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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, Timsit JF. Correction: The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Med 2024:10.1007/s00134-024-07415-6. [PMID: 38587556 DOI: 10.1007/s00134-024-07415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Niccolò Buetti
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nour Setti
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Biostatistic Department, Outcomerea, 93700, Drancy, France
| | - François Barbier
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45000, Orléans, France
- Institut Maurice Rapin, Hôpital Henri Mondor, Créteil, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK
- JVF Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Infection and Sepsis ID Group, Porto, Portugal
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, University of Palermo, Via del Vespro129, 90127, Palermo, Italy
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jean-François Timsit
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France
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Eser F, Hasanoğlu İ, Kayaaslan B, Kaya Kalem A, Bilen Ş, Orhan G, Güner R. Iatrogenic botulism cases after gastric and axillary application of botulinum toxin and review of literature. J Infect Dev Ctries 2024; 18:480-487. [PMID: 38635607 DOI: 10.3855/jidc.18868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/02/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Iatrogenic botulism is a rare, serious disease that progresses with descending paralysis and develops after cosmetic or therapeutic botulinum toxin-A (BoNT-A) application. CASE PRESENTATIONS In this case series; six cases of iatrogenic botulism followed up in our center are presented. Four of these developed after gastric BoNT-A and two after axillary BoNT-A application. RESULTS The most important cause for the disease was the use of unlicensed products and high-dose toxin applications. The first symptoms were blurred vision, double vision, difficulty in swallowing, and hoarseness. Symptoms appeared within 4-10 days after the application of BoNT-A. Symptoms progressed in the course of descending paralysis in the following days with fatigue, weakness in extremities and respiratory distress. Diagnosis was based on patient history and clinical findings. The main principles of foodborne botulism therapy were applied in the treatment of iatrogenic botulism. If clinical worsening continued, regardless of the time elapsed after BoNT-A application, the use of botulinum antitoxin made a significant contribution to clinical improvement and was recommended. CONCLUSIONS Routine and new indications for BoNT-A usage are increasing and, as a result, cases of iatrogenic botulism will be encountered more frequently. Physicians should be alert for iatrogenic botulism in the follow-up after BoNT-A applications and in the differential diagnosis of neurological diseases that are presented with similar findings.
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Affiliation(s)
- Fatma Eser
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - İmran Hasanoğlu
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Bircan Kayaaslan
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Şule Bilen
- University of Health Sciences, Ankara City Hospital, Department of Neurology, Ankara, Turkey
| | - Gürdal Orhan
- University of Health Sciences, Ankara City Hospital, Department of Neurology, Ankara, Turkey
| | - Rahmet Güner
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
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Asiltürk D, Güner R, Kalem AK, Tufan IÖ, Hasanoğlu İ, Eser F, Malhan S, Kayaaslan B. ANTIBIOTIC MANAGEMENT PROGRAM IN A TERTIARY INTENSIVE CARE UNIT: INVESTIGATION OF THE EFFECTS OF A CARBAPENEM-RESTRICTED PERIOD ON CLINICAL AND LABORATORY PARAMETERS AND COSTS OF INFECTIONS. J Hosp Infect 2024:S0195-6701(24)00100-2. [PMID: 38521418 DOI: 10.1016/j.jhin.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the effects of the carbapenem-restricted antimicrobial stewardship program (ASP) on changes in the resistance profiles of infectious agents, the amount of antibiotics used, length of stay in the intensive care unit (ICU), mortality and costs. MATERIALS AND METHODS The patients hospitalized in ICU between July 1, 2020 - May 1, 2021 were included the study. The study was divided in to two different periods, carbapenem not-restricted period (CNRP) and carbapenem restricted period (CRP). During CNRP, carbapenem were used by any restriction, and in CRP, the alternative antibiotics to carbapenems were preferred during infection. The Defined Daily Dose (DDD)-100 Patient Day (PD) methodology was used to calculate the antibiotic consumption. RESULTS Of the 572 patients included in the study, 62.2% of the patients were male, mean age was 70.5 years. In the blood culture the most frequently gram negative agent was A.baumannii (25%). A. baumannii bloodstream infections with MDR, XDR was significantly different between the two periods (CNRP: 95.6% (22), CRP: 66.6%(8) p=0.04). A gradual decrease in the incidence density and rate of nosocomial infection was noted (p=0.06). During the study, a significant decrease in meropenem consumption was detected between the two periods (CNRP-CRP: 21.19-6.37 DDD/100 PD p=0.007). ASP provided a 8600 USD of antibiotic cost savings and a total of 14% patient cost savings (p<0.05) per patient. CONCLUSION We believe that combining an effective ASP with a comprehensive infection control program will mitigate the emergence of antimicrobial-resistant bacteria.
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Affiliation(s)
- Dilek Asiltürk
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, ANKARA, TÜRKİYE.
| | - Rahmet Güner
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, ANKARA, TÜRKİYE
| | - Ayşe Kaya Kalem
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, ANKARA, TÜRKİYE
| | | | - İmran Hasanoğlu
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, ANKARA, TÜRKİYE
| | - Fatma Eser
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, ANKARA, TÜRKİYE
| | - Simten Malhan
- Department of Health Care Management,Başkent University, ANKARA, TÜRKİYE
| | - Bircan Kayaaslan
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, ANKARA, TÜRKİYE
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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, Timsit JF. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Med 2024:10.1007/s00134-024-07348-0. [PMID: 38498170 DOI: 10.1007/s00134-024-07348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/05/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). METHODS We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. RESULTS Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. CONCLUSION Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nour Setti
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Biostatistic Department, Outcomerea, 93700, Drancy, France
| | - François Barbier
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45000, Orléans, France
- Institut Maurice Rapin, Hôpital Henri Mondor, Créteil, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK
- JVF Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Infection and Sepsis ID Group, Porto, Portugal
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, University of Palermo, Via del Vespro129, 90127, Palermo, Italy
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jean-François Timsit
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France
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Başkol Elik D, Kaya Ş, Alkan S, Demirdal T, Sener A, Kaya S, Güzel Tunçcan Ö, Kayaaslan B, Güner R, Eser F, Kahraman H, Birengel S, Sarıcaoğlu EM, Eroğlu E, Çölkesen F, Öztürk E, Berk Cam H, Mermutluoğlu Ç, Özer Balin Ş, Sincan G, Altın N, Sili U, Suntur BM, Arslan Gülen T, Deveci B, Saba R, İncecik Ş, Eser Karlıdağ G, Hakko E, Akdağ D, Erdem HA, Sipahi H, Çicek C, Taşbakan MS, Taşbakan M, Pullukçu H, Yamazhan T, Arda B, Ulusoy S, Sipahi OR. The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study. Sci Rep 2024; 14:5218. [PMID: 38433274 PMCID: PMC10909849 DOI: 10.1038/s41598-024-55886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020-15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639-16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137-20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528-404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592-88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469-707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164-75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360-548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229-112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509-20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.
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Affiliation(s)
- Dilşah Başkol Elik
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.
- Infectious Disease and Clinical Microbiology, Turgutlu State Hospital, Manisa, Turkey.
| | - Şafak Kaya
- Department of Infectious Diseases, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | - Sevil Alkan
- Department of Infectious Disease, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Tuna Demirdal
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Alper Sener
- Department of Infectious Disease, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Selçuk Kaya
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Özlem Güzel Tunçcan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Hasip Kahraman
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Serhat Birengel
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Elif Mukime Sarıcaoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Esma Eroğlu
- Department of Infectious Disease and Clinical Microbiology, Konya Meram State Hospital, Konya, Turkey
| | - Fatma Çölkesen
- Department of Infectious Disease and Clinical Microbiology, Konya Meram State Hospital, Konya, Turkey
| | - Erman Öztürk
- Department of Hematology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hande Berk Cam
- Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Çiğdem Mermutluoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Şafak Özer Balin
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Gülden Sincan
- Department of Hematology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Nilgün Altın
- Department of Infectious Disease and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Uluhan Sili
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bedia Mutay Suntur
- Infectious Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Tuğba Arslan Gülen
- Infectious Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Burak Deveci
- Department of Hematology and Stem Cell Transplant Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Rabin Saba
- Department of Hematology and Stem Cell Transplant Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Şaban İncecik
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Gülden Eser Karlıdağ
- Department of Infectious Disease and Clinical Microbiology, Elazığ Fethi Sekin City Hospital, University of Health Sciences, Elazig, Turkey
| | - Elif Hakko
- Department of Infectious Disease and Clinical Microbiology, Anadolu Medical Center, Istanbul, Turkey
| | - Damla Akdağ
- Department of Infectious Diseases and Clinical Microbiology, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
| | - Hüseyin Aytaç Erdem
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Hilal Sipahi
- Bornova Directorate of Health, Bornova, Izmir, Turkey
| | - Candan Çicek
- Department of Medical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Mehmet Sezai Taşbakan
- Department of Chest Diseases, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Meltem Taşbakan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Bilgin Arda
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Sercan Ulusoy
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
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6
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Ayhan M, Coşkun B, Kayaaslan B, Hasanoğlu İ, Kalem AK, Eser F, Bilir YA, Ünlü S, Güner R. Point prevalence of antibiotic usage in major referral hospital in Turkey. PLoS One 2024; 19:e0296900. [PMID: 38295065 PMCID: PMC10830045 DOI: 10.1371/journal.pone.0296900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. MATERIALS AND METHODS A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. RESULTS Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). CONCLUSION Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.
