Browsing by Author "Erdem H."

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    Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: Risk factors for mortality
    (2013) Cilli A.; Erdem H.; Karakurt Z.; Turkan H.; Yazicioglu-Mocin O.; Adiguzel N.; Gungor G.; Bilge U.; Tasci C.; Yilmaz G.; Oncul O.; Dogan-Celik A.; Erdemli O.; Oztoprak N.; Samur A.A.; Tomak Y.; Inan A.; Karaboga B.; Tok D.; Temur S.; Oksuz H.; Senturk O.; Buyukkocak U.; Yilmaz-Karadag F.; Ozcengiz D.; Karakas A.; Savasci U.; Ozgen-Alpaydin A.; Kilic E.; Elaldi N.; Bilgic H.
    Purpose: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. Materials and Methods: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. Results: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality. Conclusion: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission. © 2013 Elsevier Inc.
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    Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey
    (2013) Erdem H.; Turkan H.; Cilli A.; Karakas A.; Karakurt Z.; Bilge U.; Yazicioglu-Mocin O.; Elaldi N.; Adiguzel N.; Gungor G.; Taşci C.; Yilmaz G.; Oncul O.; Dogan-Celik A.; Erdemli O.; Oztoprak N.; Tomak Y.; Inan A.; Karaboǧa B.; Tok D.; Temur S.; Oksuz H.; Senturk O.; Buyukkocak U.; Yilmaz-Karadag F.; Ozcengiz D.; Turker T.; Afyon M.; Samur A.A.; Ulcay A.; Savasci U.; Diktas H.; Ozgen-Alpaydin A.; Kilic E.; Bilgic H.; Leblebicioglu H.; Unal S.; Sonmez G.; Gorenek L.
    Background: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. Methods: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. Results: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. Conclusions: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease. © 2013 International Society for Infectious Diseases.
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    The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: A multicentre retrospective study
    (BioMed Central Ltd., 2014) Erdem H.; Kocak-Tufan Z.; Yilmaz O.; Karakurt Z.; Cilli A.; Turkan H.; Yazicioglu-Mocin O.; Adiguzel N.; Gungor G.; Taşci C.; Yilmaz G.; Oncul O.; Dogan-Celik A.; Erdemli O.; Oztoprak N.; Tomak Y.; Inan A.; Tok D.; Temur S.; Oksuz H.; Senturk O.; Buyukkocak U.; Yilmaz-Karadag F.; Ozturk-Engin D.; Ozcengiz D.; Karakas A.; Bilgic H.; Leblebicioglu H.
    Background: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings.Methods: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated.Results: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT.Conclusion: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series. © 2014 Erdem et al.; licensee BioMed Central Ltd.
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    The course of spinal tuberculosis (Pott disease): Results of the multinational, multicentre Backbone-2 study
    (Elsevier B.V., 2015) Batirel A.; Erdem H.; Sengoz G.; Pehlivanoglu F.; Ramosaco E.; Gülsün S.; Tekin R.; Mete B.; Balkan I.I.; Sevgi D.Y.; Giannitsioti E.; Fragou A.; Kaya S.; Cetin B.; Oktenoglu T.; Celik A.D.; Karaca B.; Horasan E.S.; Ulug M.; Senbayrak S.; Kaya S.; Arslanalp E.; Hasbun R.; Ates-Guler S.; Willke A.; Senol S.; Inan D.; Güclü E.; Ertem G.T.; Koc M.M.; Tasbakan M.; Ocal G.; Kocagoz S.; Kusoglu H.; Güven T.; Baran A.I.; Dede B.; Karadag F.Y.; Yilmaz H.; Aslan G.; Al-Gallad D.A.; Cesur S.; El-Sokkary R.; Sirmatel F.; Savasci U.; Karaahmetoglu G.; Vahaboglu H.
    We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae. © 2015 European Society of Clinical Microbiology and Infectious Diseases.
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    Comparison of brucellar and tuberculous spondylodiscitis patients: Results of the multicenter "backbone-1 Study"
    (Elsevier Inc., 2015) Erdem H.; Elaldi N.; Batirel A.; Aliyu S.; Sengoz G.; Pehlivanoglu F.; Ramosaco E.; Gulsun S.; Tekin R.; Mete B.; Balkan I.I.; Sevgi D.Y.; Giannitsioti E.; Fragou A.; Kaya S.; Cetin B.; Oktenoglu T.; Dogancelik A.; Karaca B.; Horasan E.S.; Ulug M.; Inan A.; Kaya S.; Arslanalp E.; Ates-Guler S.; Willke A.; Senol S.; Inan D.; Guclu E.; Tuncer-Ertem G.; Meric-Koc M.; Tasbakan M.; Senbayrak S.; Cicek-Senturk G.; Sirmatel F.; Ocal G.; Kocagoz S.; Kusoglu H.; Guven T.; Baran A.I.; Dede B.; Yilmaz-Karadag F.; Kose S.; Yilmaz H.; Aslan G.; Algallad D.A.; Cesur S.; El-Sokkary R.; Bekiroǧlu N.; Vahaboglu H.
    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. © 2015 Elsevier Inc.
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    Antituberculosis drug resistance patterns in adults with tuberculous meningitis: Results of haydarpasa-iv study
    (BioMed Central Ltd., 2015) Senbayrak S.; Ozkutuk N.; Erdem H.; Johansen I.S.; Civljak R.; Inal A.S.; Kayabas U.; Kursun E.; Elaldi N.; Savic B.; Simeon S.; Yilmaz E.; Dulovic O.; Ozturk-Engin D.; Ceran N.; Lakatos B.; Sipahi O.R.; Sunbul M.; Yemisen M.; Alabay S.; Beovic B.; Ulu-Kilic A.; Cag Y.; Catroux M.; Inan A.; Dragovac G.; Deveci O.; Tekin R.; Gul H.C.; Sengoz G.; Andre K.; Harxhi A.; Hansmann Y.; Oncu S.; Kose S.; Oncul O.; Parlak E.; Sener A.; Yilmaz G.; Savasci U.; Vahaboglu H.
    Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any first-line drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0:34-13:42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing. © 2015 Senbayrak et al.