Browsing by Author "Senol, S"
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Item Non-albicans Candida species in blood stream infectionsCetin, CB; Senol, S; Degerli, K; Tunger, OItem Colistin efficacy in the treatment of multidrug-resistant and extremely drug-resistant gram-negative bacterial infectionsÇetin, ÇB; Özer Türk, D; Senol, S; Dinç Horasan, G; Tünger, ÖBackground/aim: Colistin is used as a salvage therapy for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections. Our aim was to evaluate colistin efficiency and toxicity in the treatment of these resistant gram-negative bacterial infections. Materials and methods: This is a retrospective study carried out in a tertiary care hospital during 2011-2013. Study data were collected from the medical records and consultations of the infectious diseases clinic. Results: The study group included 158 patients with nosocomial infections and 136 (86.1%) of them were hospitalized in the ICU. Respiratory tract infections were the most commonly observed ones (n = 103, 65.2%). The most frequently isolated microorganism was Acinetobacter baumannii (72.2%). A total of 98 (62.0%) patients had clinical cure. There was no statistically significant difference between monotherapy (n = 3/6, 50.0%) and combination therapies (n = 95/152, 62.5%) according to clinical response. Underlying ultimately fatal disease, previous renal disease, and total parenteral nutrition were independent risk factors for poor clinical response. Nephrotoxicity developed in 80 (50.6%) patients and clinical cure was statistically unrelated with nephrotoxicity. Conclusion: Colistin may be used as an effective agent for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections with close monitoring of renal functions, especially for older and critically ill patients.Item Evaluation of nosocomial Candida infectionsSenol, S; Dindar, K; Cetin, CB; Demirci, M; Degerli, K; Ozten, D; Tunger, OItem Disseminated Aspergillosis due to Aspergillus niger in Immunocompetent Patient: A Case ReportErgene, U; Akcali, Z; Ozbalci, D; Nese, N; Senol, SInvasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients. Many cases of pulmonary, cutaneous, cerebral, and paranasal sinus aspergillosis in immunocompetent patient were defined in literature but disseminated aspergillosis is very rare. Here we present an immunocompetent case with extrapulmonary disseminated aspergillosis due to Aspergillus niger, totally recovered after effective antifungal treatment with voriconazole.Item Genetic counselling and hemophilia: nursing approachGenc, RE; Senol, S; Gungor, N; Cyray, NItem Carbapenem Versus Fosfomycin Tromethanol in the Treatment of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli-Related Complicated Lower Urinary Tract InfectionSenol, S; Tasbakan, M; Pullukcu, H; Sipahi, OR; Sipahi, H; Yamazhan, T; Arda, B; Ulusoy, SThe aim of this observational prospective study was to compare the effect of fosfomycin tromethanol (FT) and carbapenems (meropenem or imipenem cilastatin) in the treatment of extended-spectrum beta-lactamase (ESBL)producing Escherichia coli-related complicated lower urinary tract infection (CLUTI). Inclusion criteria were: patients who were aged >18 yr with dysuria or problems with frequency or urgency in passing urine; those with >20 leukocytes/mm(3) in urine microscopy and culture-proven ESBL-producing carbapenem or FT-sensitive E. coli in the urine (>10(5) cfu/mm(3)); no leukocytosis or fever; and who were treated with FT (oral 3 g sachet x 1 every other night, three times) or carbapenems between March 2005 and January 2006 in our outpatient clinic and hospital. A total of 47 CLUTI attacks in 47 patients (27 FT group, 20 carbapenem group) were observed prospectively. Clinical and microbiological