Browsing by Author "Tekin, R"

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    Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin
    Ceylan, 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, 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 (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.
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    Impact of antimicrobial drug restrictions on doctors' behaviors
    Karabay, 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, B
    Background/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.
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    The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study
    Batirel, 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, 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. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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    Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter Backbone-1 Study
    Erdem, 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, 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. (C) 2015 Elsevier Inc. All rights reserved.
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    Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study
    Senbayrak, S; Ozkutuk, N; Erdem, H; Johansen, IS; Civljak, R; Inal, AS; Kayabas, U; Kursun, E; Elaldi, N; Savic, B; Simeon, S; Yilmaz, E; Dulovic, O; Ozturk-Engin, D; Ceran, N; Lakatos, B; Sipahi, OR; Sunbul, M; Yemisen, M; Alabay, S; Beovic, B; Ulu-Kilic, A; Cag, Y; Catroux, M; Inan, A; Dragovac, G; Deveci, O; Tekin, R; Gul, HC; 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 firstline 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.