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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 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, BehiyeBackground/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.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 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.