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Affiliation(s)
- Müge Ayhan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Belgin Coşkun
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Serpil Ünlü
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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Ceylan AC, Çavdarlı B, Ceylan GG, Topçu V, Satılmış SBA, Bektaş ŞG, Kalem AK, Kayaaslan B, Eser F, Kalkan EA, İnan O, Hasanoğlu İ, Yüksel S, Ateş İ, İzdeş S, Güner R, Gündüz CNS. Impact of Inflammation-Related Genes on COVID-19: Prospective Study at Turkish Cohort. TOHOKU J EXP MED 2023; 261:179-185. [PMID: 37635061 DOI: 10.1620/tjem.2023.j071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The pandemic coronavirus disease 2019 (COVID-19) has caused a high mortality rate and poses a significant threat to the population. The disease may progress with mild symptoms or may cause the need for intensive care, depending on many factors. In this study, it was aimed to determine if there is a tendency due to genetic factors in COVID-19 patients. Ninety-four of 188 patients with mild clinical and 94 with severe clinical symptoms were included in the study. The targeted panel including coagulopathy (F2, F5), viral invasion (ACE2), and inflammation (CXCL8, IFNAR2, IFNL4, IL10, IL2, IL6, IRF7, TLR3, TLR7, TNF) related genes was performed sequenced by the next generation sequencing (NGS). The variants found were classified and univariate analyses were performed to select candidate variables for logistic model. Risk factors and variants were compared. It was revealed that the presence of 2 or more risk factors caused the disease to progress severely (p < 0.001). Heterozygous IRF7:c.1357-23dup variant had a 2.5 times higher risk for mild disease compared to severe disease. Other variants were found to be more significant in mild disease. Since polymorphic variants were not evaluated in the literature, the findings of our study could not be compared with the literature. However, as variants that may be effective in the severity of infections may differ according to ethnicity. This study has the feature of being a guide for subsequent studies to be carried out especially in Turkish population. Clinical course of the COVID-19 is likely to depend on a variety of risk factors, including age, sex, clinical status, immunology and genetic factors.
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Affiliation(s)
- Ahmet Cevdet Ceylan
- Department of Medical Genetics, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Medical Genetics, Ankara City Hospital
| | | | - Gülay Güleç Ceylan
- Department of Medical Genetics, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Medical Genetics, Ankara City Hospital
| | - Vehap Topçu
- Department of Medical Genetics, Ankara City Hospital
| | | | | | - Ayşe K Kalem
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital
| | | | - Osman İnan
- Department of Internal Medicine, Ankara City Hospital
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yıldırım Beyazıt University
| | - İhsan Ateş
- Department of Internal Medicine, Ankara City Hospital, Health Science University
| | - Seval İzdeş
- Department of Anesthesiology and Reanimation-Critical Care, Ankara City Hospital
- Department of Anesthesiology and Reanimation-Critical Care, Faculty of Medicine, Ankara Yıldırım Beyazıt University
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital
| | - C Nur Semerci Gündüz
- Department of Medical Genetics, Faculty of Medicine, Ankara Yıldırım Beyazıt University
- Department of Medical Genetics, Ankara City Hospital
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8
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Erdem H, Kocoglu E, Ankarali H, El-Sokkary R, Hakamifard A, Karaali R, Kulzhanova S, El-Kholy A, Tehrani HA, Khedr R, Kaya-Kalem A, Pandak N, Cagla-Sonmezer M, Nizamuddin S, Berk-Cam H, Guner R, Elkholy JA, Llopis F, Marino A, Stebel R, Szabo BG, Belitova M, Fadel E, Yetisyigit T, Cag Y, Alkan S, Kayaaslan B, Oncu S, Ozdemir M, Yilmaz M, Isik AC, Başkol D, Sincan G, Cascio A, Ozer-Balin S, Korkmaz N, Ripon RK, Abbas S, Dumitru IM, Eser-Karlidag G, Lanzafame M, Rafey A, Raza A, Sipahi OR, Darazam IA, Elbahr U, Erdem I, Ergen P, Bilir C, Caskurlu H, Erdem A, Makek MJ, Altindis M, Lakatos B, Luca CM, Yilmaz EM, Nsutebu E, Cakmak R, Sirmatel F. Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study. Int J Antimicrob Agents 2023; 62:106919. [PMID: 37423582 DOI: 10.1016/j.ijantimicag.2023.106919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain; Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Türkiye.
| | - Esra Kocoglu
- Department of Microbiology and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ridvan Karaali
- Department of Infectious Diseases & Clinical Microbiology, Cerrahpaşa School of Medicine, Istanbul, Türkiye
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hamed Azhdari Tehrani
- Department of Haematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reham Khedr
- Department of Paediatric Oncology, National Cancer Institute-Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Ayşe Kaya-Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | | | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Summiya Nizamuddin
- Section of Microbiology, Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Hande Berk-Cam
- Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Research Hospital, Antalya, Türkiye
| | - Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Jehan Ali Elkholy
- Department of Anaesthesia, Pain Management, Cairo University Hospital, Cairo, Egypt
| | - Ferran Llopis
- Emergency Department, Bellvitge University Hospital, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Roman Stebel
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Maya Belitova
- Medical University-Sofia, Department of Anaesthesiology and Intensive Care, University Hospital 'Queen Giovanna' ISUL, EAD, Sofia, Bulgaria
| | - Elias Fadel
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye.
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Türkiye
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Türkiye
| | - Mehmet Ozdemir
- Department of Medical Microbiology, Necmettin Erbakan University, Konya, Türkiye
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Arzu Cennet Isik
- Department of Internal Medicine, Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye
| | - Dilşah Başkol
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Gulden Sincan
- Department of Haematology, School of Medicine, Ataturk University, Erzurum, Türkiye
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Italy
| | - Safak Ozer-Balin
- Department of Infectious Diseases and Clinical Microbiology, Firat University, School of Medicine, Elazig, Türkiye
| | - Nesibe Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yıldirim Beyazit Education and Research Hospital, Ankara, Türkiye
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Salma Abbas
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | | | - Abdur Rafey
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Aun Raza
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain
| | - Ilknur Erdem
- Namık Kemal University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Tekirdağ, Türkiye
| | - Pinar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Cemil Bilir
- Department of Oncology, Istinye University, VMMedical Park Pendik Hospital, Istanbul, Türkiye; Sakarya University Faculty of Medicine Department of Medical Oncology, Sakarya, Türkiye
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Aysegul Erdem
- Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mustafa Altindis
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | | | - Esmeray Mutlu Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Türkiye
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, The United Arab Emirates
| | - Rumeysa Cakmak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Fatma Sirmatel
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Türkiye
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9
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Erol Ç, Kuloğlu ZE, Kayaaslan B, Esken G, Altunsoy A, Barlas T, Çınar G, Hasanoğlu İ, Oruç E, İncir S, Azap A, Korkmaz G, Turan Gökçe D, Kırımker OE, Coşkun Yenigün E, Ölçücüoğlu E, Ayvazoğlu Soy E, Çetinkünar S, Kurt Azap Ö, Can F, Haberal M. BNT162b2 or CoronaVac as the Third Dose against Omicron: Neutralizing Antibody Responses among Transplant Recipients Who Had Received Two Doses of CoronaVac. Viruses 2023; 15:1534. [PMID: 37515220 PMCID: PMC10383925 DOI: 10.3390/v15071534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
We evaluated neutralizing antibodies against the Omicron variant and Anti-Spike IgG response in solid organ (SOT) or hematopoietic stem cell (HSTC) recipients after a third dose of BNT162b2 (BNT) or CoronaVac (CV) following two doses of CV. In total, 95 participants underwent SOT (n = 62; 44 liver, 18 kidney) or HSCT (n = 27; 5 allogeneic, 22 autologous) were included from five centers in Turkey. The median time between third doses and serum sampling was 154 days (range between 15 to 381). The vaccine-induced antibody responses of both neutralizing antibodies and Anti-Spike IgGs were assessed by plaque neutralizing assay and immunoassay, respectively. Neutralizing antibody and Anti-Spike IgG levels were significantly higher in transplant patients receiving BNT compared to those receiving CV (Geometric mean (GMT):26.76 vs. 10.89; p = 0.03 and 2116 Au/mL vs. 172.1 Au/mL; p < 0.001). Solid organ transplantation recipients, particularly liver transplant recipients, showed lower antibody levels than HSCT recipients. Thus, among HSCT recipients, the GMT after BNT was 91.29 and it was 15.81 in the SOT group (p < 0.001). In SOT, antibody levels after BNT in kidney transplantation recipients were significantly higher than those in liver transplantation recipients (GMT: 48.32 vs. 11.72) (p < 0.001). Moreover, the neutralizing antibody levels after CV were very low (GMT: 10.81) in kidney transplantation recipients and below the detection limit (<10) in liver transplant recipients. This study highlights the superiority of BNT responses against Omicron as a third dose among transplant recipients after two doses of CV. The lack of neutralizing antibodies against Omicron after CV in liver transplant recipients should be taken into consideration, particularly in countries where inactivated vaccines are available in addition to mRNA vaccines.
