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Öğe Brucellosis in pregnancy: results of multicenter ID-IRI study(SPRINGER, 2019) Inan, Asuman; Erdem, Hakan; Elaldi, Nazif; Gulsun, Serda; Karahocagil, Mustafa K.; Pekok, Abdullah U.; Ulug, Mehmet; Tekin, Recep; Bosilkovski, Mile; Kaya, Safak; Haykir-Solay, Asli; Demirdal, Tuna; Kaya, Selcuk; Sunnetcioglu, Mahmut; Sener, Alper; Tosun, Selma; Aydin, Emsal; Ural, Serap; Yamazhan, Tansu; Muhcu, Murat; Ayaslioglu, Ergin; Bilgic-Atli, Seval; Erbay, Ayse; Ergen, Pinar; Kadanali, Ayten; Sahin, Suzan; Sahin-Horasan, Elif; Avci, Ali; Cag, Yakup; Beeching, Nicholas J.Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p<0.001), vaginal bleeding (p<0.001), anemia (blood hemoglobin <11g/dL; p<0.001), high level of serum aspartate aminotransferase (>41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.Öğe Can hantavirus infections be predicted on admission to hospital?(WILEY-BLACKWELL, 2012) Kaya, Selcuk; Caglayik, Dilek Yagci; Uyar, Yavuz; Yilmaz, Hava; Engin, Aynur; Onguru, Pinar; Yilmaz, Gurdal; Koksal, IftiharThe aim of this study was to investigate the predictive factors which contribute to diagnosis of hantavirus infection. One hundred patients from rural areas hospitalized with a preliminary diagnosis of hantavirus infection from different hospitals in Turkey were investigated. Hantavirus infection was confirmed in 20 patients (Group 1) using immunofluorescence and immunoblot assays at the Refik Saydam National Public Health Agency. Hantaviruses were not detected in the serum of the remaining 80 patients, other infectious and non-infectious diseases being diagnosed in this group (Group 2). Patients' demographic characteristics and clinical and laboratory data on admission were examined and compared between the two groups. Fever, proteinuria, hematuria, lethargy-weakness, and nausea-vomiting were the most frequent symptoms and findings in Group 1, seen in almost all patients. Proteinuria, hematuria, muscle pain, diarrhea/abdominal pain, hypotension, shock, and sweating were observed at significantly higher levels in Group 1 compared to Group 2. Serum urea, creatinine, uric acid, lactate dehydrogenase (LDH), aspartate transaminase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) were significantly higher, but serum platelet counts were lower in Group 1 patients. Area beneath the receiver operating characteristics (ROC) curve analysis was used to calculate the discriminative ability of various laboratory values to identify patients with hantavirus infection. This analysis revealed that, serum CRP had a 100% negative predictive value, whilst, platelet, and creatinine had 75% and 70% positive predictive values for the diagnosis of hantavirus infection. In summary, laboratory markers used in clinical practice are of great importance predicting hantavirus infections. J. Med. Virol. 84:17901796, 2012. (c) 2012 Wiley Periodicals, Inc.Öğe Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study"(ELSEVIER SCIENCE INC, 2015) Erdem, Hakan; Elaldi, Nazif; Batirel, Ayse; Aliyu, Sani; Sengoz, Gonul; Pehlivanoglu, Filiz; Ramosaco, Ergys; Gulsun, Serda; Tekin, Recep; Mete, Birgul; Balkan, Ilker Inanc; Sevgi, Dilek Yildiz; Giannitsioti, Efthymia; Fragou, Archontoula; Kaya, Selcuk; Cetin, Birsen; Oktenoglu, Tune; DoganCelik, Aygul; Karaca, Banu; Horasan, Elif Sahin; Ulug, Mehmet; Man, Asuman; Kaya, Safak; Arslanalp, Esra; Ates-Guler, Selma; Willke, Ayse; Senol, Sebnem; Inan, Dilara; Guclu, Ertugrul; Tuncer-Ertem, Gunay; Meric-Koc, Meliha; Tasbakan, Meitem; Senbayrak, Seniha; Cicek-Senturk, Gonul; Sirmatel, Fatma; Ocal, Gulfem; Kocagoz, Sesin; Kusoglu, Hulya; Guven, Turner; Baran, Ali Irfan; Dede, Behiye; Yilmaz-Karadag, Fatma; Kose, Sukran; Yilmaz, Hava; Asian, Gonul; Algallad, D. Ashraf; Cesur, Salih; El-Sokkary, Rehab; Bekiroglu, Nural; Vahaboglu, HalukBACKGROUND 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.