success in the carbapenem and FT groups was similar (19/20 vs 21/27 and 16/20 vs 16/27 p>0.05). Drug acquisition costs were significantly lower in the FT group (p<0.001). Although it is not a randomized controlled study, these data show that FT may be a suitable, effective and cheap alternative in the treatment of ESBL-producing E. coli-related CLUTI.Item Seroprevalance of Measles, Rubella, Mumps, Varicella, Diphtheria, Tetanus and Hepatitis B in Healthcare WorkersCiliz, N; Gazi, H; Ecemis, T; Senol, S; Akcali, S; Kurutepe, SObjective: We aimed to determine the antibody levels of healthcare workers of Celal Bayar University Hospital against vaccinepreventable diseases such as measles, rubella, mumps, diphtheria, tetanus, varicella and hepatitis B, and encourage compliance to recommended vaccinations for non-immune staff. Methods: The antibody levels were tested by enzyme-linked immunosorbent assay (ELISA). Demographic characteristics were collected by a questionnaire, and the history of the diseases, immunization and the sharps-related injuries were queried. Results: 44% percent of 309 healthcare personnel were exposed to occupational injury at least once, and 78.3% of the injuries were needle-stick injuries. Injuries were found to be more common among doctors and nurses, and pediatric and surgical departments, respectively. Frequency of anti-HBs positivity among healthcare workers was 84.1%, while 71.5% of healthcare workers were immunized with HBV vaccine before starting to work, and the immunization status directly correlated with the level of education. In general, high seropositivity was noted for measles (99.7%), rubella (97.0%), mumps (99.7%) and varicella (99.7%), while diphtheria (60.8%) and tetanus (93.5%) antibody levels significantly decreased with age. Histories of the disease and vaccination were not reliable while verifying the immunity status. Conclusions: It is necessary to increase adherence to universal protective measures in healthcare workers and to take corrective and protective measures for sharps-related injuries. It is also essential to increase hepatitis B vaccination rates and to confirm the immune status of medical staff working in high risk departments and diphtheria and tetanus vaccinations should be repeated once every ten years.Item Community-Acquired Pneumonia: Importance of Molecular Methods for Etiological Diagnosis and Clinical FeaturesÖzer-Türk, D; Tünger, Ö; Sakar-Coskun, A; Gazi, H; Sanlidag, T; Kurhan, F; Çetin, CB; Senol, SObjective: This study aims to make an early identification for the diagnosis of community-acquired pneumonia (CAP), to increase the rate of etiological diagnosis and to distinguish bacterial and viral pathogens with the use of multiplex polymerase chain reaction (PCR) in addition to conventional methods, and to compare cases in the light of clinical and laboratory results. Methods: Ninety two CAP patients who were hospitalized and followed at our hospital between January-November 2013 were included in this study. Conventional culture and multiplex PCR were used to identify the causative microorganisms in the respiratory tract samples of the patients. Demographic data, risk factors, clinical, radiological and laboratory results, treatment and follow-up results of the cases were recorded. Statistical Package for the Social Sciences (SPSS) for Windows. Version 15.0 (SPSS Inc., Chicago, IL, USA) program was used in the analysis of the data. Results: CURB-65 score was determined in >= 2 in 80.4% of the cases and 14.1% was followed in the intensive care unit. Of the patients, 42 (45.7%) were found to have bacterial and 20 (21.7%) were found to have viral agents while in 30 (32.6%) patients an agent could not be demostrated. Bacterial etiology was detected with conventional