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Affiliation(s)
- Çiğdem Erol
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Başkent University, Ankara 06490, Türkiye
| | - Zeynep Ece Kuloğlu
- Koç University-İşbank Center for Infectious Diseases (KUISCID), Istanbul 34010, Türkiye
- Graduate School of Health Sciences (GSHS), Koç University, Istanbul 34450, Türkiye
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara 06800, Türkiye
| | - Gülen Esken
- Koç University-İşbank Center for Infectious Diseases (KUISCID), Istanbul 34010, Türkiye
| | - Adalet Altunsoy
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara 06800, Türkiye
| | - Tayfun Barlas
- Koç University-İşbank Center for Infectious Diseases (KUISCID), Istanbul 34010, Türkiye
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University, Ankara 06230, Türkiye
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara 06800, Türkiye
| | - Ebru Oruç
- Department of Infectious Diseases and Clinical Microbiology, Adana City Hospital, Adana 01230, Türkiye
| | - Said İncir
- Department of Medical Biochemistry, Koç University School of Medicine, Istanbul 34450, Türkiye
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University, Ankara 06230, Türkiye
| | - Gülten Korkmaz
- Department of Hematology, Ankara City Hospital, Ankara 06800, Türkiye
| | - Dilara Turan Gökçe
- Department of Gastroenterology, Ankara City Hospital, Ankara 06800, Türkiye
| | | | | | - Erkan Ölçücüoğlu
- Department of Urology, Ankara City Hospital, Ankara 06800, Türkiye
| | - Ebru Ayvazoğlu Soy
- Department of General Surgery, Transplantation, Faculty of Medicine, Başkent University, Ankara 06490, Türkiye
| | | | - Özlem Kurt Azap
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Başkent University, Ankara 06490, Türkiye
| | - Füsun Can
- Koç University-İşbank Center for Infectious Diseases (KUISCID), Istanbul 34010, Türkiye
- Department of Medical Microbiology, Koç University School of Medicine, Istanbul 34450, Türkiye
| | - Mehmet Haberal
- Department of General Surgery, Transplantation, Faculty of Medicine, Başkent University, Ankara 06490, Türkiye
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10
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Ozdemir B, Akinci E, Koksal M, Rodoplu E, Altunsoy A, Guner R, Kayaaslan B, Kalem AK, Hasanoglu I, Eser F, Ayhan M, Saricaoglu EM, Bilir YA, Coskun B. The role of chest X-ray in coronavirus disease 2019 (COVID-19) infection: findings and correlation with clinical outcome. Eur Rev Med Pharmacol Sci 2023; 27:6563-6572. [PMID: 37522668 DOI: 10.26355/eurrev_202307_33127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE It is possible to diagnose coronavirus disease 2019 (COVID-19) faster and more accurately with chest X-ray (CXR) and chest computed tomography (CT) than with reverse transcriptase PCR (RT-PCR) tests. The aim of this study was to verify the possibility of reducing the use of CT in diagnosis and follow-up of COVID-19 infection by using CXR. PATIENTS AND METHODS A total of 326 COVID-19 patients who were hospitalized in Ankara City Hospital were included in this retrospective study. RESULTS A total of 326 patients were RT-PCR positive for COVID-19 infection; 178 were male (54.6%) and 148 were female (45.4%), with a median age of 45. Considering the results, the baseline CXR sensitivity in our experience was approximately 72%. The CXRs of 113 patients with abnormal CT were divided into 2 groups, the CXR normal and abnormal groups, and were then compared. In the 1st group with abnormal CXR, the mean age, the number of patients over 65 years old, and the comorbidity rate were higher. Additionally, it was determined that the number of patients requiring respiratory support and intensive care unit (ICU) admission in this 1st group was higher than in the 2nd group (with normal CXR). Most of the patients who died (91%, 10/11) were in Group 1. In the group with normal CXR, no patients in the critically ill category needed invasive or non-invasive mechanical ventilators. CONCLUSIONS CXR can help in detecting clinically moderate and severe cases of COVID-19. CXR can assist clinicians in patient management and treatment planning regarding the clinical course, respiratory support, ICU need, and mortality and can help them prepare for potential negative outcomes.
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Affiliation(s)
- B Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
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Erdem H, Baymakova M, Alkan S, Letaief A, Yahia WB, Dayyab F, Kolovani E, Grgic S, Cosentino F, Hasanoglu I, Khedr R, Marino A, Pekok AU, Eser F, Arapovic J, Guner HR, Miftode IL, Poposki K, Sanlidag G, Tahmaz A, Sipahi OR, Miftode EG, Oncu S, Cagla-Sonmezer M, Addepalli SK, Darazam IA, Kumari HP, Koc MM, Kumar MR, Sayana SB, Wegdan AA, Amer F, Ceylan MR, El-Kholy A, Onder T, Tehrani HA, Hakamifard A, Kayaaslan B, Shehata G, Caskurlu H, El-Sayed NM, Mortazavi SE, Pourali M, Elbahr U, Kulzhanova S, Yetisyigit T, Saad SA, Cag Y, Eser-Karlidag G, Pshenichnaya N, Belitova M, Akhtar N, Al-Majid F, Ayhan M, Khan MA, Lanzafame M, Makek MJ, Nsutebu E, Cascio A, Dindar-Demiray EK, Evren EU, Kalas R, Kalem AK, Baljić R, Ikram A, Kaya S, Liskova A, Szabo BG, Rahimi BA, Mutlu-Yilmaz E, Sener A, Rello J. Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study. Eur J Clin Microbiol Infect Dis 2023; 42:387-398. [PMID: 36790531 PMCID: PMC9930069 DOI: 10.1007/s10096-023-04561-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
| | - Magdalena Baymakova
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Amel Letaief
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Wissal Ben Yahia
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Farouq Dayyab
- Department of Internal Medicine, King Hamad University Hospital, Al Sayh, Manama, Bahrain
| | - Entela Kolovani
- Infectious Disease Clinic, University Hospital Center 'Mother Theresa', Tirana, Albania
| | - Svjetlana Grgic
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Federica Cosentino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Imran Hasanoglu
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | | | - Fatma Eser
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Jurica Arapovic
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Hatice Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Kostadin Poposki
- Faculty of Medicine, University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of North Macedonia
| | - Gamze Sanlidag
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | - Alper Tahmaz
- Department of Infectious Diseases & Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | | | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Turkey
| | - Syam Kumar Addepalli
- Department of Pharmacology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hema Prakash Kumari
- Department of Microbiology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Meliha Meriç Koc
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Meela Ranjith Kumar
- Department of Pharmacology, Government Medical College &, Government General Hospital, Suryapet, Telangana, India
| | - Suresh Babu Sayana
- Department of Pharmacology, Government Medical College, Suryapet, Telangana, India
| | - Ahmed Ashraf Wegdan
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mehmet Resat Ceylan
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Taylan Onder
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Hamed Azhdari Tehrani
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Seyed Erfan Mortazavi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Pourali
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sahar Ahmed Saad
- Department of Rheumatology, King Hamad Univesity Hospital, Al Sayh, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | | | | | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, G-8/3, Pakistan
| | - Fahad Al-Majid
- Department of Medicine, Infectious Diseases Division, King Saud University, Riyadh, Saudi Arabia
| | - Muge Ayhan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | | | | | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Palermo, Italy
| | | | - Emine Unal Evren
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Rama Kalas
- Internal Medicine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Esmeray Mutlu-Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Alper Sener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Jordi Rello
- Clinical Research and Epidemiology in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Clinical Research, CHRU Nîmes, Nîmes, France
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Erdem D, Kayaaslan B, Cakir EY, Dinc B, Asilturk D, Kirca F, Segmen F, Turan IO, Guner R. Investigation of SARS-CoV-2 using RT-PCR in vaginal swab samples of female patients with a diagnosis of severe COVID-19. Taiwan J Obstet Gynecol 2023; 62:270-274. [PMID: 36965894 PMCID: PMC9729648 DOI: 10.1016/j.tjog.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE It is important to determine the presence of SARS-CoV-2 in the vaginal fluid samples of reproductive-aged women with severe disease during the acute stage of the disease and to determine the risks of transmission by sexual or vertical transmission. MATERIAL AND METHODS Adult women with confirmed severe COVID-19 who were admitted to Ankara City Hospital intensive care unit (ICU) between December 1st, 2020, and January 1st, 2021, were enrolled in the study. Vaginal swab samples were collected within 48 h in the ICU using Dacron or rayon swabs and tested for SARS-CoV-2 using reverse transcription real-time polymerase chain reaction (RT PCR). RESULTS Thirty women of reproductive age were included in the study, five (16.7%) of whom were pregnant. The mean age was 44.9 (±10.5) years. The most common symptoms were headache (100%), muscle soreness (86.7%), cough (76.7%), fever (60%), and nausea and vomiting (20%). Nineteen (63.3%) patients had underlying medical conditions. The time interval from obtaining vaginal swab samples to admission to the ICU was 48 h. The time between vaginal sampling and PCR positivity ranged from 2 to 18 days. SARS-CoV-2 was not detected in any vaginal samples. CONCLUSION Our study showed that women with severe COVID-19 did not have SARS-CoV-2 in their vaginal fluids. Investigation of the presence of SARS-CoV-2 in vaginal secretions may help in determining the risks of sexual transmission and vertical transmission from mother to baby. Information on this subject is still limited. Larger studies on comprehensive biological samples are needed.