Öğe Foam rolling during a simulated half-time attenuates subsequent soccer-specific performance decrements(Elsevier, 2021) Kaya, Selcuk; Cug, Mutlu; Behm, David G.The passive nature of the half-time period with soccer/football can result in second-half performance decrements. As foam rolling (FR) can increase range of motion, neuromuscular efficiency, and enhance arterial function, the inclusion of FR during half-time may attenuate performance decrements. The objective of this acute study was to compare FR versus passive recovery during a simulated half-time period on simulated second-half soccer pass, sprint performance as well as quality of recovery. Thirteen male soccer players simulated a soccer match by performing two bouts of 15 x 20 m sprints with 30-s rest intervals. The bouts were separated by 10-min with either a passive recovery or they performed five FR exercises on both legs for 45-s each with 15-s rest. Tests were conducted before and following the simulated half-time period and consisted of Total Quality of Recovery (TQR), Loughborough Soccer Pass Test (LSPT), blood lactate (LAC), and sprint velocity of the simulated soccer match. Heart rates (HR) were recorded at the end of each test session and each sprint. Results showed no significant changes between conditions for TQR, LSPT, LAC and HR. However, while all sprint speed measures (mean, best of 15 sprints and mean of the first 5 sprints) significantly decreased with the passive condition, no decrement was noted with all sprint measures with the FR condition; there was only a significant (p = 0.001; d = 0.63) 2.1% decrease with the mean of the first 5 sprints. In conclusion, there is some evidence that FR may be beneficial to attenuate sprint speed impairments. (C) 2020 Elsevier Ltd. All rights reserved.Öğe International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012(BMC, 2014) Leblebicioglu, Hakan; Erben, Nurettin; Rosenthal, Victor Daniel; Atasay, Begum; Erbay, Ayse; Unal, Serhat; Senol, Gunes; Willke, Ayse; Ozgultekin, Asu; Altin, Nilgun; Bakir, Mehmet; Oncul, Oral; Ersoz, Gulden; Ozdemir, Davut; Yalcin, Ata Nevzat; Ozdemir, Halil; Yildizdas, Dincer; Koksal, Iftihar; Aygun, Canan; Sirmatel, Fatma; Sener, Alper; Tuna, Nazan; Akan, OTzay Arikan; Turgut, Huseyin; Demiroz, A. Pekcan; Kendirli, Tanil; Alp, Emine; Uzun, Cengiz; Ulusoy, Sercan; Arman, Dilek; Ozgunes, Ilhan; Usluer, Gaye; Kilic, Atila; Arsan, Saadet; Cabadak, Hatice; Sen, Suha; Gelebek, Yasemin; Zengin, Humeyra; Topeli, Arzu; Alper, Yusuf; Meric, Meliha; Azak, Emel; Inan, Asuman; Turan, Guldem; Haznedaroglu, Tuncer; Gorenek, Levent; Acar, Ali; Cesur, Salih; Engin, Aynur; Kaya, Ali; Kuyucu, Necdet; Geyik, Mehmet Faruk; Aydin, Ozlem Cetinkaya; Erdogan, Nurse Selvi; Turhan, Ozge; Gunay, Nurgul; Gumus, Eylul; Dursun, Oguz; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Yilmaz, Hava; Sunbul, Mustafa; Gokmen, Zeynel; Ozdemir, Sonay Incesoy; Horoz, Ozden Ozgur; Yylmaz, Gurdal; Kaya, Selcuk; Ulusoy, Hulya; Kucukoduk, Sukru; Ustun, Cemal; Baysal, Abant Izzet; Otkun, Metin; Tulunay, Melek; Oral, Mehmet; Unal, Necmettin; Cengiz, Mustafa; Yilmaz, Leyla; Sacar, Suzan; Sungurtekin, Hulya; Ugurcan, Dogac; Yetkin, M. Arzu; Bulut, Cemal; Erdinc, F. Sebnem; Hatipoglu, Cigdem Ataman; Ince, Erdal; Ciftci, Ergin; Odek, Caglar; Yaman, Ayhan; Karbuz, Adem; Aldemir, Bilge; Kilic, Aysegul Ulu; Arda, Bilgin; Bacakoglu, Feza; Hizel, KenanBackground: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U. S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). Conclusions: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.