Browsing by Author "Yamazhan, T"
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Item 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 Tenofovir alafenamid prophylaxis for the prevention of HBV reactivation in immunosuppressed subjects: a multicenter studyAkar, SS; Sönmez, U; Demirdal, T; Sen, P; Özer, D; Atalay, S; Akyol, D; Mermutluoglu, Ç; Çelen, MK; Yamazhan, T; Pullukçu, HPurpose: Reactivation of hepatitis B may be prevented by antiviral therapy in immunosuppressed high risk patients. Entecavir (ETC) and tenofovir disoproksil fumarat (TDF) have been used for a long time and recently introduced tenofovir alafenamid (TAF) seems to be a good alternative with rare side effects. This multicentered study with a large patient population aimed to investigate the effectiveness of tenofovir alafenamid (TAF) in immunsuppressed subjects. Materials and Methods: The records of six training and research hospitals between January 1, 2019 and September 30, 2021 were retrospectively reviewed, and patients who were started antiviral prophylaxis for hepatitis B and followed up for at least 6 months while under immunosuppressive therapy were included in the study. Risk groups were determined according to the immunosuppressive treatment or chemotherapy they received, as well as hepatitis B serology, and were examined in terms of the presence of hepatitis B reactivation and its side effects. Results: The mean age of patients was found as 62.5 +/- 29. Out of 148 patients, 85 (57.4%) received TAF, 63 (42.6%) received either Entecavir (ETC) or tenofovir disoproksil fumarat (TDF). The majority (83.1%) was found as HBsAg (-) antiHBc (+) and 16.9% was HBsAg (+). HBV DNA was traced in 36% of chronic HBV patients. Most of the patients (69.6%) were receiving immunospuppressives for treatment of a haematologic malignancy and 89.2% was in the high risk treatment group. There was no difference between TAF and the other drugs in terms of risks. Reactivation was not seen in any of the treatment groups. Conclusion: TAF is as effective as TDF and ETC when used for prophylaxis in immunosuppressed HBV patients. Side effects on kidney and bone are not seen in TAF treatment groups which will probably play a role in preferring this new drug.Item Are Soap, Paper Towel and Alcohol-based Disinfectants Easily Accessible in Intensive Care Units in Turkey?: Results of the Phokai StudyUyan, A; Durmus, G; Sezak, N; Özdemir, B; Kaygusuz, T; Öztoprak, N; Özdemir, K; Aksoy, F; Özgültekin, A; Koç, MM; Öncül, A; Çagan Aktas, S; Isik, B; Çelebi, G; Evik, G; Özger, S; Harman, R; Dindar Demiray, EK; Özkören Çalik, S; Alkan Çeviker, S; Yildiz, IE; Isik, ME; Senol, G; Sari, S; Dogan, M; Ugurlu, K; Arslan, M; Akgül, F; Koç, F; Kürekçi, Y; Çaglayan, D; Uçar, M; Gözüküçük, R; Elmaslar Mert, HT; Alay, H; Erdogan, H; Demirel, A; Dogan, N; Koçak, F; Güven, E; Ünsal, G; Sipahi, H; Yamazhan, T; Arda, B; Ulusoy, S; Sipahi, ORIntroduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001). Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.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 Epidemiology and Risk Factors of Hepatitis Delta Infection in TurkeyAyaz, C; Koruk, ST; Yalci, A; Yamazhan, T; Aygen, B; Tosun, S; Dal, T; Celen, MK; Tabak, FThis study is aimed to investigate the prevalence and risk factors of HDV co-infection in patients with chronic HBV infection in Turkey, where HBV infection is endemic. The date of this study was obtained from Turk-Hep-Net project. The project includes real-life cohort of HBV patients from 15 centers in Turkey and is supported by Viral Hepatitis Society. Of the 7366 HBsAg positive individuals tested for the presence of anti-HDV antibodies, 63,6 were male and 36.4 % were female. Of the 7366 HBsAg positif patients, 206 (2.8%) contained anti-HDV. Southeastern Anatolia Region of the country's anti-HDV positivity rate was found to be 4.5%. The risk factors in anti-HDV positivity patient were; male gender, long-term (>5 year) HBsAg positivity and living in Southeastern Anatolia. Our study revealed that recognizing the risk factors associated with HBV and HDV co-infection will be beneficial to control of these infections.