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Affiliation(s)
- Deniz Erdem
- Department of Intensive Care Unıt, Univeristy of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Bircan Kayaaslan
- Infectious Disease and Clinical Microbiology, Ankara Yildırım Beyazit University, Ankara City Hospital, Ankara, Turkey
| | | | - Bedia Dinc
- Department of Medical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dilek Asilturk
- Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Fisun Kirca
- Department of Medical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Fatih Segmen
- Department of Intensive Care Unıt, Ankara City Hospital, Ankara, Turkey
| | - Isil Ozkocak Turan
- Department of Intensive Care Unıt, Univeristy of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Infectious Disease and Clinical Microbiology, Ankara Yildırım Beyazit University, Ankara City Hospital, Ankara, Turkey
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Baydar Toprak O, Akpolat T, Uzun O, Pınar Deniz P, Kokturk N, Varol A, Guzel E, Ercelik M, Gultekin O, Guner R, Turan S, Gökbulut Bektaş Ş, Coskun N, Bakan N, Nuri Yakar M, Eren Kutsoylu O, Ergan B, Argun Barış S, Başyiğit I, Boyacı H, Çetinkaya F, Çolak H, Aykac N, Baran Ketencioğlu B, Türe Yüce Z, Akkaya Isık S, Serap Yılmaz E, Karaoğlanoğlu S, Berik Safci S, Ozkan G, Kose N, Kizilirmak D, Havlucu Y, Nural S, Kerget F, Sunal Ö, Yuksel A, Bestepe Dursun Z, Deveci F, Kuluozturk M, Ataoglu O, Dursun M, Keskin S, Emin Sezgin M, Aktepe Sezgin EN, Eser F, Akyildiz L, Selim Almaz M, Kayaaslan B, Hasanoğlu I, Bayrak M, Gümüş A, Sağcan G, Cuhadaroglu C, Kucuk H, Onyilmaz T, Mete B, Kilinc O, Oya Itil B. COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission. Eur Rev Med Pharmacol Sci 2023; 27:2132-2142. [PMID: 36930513 DOI: 10.26355/eurrev_202303_31586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.
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Affiliation(s)
- O Baydar Toprak
- Department of Chest Diseases, Faculty of Medicine, Cukurova University, Adana, Turkey.
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Eser F, Kayaaslan B, Kaya Kalem A, Hasanoğlu İ, Bilgiç Z, Asiltürk D, Kaplan B, Güner R. Effect of 2 Different High-Dose Methylprednisolone Treatments on Clinical Outcomes in Severe COVID-19 Patients. Thorac Res Pract 2023; 24:66-75. [PMID: 37503642 PMCID: PMC10652074 DOI: 10.5152/thoracrespract.2023.22050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/06/2022] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The present study aimed to evaluate and compare the use of 2 different high-dose methylprednisolone posology in treating severe coronavirus disease 2019 pneumonia regarding mortality and recovery time between themselves and against steroidal/ non-steroidal treatment. MATERIAL AND METHODS Severe coronavirus disease 2019 patients followed up between March 2020 and January 2021 were included. The steroid-free treatment protocol was applied before August 2020 (non-pulse group) and a treatment algorithm containing normal and high doses of methylprednisolone was applied after August 2020 (pulse group). Patients with clinical deterioration under the normal dose of methylprednisolone were administered 250 mg or 1000 mg of methylprednisolone for 3 days. We compared the pulse and non-pulse groups, in addition to pulse subgroups with each other, for clinical outcomes. RESULTS A total of 138 patients were included, including 36 patients in the non-pulse group and 102 in the pulse group. In the pulse group, 70 patients received 1000 mg/day and 32 received 250 mg/day of high-dose methylprednisolone therapy. In the comparison of pulse and non-pulse patient groups, mortality rate was lower in the pulse group (P < .001), and the time to discharge without oxygen support was shorter. Although the patients in the 250 mg subgroup were older, there was no difference between the 250 mg and 1000 mg subgroups in terms of end of oxygen requirement, discharge with oxygen support, and mortality. In addition, the required time to reach the oxygen-free period in patients discharged without oxygen support was similar in the 2 subgroups, and the majority of patients in both subgroups reached the oxygen-free period on the 20th day after initiating methylprednisolone. CONCLUSION Since there was no difference in clinical improvement between the use of 250 mg or 1000 mg methylprednisolone in patients with severe coronavirus disease 2019 infection, 1000 mg methylprednisolone was not required.
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Affiliation(s)
- Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım BeyazıtUniversity, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım BeyazıtUniversity, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım BeyazıtUniversity, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım BeyazıtUniversity, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Zeynep Bilgiç
- Department of Infectious Diseases and Clinical Microbiology, nkara City Hospital, , Ankara, Turkey
| | - Dilek Asiltürk
- Department of Infectious Diseases and Clinical Microbiology, nkara City Hospital, , Ankara, Turkey
| | - Betül Kaplan
- Department of Infectious Diseases and Clinical Microbiology, nkara City Hospital, , Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım BeyazıtUniversity, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
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Pascale R, Toschi A, Aslan AT, Massaro G, Maccaro A, Fabbricatore D, Dell'Aquila A, Ripa M, Işık ME, Kızmaz YU, Iacopino S, Camici M, Perna F, Akinosoglou K, Karruli A, Papadimitriou-Olivgeris M, Kayaaslan B, Bilir YA, Evren Özcan E, Turan OE, Işık MC, Pérez-Rodríguez MT, Yagüe BL, Quirós AM, Yılmaz M, Petersdorf S, De Potter T, Durante-Mangoni E, Akova M, Curnis A, Gibertoni D, Diemberger I, Scudeller L, Viale P, Giannella M. Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study). Int J Antimicrob Agents 2023; 61:106734. [PMID: 36690123 DOI: 10.1016/j.ijantimicag.2023.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. METHODS A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. RESULTS A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). CONCLUSIONS Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.
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Affiliation(s)
- Renato Pascale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Alice Toschi
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Abdullah Tarik Aslan
- Golhisar State Hospital, Department of Internal Medicine, Burdur, Turkey; Hacettepe University School of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Giulia Massaro
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Andrea Dell'Aquila
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Hospital of Brescia and University of Brescia, Brescia, Italy
| | - Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mehmet Emirhan Işık
- University of Health Sciences Kosuyolu Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Yeşim Uygun Kızmaz
- University of Health Sciences Kosuyolu Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | | | - Marta Camici
- Institute of infectious diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; HIV/AIDS Clinical Unit, National Institute for infectious Diseases L. Spallanzani IRCCS, Rome, Italy
| | - Francesco Perna
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Arta Karruli
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | - Bircan Kayaaslan
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Emin Evren Özcan
- Dokuz Eylul University, Heart Rhythm Management Center, İzmir, Turkey
| | | | - Muhammed Cihan Işık
- Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain Instituto de Investigación Biomédica Galicia Sur, Spain
| | - Belén Loeches Yagüe
- Infectious Diseases Unit, Hospital Universitario La Paz - IDIPAZ, Madrid, Spain
| | | | - Mesut Yılmaz
- Istanbul Medipol University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Sabine Petersdorf
- Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Murat Akova
- Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Antonio Curnis
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Hospital of Brescia and University of Brescia, Brescia, Italy
| | - Dino Gibertoni