Öğe Mortality indicators in pneumococcal meningitis: therapeutic implications(ELSEVIER SCI LTD, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, Asuman; Nayman-Alpat, Saygin; Ulu-Kilic, Aysegul; Pekok, Abdullah Umut; Gunduz, Alper; Gozel, Mustafa G.; Pehlivanoglu, Filiz; Yasar, Kadriye; Yilmaz, Hava; Hatipoglu, Mustafa; Cicek-Senturk, Gonul; Akcam, Fusun Z.; Inkaya, Ahmet C.; Kazak, Esra; Sagmak-Tartar, Ayse; Tekin, Recep; Ozturk-Engin, Derya; Ersoy, Yasemin; Sipahi, Oguz Resat; Guven, Tumer; Tuncer-Ertem, Gunay; Alabay, Selma; Akbulut, Ayhan; Balkan, Ilker I.; Oncul, Oral; Cetin, Birsen; Dayan, Saim; Ersoz, Gulden; Karakas, Ahmet; Ozgunes, Nail; Sener, Alper; Yesilkaya, Aysegul; Erturk, Ayse; Gundes, Sibel; Karabay, Oguz; Sirmatel, Fatma; Tosun, Selma; Turhan, Vedat; Yalci, Aysun; Akkoyunlu, Yasemin; Aydin, Emsal; Diktas, Husrev; Kose, Sukran; Ulcay, Asim; Seyman, Derya; Savasci, Umit; Leblebicioglu, Hakan; Vahaboglu, HalukBackground: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.Öğe Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran - A prospective multicenter point prevalence study(W B SAUNDERS CO LTD, 2014) Erdem, Hakan; Inan, Asuman; Altindis, Selma; Carevic, Biljana; Askarian, Mehrdad; Cottle, Lucy; Beovic, Bojana; Csomos, Akos; Metodiev, Krassimir; Ahmetagic, Sead; Harxhi, Arjan; Raka, Lul; Grozdanovski, Krsto; Nechifor, Mihai; Alp, Emine; Bozkurt, Fatma; Hosoglu, Salih; Balik, Ismail; Yilmaz, Gulden; Jereb, Matjaz; Moradi, Fatemeh; Petrov, Nikolay; Kaya, Selcuk; Koksal, Iftihar; Aslan, Turan; Elaldi, Nazif; Akkoyunlu, Yasemin; Moravveji, Seyyed Alireza; Csato, Gabor; Szedlak, Balazs; Akata, Filiz; Oncu, Serkan; Grgic, Svjetlana; Cosic, Gorana; Stefanov, Chavdar; Farrokhnia, Mehrdad; Mueller, Maria; Luca, Catalina; Koluder, Nada; Korten, Volkan; Platikanov, Viliyan; Ivanova, Petja; Soltanipour, Soheil; Vakili, Mahmood; Farahangiz, Saman; Afkhamzadeh, Abdorrahim; Beeching, Nicholas; Ahmed, Salman Shaheer; Cami, Alma; Shiraly, Ramin; Jazbec, Anja; Mirkovic, Tomislav; Leblebicioglu, Hakan; Naber, KurtObjective: We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. Methods: A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. Results: Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). Conclusion: ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area. (C) 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.Öğe Withdrawal of Staphylococcus aureus from intensive care units in Turkey(MOSBY-ELSEVIER, 2013) Erdem, Hakan; Dizbay, Murat; Karabey, Selma; Kaya, Selcuk; Demirdal, Tuna; Koksal, Iftihar; Inan, Asuman; Erayman, Ibrahim; Ak, Oznur; Ulu-Kilic, Aysegul; Karasahin, Omer; Akbulut, Ayhan; Elaldi, Nazif; Yilmaz, Gulden; Candevir, Aslihan; Gul, Hanefi Cem; Gonen, Ibak; Oncul, Oral; Aslan, Turan; Azak, Emel; Tekin, Recep; Tufan, Zeliha Kocak; Yenilmez, Ercan; Arda, Bilgin; Gungor, Gokay; Cetin, Birsen; Kose, Sukran; Turan, Hale; Akalin, Halis; Karabay, Oguz; Dogan-Celik, Aygul; Albayrak, Adem; Guven, Tumer; Celebi, Guven; Ozgunes, Nail; Ersoy, Yasemin; Sirmatel, Fatma; Oztoprak, Nefise; Balkan, Ilker Inanc; Bayazit, Fatma Nurhayat; Ucmak, Hasan; Oncu, Serkan; Ozdemir, Davut; Ozturk-Engin, Derya; Bitirgen, Mehmet; Tabak, Fehmi; Akata, Filiz; Willke, Ayse; Gorenek, Levent; Ahmed, Salman Shaheer; Tasova, Yesim; Ulcay, Asim; Dayan, Saim; Esen, Saban; Leblebicioglu, Hakan; Altun, Begin; Unal, SerhatBackground: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value <=.01 was considered significant. Results: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). Conclusions: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