culture methods in 15 (16.3%) and with multiplex PCR in 42 (45.6%) cases. The difference between them was found to be statistically significant (p<0.001). It was found out that mostly bacterial factors were responsible for the CAP cases which were seen in fall or winter, and the etiology of the cases which were seen in spring and summer could not be determined in general (p<0.05). Variables such as sputum production, sore throat, auscultation findings and corticosteroid use were found to be statistically significant among bacterial, viral and unidentified etiology groups. Conclusions: It was demonstrated that molecular methods are beneficial for the early diagnosis of CAP. It was also thought that early diagnosis of viral etiology can prevent the unnecessary use of antibiotics as well as contributing to the patient management.Item Antifungal Prophylaxis in Solid Organ Transplant RecipientsSenol, S; Kutsoylu, OE; Kaya, O; Avci, M; Tasbakan, MI; Oguz, VA; Baysan, BÖ; Çavus, SA; Çetin, CB; Ergin, C; Ertugrul, B; Kutlu, SS; Kutlu, M; Mermut, G; Metin, DY; Öztürk, B; Pullukçu, H; Turhan, Ö; Yapar, NSolid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed.Item Association between hematologic parameters and in-hospital mortality in patients with infective endocarditisZencir, C; Akpek, M; Senol, S; Selvi, M; Onay, S; Cetin, M; Akgullu, C; Elbi, H; Gungor, HEarly and accurate risk prediction is an important clinical demand in patients with infective endocarditis (IE). The platelet-to-lymphocyte ratio (PLR) is an independent predictor of worse prognosis in various cardiovascular diseases. The aim of this study was to determine the value of PLR in the prediction of in-hospital mortality among IE patients. We retrospectively analyzed the clinical, laboratory, and echocardiographic data of 59 adult patients with definite IE and in 40 adult controls. In-hospital mortality occurred in 16 (27%) patients. Vegetation size, levels of high-sensitive C-reactive protein and procalcitonin, neutrophil-to-lymphocyte ratio, and PLR were significantly higher in the in-hospital-mortality-positive group than in the in-hospital-mortality-negative group (p = 0.004, p = 0.009, p = 0.030, p = 0.001, and p = 0.008, respectively). Lymphocyte count was, however, significantly lower in the in-hospital-mortality-positive group (p = 0.004). In the receiver-operating characteristic analysis, PLRs over 191.01 predicted in-hospital mortality with 56.3% sensitivity and 81.4% specificity [area under the curve 0.725, 95% confidence interval (CI) 0.594-0.833; p = 0.0027]. In the multivariate analysis, PLR was found to be an independent predictor of in-hospital mortality in patients with IE (odds ratio 1.022, 95% CI 1.003-1.042; p = 0.021). In conclusion, higher PLR may predict in-hospital mortality in patients with IE. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.Item Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistinCeylan, B; Arslan, F; Sipahi, OR; Sunbul, M; Ormen, B; Hakyemez, IN; Turunc, T; Yildiz, Y; Karsen, H; Karagoz, G; Tekin, R; Hizarci, B; Turhan, V; Senol, S; Oztoprak, N; Yilmaz, M; Ozdemir, K; Mermer, S; Kokoglu, OF; Mert, AAim: 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.Item The evaluation of antifungal consumption: a point-prevalence surveySenol, S; Eren-Kutsoylu, OO; Turhan, O; Alp-Cavus, S; Tasbakan, M; Ozturk, B; Sayin-Kutlu, S; Cetin, CB; Kaya, O; Ozhak, B; Pullukcu, H; Ertugrul, B; Kutlu, M; Mermut, G; Ergin, C; Metin, DY; Yapar, N; Avkan-Oguz, VItem Evaluation of patients with zygomycosisKaya, O; Alp Çavus, S; Turhan, O; Isikgöz Tasbakan, M; Pullukcu, H; Ertugrul, MB; Senol, S; Çetin, CB; Özhak Baysan, B; Sayin Kutlu, S; Metin, DY; Avci, M; Mermut, G; Avkan Oguz, V; Yapar, NAim: Zygomycosis is a severe angioinvasive