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Lipman J, Ferrer R, Qiu H, Paiva JA, Povoa P, De Bus L, De Waele J, Zand F, Gurjar M, Alsisi A, Abidi K, Bracht H, Hayashi Y, Jeon K, Elhadi M, Barbier F, Timsit JF, Pollock H, Margetts B, Young M, Bhadange N, Tyler S, Ledtischke A, Finnis M, Ledtischke A, Finnis M, Dwivedi J, Saxena M, Biradar V, Soar N, Sarode V, Brewster D, Regli A, Weeda E, Ahmed S, Fourie C, Laupland K, Ramanan M, Walsham J, Meyer J, Litton E, Palermo AM, Yap T, Eroglu E, Attokaran AG, Jaramillo C, Nafees KMK, Rashid NAHA, Walid HAMI, Mon T, Moorthi PD, Sudhirchandra S, Sridharan DD, Haibo Q, Jianfeng X, Wei-Hua L, Zhen W, Qian C, Luo J, Chen X, Wang H, Zhao P, Zhao J, Wusi Q, Mingmin C, Xu L, Yin C, Wang R, Wang J, Yin Y, Zhang M, Ye J, Hu C, Zhou S, Huang M, Yan J, Wang Y, Qin B, Ye L, Weifeng X, Peije L, Geng N, Hayashi Y, Karumai T, Yamasaki M, Hashimoto S, Hosokawa K, Makino J, Matsuyoshi T, Kuriyama A, Shigemitsu H, Mishima Y, Nagashima M, Yoshida H, Fujitani S, Omori K, Rinka H, Saito H, Atobe K, Kato H, Takaki S, Hasan MS, Jamaluddin MFH, Pheng LS, Visvalingam S, Liew MT, Wong SLD, Fong KK, Rahman HBA, Noor ZM, Tong LK, Azman AH, Mazlan MZ, Ali S, Jeon K, Lee SM, Park S, Park SY, Lim SY, Goh QY, Ng SY, Lie SA, Kwa ALH, Goh KJ, Li AY, Ong CYM, Lim JY, Quah JL, Ng K, Ng LXL, Yeh YC, Chou NK, Cia CT, Hu TY, Kuo LK, Ku SC, Wongsurakiat P, Apichatbutr Y, Chiewroongroj S, Nadeem R, Houfi AE, Alsisi A, Elhadidy A, Barsoum M, Osman N, Mostafa T, Elbahnasawy M, Saber A, Aldhalia A, Elmandouh O, Elsayed A, Elbadawy MA, Awad AK, Hemead HM, Zand F, Ouhadian M, Borsi SH, Mehraban Z, Kashipazha D, Ahmadi F, Savaie M, Soltani F, Rashidi M, Baghbanian R, Javaherforoosh F, Amiri F, Kiani A, Zargar MA, Mahmoodpoor A, Aalinezhad F, Dabiri G, Sabetian G, Sarshad H, Masjedi M, Tajvidi R, Tabatabaei SMN, Ahmed AK, Singer P, Kagan I, Rigler M, Belman D, Levin P, Harara B, Diab A, Abilama F, Ibrahim R, Fares A, Buimsaedah A, Gamra M, Aqeelah A, AliAli AM, Homaidan AGS, Almiqlash B, Bilkhayr H, Bouhuwaish A, Taher AS, Abdulwahed E, Abousnina FA, Hdada AK, Jobran R, Hasan HB, Hasan RSB, Serghini I, Seddiki R, Boukatta B, Kanjaa N, Mouhssine D, Wajdi MA, Dendane T, Zeggwagh AA, Housni B, Younes O, Hachimi A, Ghannam A, Belkhadir Z, Amro S, Jayyab MA, Hssain AA, Elbuzidi A, Karic E, Lance M, Nissar S, Sallam H, Elrabi O, Almekhlafi GA, Awad M, Aljabbary A, Chaaban MK, Abu-Sayf N, Al-Jadaan M, Bakr L, Bouaziz M, Turki O, Sellami W, Centeno P, Morvillo LN, Acevedo JO, Lopez PM, Fernández R, Segura M, Aparicio DM, Alonzo MI, Nuccetelli Y, Montefiore P, Reyes LF, Reyes LF, Ñamendys-Silva SA, Romero-Gonzalez JP, Hermosillo M, Castillo RA, Leal JNP, Aguilar CG, Herrera MOG, Villafuerte MVE, Lomeli-Teran M, Dominguez-Cherit JG, Davalos-Alvarez A, Ñamendys-Silva SA, Sánchez-Hurtado L, Tejeda-Huezo B, Perez-Nieto OR, Tomas ED, De Bus L, De Waele J, Hollevoet I, Denys W, Bourgeois M, Vanderhaeghen SFM, Mesland JB, Henin P, Haentjens L, Biston P, Noel C, Layos N, Misset B, De Schryver N, Serck N, Wittebole X, De Waele E, Opdenacker G, Kovacevic P, Zlojutro B, Custovic A, Filipovic-Grcic I, Radonic R, Brajkovic AV, Persec J, Sakan S, Nikolic M, Lasic H, Leone M, Arbelot C, Timsit JF, Patrier J, Zappela N, Montravers P, Dulac T, Castanera J, Auchabie J, Le Meur A, Marchalot A, Beuzelin M, Massri A, Guesdon C, Escudier E, Mateu P, Rosman J, Leroy O, Alfandari S, Nica A, Souweine B, Coupez E, Duburcq T, Kipnis E, Bortolotti P, Le Souhaitier M, Mira JP, Garcon P, Duprey M, Thyrault M, Paulet R, Philippart F, Tran M, Bruel C, Weiss E, Janny S, Foucrier A, Perrigault PF, Djanikian F, Barbier F, Gainnier M, Bourenne J, Louis G, Smonig R, Argaud L, Baudry T, Dessap AM, Razazi K, Kalfon P, Badre G, Larcher R, Lefrant JY, Roger C, Sarton B, Silva S, Demeret S, Le Guennec L, Siami S, Aparicio C, Voiriot G, Fartoukh M, Dahyot-Fizelier C, Imzi N, Klouche K, Bracht H, Hoheisen S, Bloos F, Thomas-Rueddel D, Petros S, Pasieka B, Dubler S, Schmidt K, Gottschalk A, Wempe C, Lepper P, Metz C, Viderman D, Ymbetzhanov Y, Mugazov M, Bazhykayeva Y, Kaligozhin Z, Babashev B, Merenkov Y, Temirov T, Arvaniti K, Smyrniotis D, Psallida V, Fildisis G, Soulountsi V, Kaimakamis E, Iasonidou C, Papoti S, Renta F, Vasileiou M, Romanou V, Koutsoukou V, Matei MK, Moldovan L, Karaiskos I, Paskalis H, Marmanidou K, Papanikolaou M, Kampolis C, Oikonomou M, Kogkopoulos E, Nikolaou C, Sakkalis A, Chatzis M, Georgopoulou M, Efthymiou A, Chantziara V, Sakagianni A, Athanasa Z, Papageorgiou E, Ali F, Dimopoulos G, Almiroudi MP, Malliotakis P, Marouli D, Theodorou V, Retselas I, Kouroulas V, Papathanakos G, Montrucchio G, Sales G, De Pascale G, Montini LM, Carelli S, Vargas J, Di Gravio V, Giacobbe DR, Gratarola A, Porcile E, Mirabella M, Daroui I, Lodi G, Zuccaro F, Schlevenin MG, Pelosi P, Battaglini D, Cortegiani A, Ippolito M, Bellina D, Di Guardo A, Pelagalli L, Covotta M, Rocco M, Fiorelli S, Cotoia A, Rizzo AC, Mikstacki A, Tamowicz B, Komorowska IK, Szczesniak A, Bojko J, Kotkowska A, Walczak-Wieteska P, Wasowska D, Nowakowski T, Broda H, Peichota M, Pietraszek-Grzywaczewska I, Martin-Loeches I, Bisanti A, Cartoze N, Pereira T, Guimarães N, Alves M, Marques AJP, Pinto AR, Krystopchuk A, Teresa A, de Figueiredo AMP, Botelho I, Duarte T, Costa V, Cunha RP, Molinos E, da Costa T, Ledo S, Queiró J, Pascoalinho D, Nunes C, Moura JP, Pereira É, Mendes AC, Valeanu L, Bubenek-Turconi S, Grintescu IM, Cobilinschi C, Filipescu DC, Predoi CE, Tomescu D, Popescu M, Marcu A, Grigoras I, Lungu O, Gritsan A, Anderzhanova A, Meleshkina Y, Magomedov M, Zubareva N, Tribulev M, Gaigolnik D, Eremenko A, Vistovskaya N, Chukina M, Belskiy V, Furman M, Rocca RF, Martinez M, Casares V, Vera P, Flores M, Amerigo JA, Arnillas MPG, Bermudez RM, Armestar F, Catalan B, Roig R, Raguer L, Quesada MD, Santos ED, Gomà G, Ubeda A, Salgado DM, Espina LF, Prieto EG, Asensio DM, Rodriguez DM, Maseda E, De La Rica AS, Ayestaran JI, Novo M, Blasco-Navalpotro MA, Gallego AO, Sjövall F, Spahic D, Svensson CJ, Haney M, Edin A, Åkerlund J, De Geer L, Prazak J, Jakob S, Pagani J, Abed-Maillard S, Akova M, Aslan AT, Timuroglu A, Kocagoz S, Kusoglu H, Mehtap S, Ceyhun S, Altintas ND, Talan L, Kayaaslan B, Kalem AK, Kurt I, Telli M, Ozturk B, Erol Ç, Demiray EKD, Çolak S, Akbas T, Gundogan K, Sari A, Agalar C, Çolak O, Baykam NN, Akdogan OO, Yilmaz M, Tunay B, Cakmak R, Saltoglu N, Karaali R, Koksal I, Aksoy F, Eroglu A, Saracoglu KT, Bilir Y, Guzeldag S, Ersoz G, Evik G, Sungurtekin H, Ozgen C, Erdoğan C, Gürbüz Y, Altin N, Bayindir Y, Ersoy Y, Goksu S, Akyol A, Batirel A, Aktas SC, Morris AC, Routledge M, Morris AC, Ercole A, Antcliffe D, Rojo R, Tizard K, Faulkner M, Cowton A, Kent M, Raj A, Zormpa A, Tinaslanidis G, Khade R, Torlinski T, Mulhi R, Goyal S, Bajaj M, Soltan M, Yonan A, Dolan R, Johnson A, Macfie C, Lennard J, Templeton M, Arias SS, Franke U, Hugill K, Angell H, Parcell BJ, Cobb K, Cole S, Smith T, Graham C, Cerman J, Keegan A, Ritzema J, Sanderson A, Roshdy A, Szakmany T, Baumer T, Longbottom R, Hall D, Tatham K, Loftus S, Husain A, Black E, Jhanji S, Baikady RR, Mcguigan P, Mckee R, Kannan S, Antrolikar S, Marsden N, Torre VD, Banach D, Zaki A, Jackson M, Chikungwa M, Attwood B, Patel J, Tilley RE, Humphreys MSK, Renaud PJ, Sokhan A, Burma Y, Sligl W, Baig N, McCoshen L, Kutsogiannis DJ, Sligl W, Thompson P, Hewer T, Rabbani R, Huq SMR, Hasan R, Islam MM, Gurjar M, Baronia A, Kothari N, Sharma A, Karmakar S, Sharma P, Nimbolkar J, Samdani P, Vaidyanathan R, Rubina NA, Jain N, Pahuja M, Singh R, Shekhar S, Muzaffar SN, Ozair A, Siddiqui SS, Bose P, Datta A, Rathod D, Patel M, Renuka MK, Baby SK, Dsilva C, Chandran J, Ghosh P, Mukherjee S, Sheshala K, Misra KC, Yakubu SY, Ugwu EM, Olatosi JO, Desalu I, Asiyanbi G, Oladimeji M, Idowu O, Adeola F, Mc Cree M, Karar AAA, Saidahmed E, Hamid HKS. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med 2023; 49:178-190. [PMID: 36764959 PMCID: PMC9916499 DOI: 10.1007/s00134-022-06944-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. METHODS We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. RESULTS 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. CONCLUSIONS HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia. .,Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France
| | | | - Stéphane Ruckly
- Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France.,ICUREsearch, Biometry, 38600, Fontaine, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK.,JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Jeffrey Lipman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Nimes University Hospital, University of Montpellier, Nimes, France.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal.,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Infection and Sepsis ID Group, Porto, Portugal
| | - Pedro Povoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.,Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Liesbet De Bus
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Adel Alsisi
- ICU Department, Prime Hospital, Dubai, United Arab Emirates.,Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalid Abidi
- Medical ICU, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hendrik Bracht
- Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda General Hospital, Kamogawa, Japan
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de L'Hôpital, 45100, Orléans, France
| | - Jean-François Timsit
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Omdurman maternity hospitalrue Henri Huchard, 75877, Paris Cedex, France
