Browsing by Author "Sunbul M."

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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.
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    Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin
    (Elsevier B.V., 2017) Ceylan B.; Arslan F.; Sipahi O.R.; Sunbul M.; Ormen B.; Hakyemez İ.N.; Turunc T.; Yıldız Y.; Karsen H.; Karagoz G.; Tekin R.; Hizarci B.; Turhan V.; Senol S.; Oztoprak N.; Yılmaz M.; Ozdemir K.; Mermer S.; Kokoglu O.F.; Mert A.
    Aim 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 (CI), 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. © 2016