infection caused by Zygomycetes. We retrospectively investigated 16 cases of zygomycosis. Materials and methods: The data of patients, who had been followed between 2004 and 2010 in 8 tertiary-care teaching hospitals, were reviewed. Demographic characteristics, underlying diseases, and clinical signs and symptoms of the patients, as well as diagnostic methods, data obtained by radiological imaging methods, and the therapies, were recorded. Therapeutic approaches, antifungal agents and duration of use, and the characteristics of the cases were identified. Results: The study included 11 female and 5 male subjects. The most common symptoms and clinical signs were fever (n = 9) and retro-orbital pain (n = 7). Rhinocerebral zygomycosis was the most common form. The mean time elapsed for diagnosis was 14.26 +/- 13.96 (range: 2-52) days. Antifungal therapy was given to 15 patients (94%). In addition to antifungal therapy, 12 patients underwent surgical intervention 1 to 4 times. The mean duration of receiving antifungal therapy was 61.4 +/- 58.02 (range: 1-180) days. The median duration of treatment was 62.5 (range: 42-180) days in survivors. Conclusion: Zygomycosis is an infectious disease with high mortality despite antifungal therapy and surgical interventions.Item Investigation of Bacterial and Viral Etiology in Community Acquired Central Nervous System Infections with Molecular MethodsKahraman, H; Tünger, A; Senol, S; Gazi, H; Avci, M; Örmen, B; Türker, N; Atalay, S; Köse, S; Ulusoy, S; Tasbakan, MI; Sipahi, OR; Yamazhan, T; Gülay, Z; Çavus, SA; Pullukçu, HIn this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 +/- 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.Item Effectiveness and safety of anidulafungin: A real-life multicenter data in TurkeyMeltem, T; Kutsoylu, OE; Pullukcu, H; Sayin-Kutlu, S; Ozturk, B; Kaya, O; Turhan, O; Senol, S; Alp-Cavus, S; Kutlu, M; Mermut, G; Metin, D; Baysan-Ozhak, B; Ergin, C; Cetin, C; Ertugrul, MB; Avkan-Oguz, V; Yapar, NItem Impact of antimicrobial drug restrictions on doctors' behaviorsKarabay, O; Hosoglu, S; Güçlü, E; Akalin, S; Altay, FA; Aydin, E; Ceylan, B; Çelik, A; Çelik, I; Demirdal, T; Demirli, K; Erben, N; Erkorkmaz, Ü; Erol, S; Evirgen, Ö; Gönen, I; Güner, AE; Güven, T; Kadanali, A; Koçoglu, ME; Kökoglu, OF; Küçükbayrak, A; Sargin, F; Sünnetçioglu, M; Senol, S; Isikgöz Tasbakan, M; Tekin, R; Turhan, V; Yilmaz, G; Dede, BBackground/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.Item The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 studyBatirel, A; Erdem, H; Sengoz, G; Pehlivanoglu, F; Ramosaco, E; Gulsun, S; Tekin, R; Mete, B; Balkan, II; Sevgi, DY; Giannitsioti, E; Fragou, A; Kaya, S; Cetin, B; Oktenoglu, T; Celik, AD; Karaca, B; Horasan, ES; Ulug, M; Senbayrak, S; Kaya, S; Arslanalp, E; Hasbun, R; Ates-Guler, S; Willke, A; Senol, S; Inan, D; Guclu, E; Ertem, GT; Koc, MM; Tasbakan, M; Ocal, G; Kocagoz, S; Kusoglu, H; Guven, T; Baran, AI; Dede, B; Karadag, FY; Yilmaz, H; Aslan, G; Al-Gallad, DA; Cesur, S; El-Sokkary, R; Sirmatel, F; Savasci, U; Karaahmetoglu, G; Vahaboglu, HWe 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. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Item Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter Backbone-1 StudyErdem, H; Elaldi, N; Batirel, A; Aliyu, S; Sengoz, G; Pehlivanoglu, F; Ramosaco, E; Gulsun, S; Tekin, R; Mete, B; Balkan, II; Sevgi, DY; Giannitsioti, E; Fragou, A; Kaya, S; Cetin, B; Oktenoglu, T; DoganCelik, A; Karaca, B; Horasan, ES; Ulug, M; Man, 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, AI; Dede, B; Yilmaz-Karadag, F; Kose, S; Yilmaz, H; Asian, G; Algallad, DA; Cesur, S; El-Sokkary, R; Bekiroglu, N; Vahaboglu, HBACKGROUND 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.