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Sezer S, Bal C, Kalem AK, Kayaaslan B, Eser F, Hasanoglu İ, Akıncı E, Güner R, Erel Ö, Yılmaz G. COVID-19 patients with altered steroid hormone levels are more likely to have higher disease severity. Endocrine 2022; 78:373-379. [PMID: 35907083 PMCID: PMC9362412 DOI: 10.1007/s12020-022-03140-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to evaluate the correlations between the severity of the disease and serum steroid levels by analyzing the serum steroid levels in COVID-19 patients with different levels of disease progression and the control group. METHODS Morning serum Aldosterone, 11-deoxycortisol, Androstenedione, 17-hydroxyprogesterone, Dihydrotestosterone (DHT), Dehydroepiandrosterone (DHEA), Corticosterone, Dehydroepiandrosterone sulfate (DHEAS), Estrone, Estradiol, Progesterone, 11-deoxycorticosterone, Cortisol, Corticosterone, Androsterone, Pregnenolone, 17-hydroxypregnenolone and 21-deoxycortisol levels were measured in 153 consecutive patients were grouped as mild, moderate, and severe based on the WHO COVID-19 disease severity classification and the control group. Steroid hormone levels were analyzed at once with a liquid chromatography-tandem mass spectrometric method (LC-MS/MS). RESULTS In our study, nearly all steroids were statistically significantly higher in the patients' group than in the control group (p < 0.001). Also, DHEA was an independent indicator of the disease severity with COVID-19 CONCLUSIONS: Our study reveals that the alteration in steroid hormone levels was correlated with disease severity. Also, steroid hormone levels should be followed up during COVID-19 disease management.
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Affiliation(s)
- Sevilay Sezer
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey.
| | - Ceylan Bal
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - İmran Hasanoglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Esragül Akıncı
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Özcan Erel
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Gülsen Yılmaz
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
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18
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Kayaaslan B, Eser F, Asilturk D, Oktay Z, Hasanoglu I, Kalem AK, Dönertaş G, Kaplan B, Ozkocak Turan I, Erdem D, Bektas H, Guner R. Development and validation of COVID-19 associated candidemia score (CAC-Score) in ICU patients. Mycoses 2022; 66:128-137. [PMID: 36135336 PMCID: PMC9537877 DOI: 10.1111/myc.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The development of candidemia is a highly fatal condition in severe COVID-19 infection. OBJECTIVES This study aimed to develop a candidemia prediction score in COVID-19 patient based on the patient's clinical characteristics, and healthcare-related factors during intensive care units (ICU) follow-up. PATIENTS/METHODS Severe COVID-19 patients hospitalised in ICU in Ankara City Hospital during the one-year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score. RESULTS Of 1305 COVID-19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12-44.8, p < .0001), multifocal colonisation (OR 2.28, CI 1.39-3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42-5.44, p < .0001) and corticosteroids (OR 0.51, CI 0.34-0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81-0.87). CONCLUSION We developed and validated an easy-to-use clinical prediction score for candidemia in severe COVID-19 infection. In COVID-19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Dilek Asilturk
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Zeynep Oktay
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Ayşe Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Gülen Dönertaş
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Betul Kaplan
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Isıl Ozkocak Turan
- Department of Intensive Care UnitUniversity of Health Sciences Ankara City HospitalAnkaraTurkey
| | - Deniz Erdem
- Department of Intensive Care UnitUniversity of Health Sciences Ankara City HospitalAnkaraTurkey
| | - Hesna Bektas
- Department of Neurology, Ankara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
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Kayaaslan B, Kaya Kalem A, Asilturk D, Kaplan B, Dönertas G, Hasanoglu I, Eser F, Korkmazer R, Oktay Z, Ozkocak Turan I, Erdem D, Bektas H, Guner R. Incidence and risk factors for COVID-19 associated candidemia (CAC) in ICU patients. Mycoses 2022; 65:508-516. [PMID: 35156742 PMCID: PMC9115269 DOI: 10.1111/myc.13431] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Critically ill COVID-19 patients have a high risk for the development of candidemia due to being exposed to both well-defined classical risk factors and COVID-19-specific risk factors in ICU. OBJECTIVES In this study, we investigated the incidence of candidemia in critically COVID-19 patients, and the independent risk factors for candidemia. PATIENTS/METHODS COVID-19 patients hospitalised in ICU during 1-year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID-19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded. RESULTS Of 1229 COVID-19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8-12.2, p < .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4-5.2, p < .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08-3-37, p < .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1-0.9, p < .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14-0.52, p < .0001) were significantly associated with candidemia. CONCLUSIONS Our study filled the knowledge gap in the literature about the impact of COVID-19-associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID-19 patients should be confirmed by further studies.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkara City HospitalAnkaraTurkey
| | - Ayşe Kaya Kalem
- Department of Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkara City HospitalAnkaraTurkey
| | - Dilek Asilturk
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Betul Kaplan
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Gülen Dönertas
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkara City HospitalAnkaraTurkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkara City HospitalAnkaraTurkey
| | - Ruveyda Korkmazer
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Zeynep Oktay
- Department of Infectious Disease and Clinical MicrobiologyAnkara City HospitalAnkaraTurkey
| | - Isıl Ozkocak Turan
- Department of Intensive Care UnitUniversity of Health Sciences Ankara City HospitalAnkaraTurkey
| | - Deniz Erdem
- Department of Intensive Care UnitUniversity of Health Sciences Ankara City HospitalAnkaraTurkey
| | - Hesna Bektas
- Department of NeurologyAnkara City HospitalAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkara City HospitalAnkaraTurkey
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20
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Erdol MA, Kayaaslan B, Erdogan M, Hasanoglu I, Yayla C, Civelek Eser F, Besler MS, Kaya Kalem A, Gayretli Yayla K, Erdol AK, Ertem AG, Guner HR. Sarcopenia and Its Prognostic Role on Hospitalization and In-Hospital Mortality in Coronavirus Disease 2019 Patients with At Least One Cardiovascular Risk Factor. Turk Kardiyol Dern Ars 2022; 50:103-111. [DOI: 10.5543/tkda.2022.21167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Kazancioglu S, Bastug A, Kayaaslan B, Mutlu NM, Calci E, Turhan T, Mumcuoglu I, Akinci E, Bodur H. Diagnostic value of β-D-glucan alone or combined with Candida score, colonization index and C-reactive protein for candidemia. J Infect Dev Ctries 2022; 16:362-368. [PMID: 35298433 DOI: 10.3855/jidc.15711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/13/2022] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients. However the usefulness of BDG in ICUs is unclear. METHODOLOGY This study was conducted to compare the diagnostic value of Candida score (CS), colonization index (CI), serum BDG detection, and routine laboratory parameters in ICU patients. Characteristics and laboratory data of 83 patients (15 patients with candidemia and 68 patients without candidemia) were evaluated. RESULTS Median serum BDG was significantly higher in the candidemia group (129 pg/mL vs. 36 pg/mL, p < 0.001). BDG assay with standard cut-off value ≥ of 80 pg/mL had 93.33% sensitivity and 64.18% specificity (Areas under the ROC curve (AUC): 0.788). This study concluded that the optimal cut-off value for BDG assay was 112 pg/mL with sensitivity of 86.67% and specificity of 82.09% (AUC: 0.844). C-reactive protein (CRP) with optimal cut-off value ≥ 85 mg/L and BDG ≥ 80 pg/mL had the highest AUC (0.862, 95% CI: 0.768 - 0.928) with sensitivity 93.33% and specificity 79.1%. CONCLUSIONS Predicting candidemia is essential in critically ill patients who are at high risk and have high mortality rates. The results of this study suggest that BDG testing is useful for predicting candidemia in ICU. However, BDG combined with CRP may be a stronger predictor for candidemia.
