfective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulase-negative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).Öğe Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin(Elsevier Science Bv, 2017) Ceylan, Bahadir; Arslan, Ferhat; Sipahi, Oguz Resat; Sunbul, Mustafa; Ormen, Bahar; Hakyemez, Ismail N.; Turunc, Tuba; Yildiz, Yesim; Karsen, Hasan; Karagoz, Gul; Tekin, Recep; Hizarci, Burcu; Turhan, Vedat; Senol, Sebnem; Oztoprak, Nefise; Yilmaz, Mesut; Ozdemir, Kevser; Mermer, Sinan; Kokoglu, Omer F.; Mert, AliAim: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. Materials and methods: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. Results: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (Cl), 1.004-1.067; p = 0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p = 0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. Conclusions: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation. (C) 2016 Published by Elsevier B.V.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.