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Affiliation(s)
- Sumeyye Kazancioglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | | | - Esin Calci
- Department of Clinical Biochemistry, Uşak Public Health laboratory, Uşak, Turkey
| | - Turan Turhan
- Department of Clinical Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Ipek Mumcuoglu
- Department of Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Health Science University Turkey, Ankara City Hospital, Ankara, Turkey
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22
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Erdogan M, Kaya Kalem A, Ozturk S, Erdol MA, Kayaaslan B, Ozbebek YE, Guner R. Reply to letter to the editor: “Interleukin-6 level, right ventricular systolic dysfunction, and coronavirus disease 2019”. Anatol J Cardiol 2022; 26:152. [DOI: 10.5152/anatoljcardiol.2022.l2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Kaya Kalem A, Kayaaslan B, Eser F, Hasanoglu İ, Ayhan M, Coskun B, Guner R. Investigation of the relation between risk assessment of exposure and nosocomial SARS-CoV-2 transmission in healthcare workers: a prospective single-centre study. BMJ Open 2022; 12:e056858. [PMID: 35039302 PMCID: PMC8764715 DOI: 10.1136/bmjopen-2021-056858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Healthcare workers (HCWs) are among the risk groups for COVID-19. Determining transmission routes and risk levels during healthcare is of great importance in preventing nosocomial outbreaks. This study aimed to investigate the frequency of nosocomial transmission and factors affecting the transmission in HCW. METHODS HCWs admitted to the infectious diseases outpatient clinic due to contact with a COVID-19 patient and diagnosed with SARS-COV-2 by reverse-transcriptase PCR (RT-PCR) between 20 March 2020 and 30 June 2020 were included in the study. RESULTS A total of 822 HCWs with 295 low, 284 intermediate and 243 high-risk exposures were included in the study. 27.1% of the HCWs were male, and the median age was 31.9 years (20-62). 89.5% of these patients were directly in charge of patient care. Of the index cases contacted, 72.6% were HCW, and 27.4% were non-HCW patients. Most of the risky exposure (51.7%) occurred in nurses. The occurrence frequency of high-risk exposure was lower in those assigned to direct patient care when compared with the occurrence frequency of moderate-risk or low-risk exposures (76.5%, 94.7, 95.3, respectively p<0.001). In most high-risk exposures (220/253), the index cases were HCWs (p<0.001). Symptoms were detected in 311 of the HCWs (37.8%) during the follow-up. The median time to perform SARS-CoV-2 RT-PCR was 5.3 days (IQR) after the last risky exposure. In multivariate analysis, SARS-CoV-2 RT-PCR positivity was 5.65 times higher in HCWs not directly involved in patient care than HCWs who are not involved in patient care (95% CI 2.437 to 13.111; p<0.001). CONCLUSIONS This study provides particularly useful information on post-exposure COVID-19 follow-up and management of working schedules and procedures of HCWs.
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Affiliation(s)
- Ayse Kaya Kalem
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoglu
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Muge Ayhan
- Infectious Diseases and Clinical Microbiology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Belgin Coskun
- Infectious Diseases and Clinical Microbiology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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24
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Kayaaslan B, Oktay Z, Hasanoglu I, Kalem AK, Eser F, Ayhan M, Guner R. Increasing rates of extended-spectrum B-lactamase-producing Escherichia coli and Klebsiella pneumoniae in uncomplicated and complicated acute pyelonephritis and evaluation of empirical treatments based on culture results. Eur J Clin Microbiol Infect Dis 2022; 41:421-430. [PMID: 34977996 DOI: 10.1007/s10096-021-04392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
Increasing rates of extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae over time made empirical treatment complicated. Knowing local antimicrobial resistance patterns of common pathogens can make it easier to decide on empirical antibiotics. We aimed to investigate the prevalence and risk factors of ESBL positivity of E. coli and K. pneumoniae strains in uncomplicated and complicated pyelonephritis acquired in community and healthcare associations and to evaluate the appropriateness of empirical treatment. Adult patients hospitalized with diagnosis of community-acquired or healthcare-associated uncomplicated/complicated pyelonephritis initiated empirical antimicrobial therapy were included in the study. Appropriateness of empirical treatment at 48-72 h based on culture results and treatment modifications were evaluated. A total of 369 uncomplicated (94) and complicated (275) episodes of pyelonephritis were evaluated. The most common agents were E. coli (71.0%) and K. pneumoniae (17.7%), and the ESBL-production rate was 64.4%, and higher in healthcare-associated pyelonephritis (P 0.013). Being of healthcare-associated infection, previous antibiotic use, and presence of urinary catheters were independent risk factors for ESBL-producing E. coli and K. pneumoniae (P 0.009, < 0.001, and 0.024, respectively). The treatment inappropriateness was mostly associated with use of ceftriaxone (56.3%) (P < 0.001). Treatment has escalated in 41.5% of ceftriaxone-initiated patients, in only 8.8% and 9.5% ertapenem and piperacillin-tazobactam-initiated patients, respectively. ESBL-production rates are quite high even in community-acquired infections. The use of broad-spectrum antibiotics covering ESBL-producing pathogens to increase the appropriateness of empirical treatment and then narrowing treatment based on culture results appears a better and life-saving choice.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey.
| | - Zeynep Oktay
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Muge Ayhan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
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25
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Guner R, Hasanoglu I, Kayaaslan B, Aypak A, Akinci E, Bodur H, Eser F, Kaya Kalem A, Kucuksahin O, Ates I, Bastug A, Tezer Tekce Y, Bilgic Z, Gursoy FM, Akca HN, Izdes S, Erdem D, Asfuroglu E, Hezer H, Kilic H, Civak M, Aydogan S, Buzgan T. Response to the letter to the editor. J Infect Public Health 2022; 15:65-67. [PMID: 34915424 PMCID: PMC8664607 DOI: 10.1016/j.jiph.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Adalet Aypak
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Esragul Akinci
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Orhan Kucuksahin
- Department of Rheumatology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Yasemin Tezer Tekce
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Zeynep Bilgic
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fahriye Melis Gursoy
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Nisa Akca
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Seval Izdes
- Department of Anaesthesiology and Reanimation Ankara, Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Deniz Erdem
- Department of Anaesthesiology and Reanimation Ankara, Ankara City Hospital, Ankara, Turkey.
| | - Emra Asfuroglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Habibe Hezer
- Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Kilic
- Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Musa Civak
- Department of Internal Medicine Ankara City Hospital, Ankara, Turkey.
| | - Sibel Aydogan
- Department of Virology, Ankara City Hospital, Ankara, Turkey.
| | - Turan Buzgan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
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Abstract
Coronavirus disease 2019 has a wide range of clinical spectrum from asymptomatic infection to severe infection resulting in death within a short time. Currently, it is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) does not only cause a respiratory tract infection but a more complicated disease that can lead to multiple system involvement including the liver. Herein, we evaluate the epidemiology, the impact of liver injury/ dysfunction on disease prognosis, the pathophysiological mechanisms and management of liver injury. More than one-fourth of the patients have abnormal liver function tests, mostly a mild-to-moderate liver dysfunction. Liver injury is significantly associated with a poor clinical outcome. Direct cytotoxic effect of SARS-CoV-2, the immune response (“cytokine storm”), the complications related to the disease, and drugs used in the treatments are the pathophysiological mechanisms responsible for liver injury. However, the exact mechanism is not yet clearly explained. The binding of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors and entering the hepatocyte and cholangiocytes can cause cytotoxic effects on the liver. Excessive immune response has an important role in disease progression and causes acute respiratory distress syndrome and multi-organ failures accompanied by liver injury. Treatment drugs, particularly lopinavir/ritonavir, remdesivir and antibiotics are a frequent reason for liver injury. The possible reasons should be meticulously investigated and resolved.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara 06800, Turkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara 06800, Turkey
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27
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Abstract
The COVID-19 pandemic has created a major alteration in the medical literature including the sepsis discussion. From the outset of the pandemic, various reports have indicated that although there are some unique features pertinent to COVID-19, many of its acute manifestations are similar to sepsis caused by other pathogens. As a consequence, the old definitions now require consideration of this new etiologic agent, namely SARS-CoV-2. Although the pathogenesis of COVID-19 has not been fully explained, the data obtained so far in hospitalized patients has revealed that serum cytokine and chemokine levels are high in severe COVID-19 patients, similar to those found with sepsis. COVID-19 may involve multiple organ systems. In addition to the lungs, the virus has been isolated from blood, urine, faeces, liver, and gallbladder. Results from autopsy series in COVID-19 patients have demonstrated a wide range of findings, including vascular involvement, congestion, consolidation, and hemorrhage as well as diffuse alveolar damage in lung tissue consistent with acute respiratory distress syndrome (ARDS). The presence of viral cytopathic-like changes, infiltration of inflammatory cells (mononuclear cells and macrophages), and viral particles in histopathological samples are considered a consequence of both direct viral infection and immune hyperactivation. Thromboembolism and hyper-coagulopathy are other components in the pathogenesis of severe COVID-19. Although the pathogenesis of hypercoagulability is not fully understood, it has been pointed out that all three components of Virchow’s triad (endothelial injury, stasis, and hypercoagulable state) play a major role in contributing to clot formation in severe COVID-19 infection. In severe COVID-19 cases, laboratory parameters such as hematological findings, coagulation tests, liver function tests, D-dimer, ferritin, and acute phase reactants such as CRP show marked alterations, which are suggestive of a cytokine storm. Another key element of COVID-19 pathogenesis in severe cases is its similarity or association with hemophagocytic lymphohistiocytosis (HLH). SARS-CoV-2 induced cytokine storm has significant clinical and laboratory findings overlapping with HLH. Viral sepsis has some similarities but also some differences when compared to bacterial sepsis. In bacterial sepsis, systemic inflammation affecting multiple organs is more dominant than in COVID-19 sepsis. While bacterial sepsis causes an early and sudden onset clinical deterioration, viral diseases may exhibit a relatively late onset and chronic course. Consideration of severe COVID-19 disease as a sepsis syndrome has relevance and may assist in terms of determining treatments that will modulate the immune response, limit intrinsic damage to tissue and organs, and potentially improve outcome.
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Affiliation(s)
- Zeliha Koçak Tufan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
- Executive Board Member of Council of Higher Education of Turkey (YÖK)
- Member of COVID-19 Advisory Committee of Ministry of Health of Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Mervyn Mer
- Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
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Guner R, Kayaaslan B, Hasanoglu I, Aypak A, Bodur H, Ates I, Akinci E, Erdem D, Eser F, Izdes S, Kalem AK, Bastug A, Karalezli A, Surel AA, Ayhan M, Karaahmetoglu S, Turan IO, Arguder E, Ozdemir B, Mutlu MN, Bilir YA, Sarıcaoglu EM, Gokcinar D, Gunay S, Dinc B, Gemcioglu E, Bilmez R, Aydos O, Asilturk D, Inan O, Buzgan T. Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases. BMC Infect Dis 2021; 21:1004. [PMID: 34563117 PMCID: PMC8467006 DOI: 10.1186/s12879-021-06656-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.
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Affiliation(s)
- Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey.
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Adalet Aypak
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Deniz Erdem
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Seval Izdes
- Department of Anesthesiology and Reanimation and Intensive Care Unıt, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Aysegul Karalezli
- Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Aziz Ahmet Surel
- Department of General Surgery, Ankara City Hospital, Ankara, Turkey
| | - Muge Ayhan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Isıl Ozkocak Turan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Emine Arguder
- Department of Anesthesiology and Reanimation and Intensive Care Unıt, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Burcu Ozdemir
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Nevzat Mutlu
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Yesim Aybar Bilir
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Elif Mukime Sarıcaoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Derya Gokcinar
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Sibel Gunay
- Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey
| | - Bedia Dinc
- Department of Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Emin Gemcioglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Ruveyda Bilmez
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Omer Aydos
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Dilek Asilturk
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Osman Inan
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Turan Buzgan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Bilkent Street no:1, Ankara, 06800, Turkey
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Erdoğan M, Öztürk S, Erdöl MA, Kasapkara A, Beşler MS, Kayaaslan B, Hasanoğlu İ, Durmaz T, Güner R. Prognostic utility of pulmonary artery and ascending aorta diameters derived from computed tomography in COVID-19 patients. Echocardiography 2021; 38:1543-1551. [PMID: 34355824 PMCID: PMC8444889 DOI: 10.1111/echo.15170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 11/22/2022] Open
Abstract
Aim Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID‐19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA‐to‐AAo ratio to determine in‐hospital mortality in COVID‐19 patients. Materials and methods This retrospective study included 255 hospitalized severe or critical COVID‐19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA‐to‐AAo ratio was calculated by division of MPA to AAo. Results Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01–12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13–1.46, p < 0.001), AAo (OR: .90, 95% CI: .81–.99, p = 0.040), and MPA‐to‐AAo ratio ≥.82 (OR: 4.67, 95% CI: 1.86–11.7, p = 0.001) as independent predictors of in‐hospital mortality. Time‐dependent multivariate Cox‐proportion regression model demonstrated MPA ≥29.15 mm (HR: 1.96, 95% CI: 1.03–3.90, p = 0.047) and MPA (HR: 1.08, 95% CI: 1.01–1.17, p = 0.048) as independent predictors of in‐hospital mortality, whereas AAo and MPA‐to‐AAo ratio did not reach statistical significance. Conclusion Pulmonary artery enlargement strongly predicts in‐hospital mortality in hospitalized COVID‐19 patients. MPA, which can be calculated easily from chest CT imaging, can be beneficial in the prognostication of these patients.
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Affiliation(s)
- Mehmet Erdoğan
- Department of Cardiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Bozok University Yozgat, Ankara, Turkey
| | - Mehmet Akif Erdöl
- Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ahmet Kasapkara
- Department of Cardiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Muhammed Said Beşler
- Department of Radiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Erdoğan M, Kaya Kalem A, Öztürk S, Erdöl MA, Kayaaslan B, Özbebek YE, Güner R. Interleukin-6 level is an independent predictor of right ventricular systolic dysfunction in patients hospitalized with COVID-19. Anatol J Cardiol 2021; 25:555-564. [PMID: 34369883 PMCID: PMC8357443 DOI: 10.5152/anatoljcardiol.2021.24946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Cytokine storm with elevated levels of multiple proinflammatory cytokines and inflammatory system activation underlie the pathogenesis of coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate whether increased interleukin (IL)-6 levels can predict right ventricular (RV) systolic impairment in patients hospitalized with COVID-19. METHODS This prospective, observational study included 100 consecutive patients hospitalized with mild and moderate COVID-19. All the patients underwent chest computerized tomography, detailed laboratory tests including IL-6, and two dimensional (2D) transthoracic echocardiography (TTE) with assessment of 2D conventional and Doppler echocardiography parameters and RV systolic functions. RESULTS After the elimination of six patients with exclusion criteria, the remaining patients were classified into two groups, namely normal RV systolic functions (n=60) and impaired RV systolic functions (n=34). IL-6 levels were significantly higher in patients with impaired RV systolic functions than in those with normal RV systolic functions (20.3, 4.6, p<0.001, respectively). Tricuspid annular plane systolic excursion and RV derived tissue Doppler imaging (TDI) S' measurements were similar between the two groups. RV fractional area change was significantly lower, and RV TDI derived index of myocardial performance was significantly higher in patients with impaired RV systolic functions. In multivariate analysis, IL-6 levels independently predicted deterioration in RV systolic function at a significant level (odds ratio: 1.12, 95% confidence interval: 1.04-1.20, p=0.003). CONCLUSION IL-6 is an independent predictor of RV systolic impairment in patients hospitalized with mild and moderate COVID-19 suggesting a possible pathogenetic mechanism. IL-6 levels can be used to predict RV systolic impairment in patients suffering from this infection.
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Affiliation(s)
- Mehmet Erdoğan
- Department of Cardiology, Ankara Yıldırım Beyazıt University; Ankara-Turkey
- Department of Cardiology, Ministry of Health, Ankara City Hospital; Ankara-Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University; Ankara-Turkey
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Yozgat Bozok University; Yozgat-Turkey
| | - Mehmet Akif Erdöl
- Department of Cardiology, Ministry of Health, Ankara City Hospital; Ankara-Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University; Ankara-Turkey
| | - Yunus Emre Özbebek
- Department of Cardiology, Ankara Yıldırım Beyazıt University; Ankara-Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University; Ankara-Turkey
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Kayaaslan B, Eser F, Kalem AK, Kaya G, Kaplan B, Kacar D, Hasanoglu I, Coskun B, Guner R. Post-COVID syndrome: A single-center questionnaire study on 1007 participants recovered from COVID-19. J Med Virol 2021; 93:6566-6574. [PMID: 34255355 PMCID: PMC8426910 DOI: 10.1002/jmv.27198] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
Post recovery manifestations have become another concern in patients who have recovered from coronavirus disease 2019 (COVID-19). Numerous reports have shown that COVID-19 has a variety of long-term effects on almost all systems including respiratory, cardiovascular, gastrointestinal, neurological, psychiatric, and dermatological systems. We aimed to investigate the prevalence and characteristics of the post-COVID syndrome among COVID-19 survivors and to determine the factors associated with persistent symptoms. This prospective study enrolled in patients with COVID-19 followed in hospital or outpatient clinics in Ankara City Hospital. We performed a special questionnaire to inquire about the presence of persistent symptoms beyond 12 weeks from the first diagnosis. Demographic data, comorbid diseases, characteristics of acute COVID-19, presence of persistent symptoms by systems, and knowledge about outpatient clinic visits after recovery were assessed. Of a total of 1007 participants, 39.0% had at least one comorbidity, and 47.5% had persistent symptoms. Fatigue/easy fatigability, myalgia, and loss of weight were the most frequent persistent symptoms (overall 29.3%) followed by respiratory symptoms (25.4%). A total of 235 participants had visited outpatient clinics due to several reasons during the post-COVID-19 period, and 17 of them were hospitalized. Severe acute COVID-19, hospitalization, and presence of comorbidity were independent factors for the development of persistent symptoms. Fully understanding the spectrum of the post-COVID syndrome is essential for appropriate management of all its long-term effects. Our study once again underlined the fact that the prevalence of post-COVID syndrome is higher than expected and concerns many systems, and a multidisciplinary follow-up should be provided to COVID-19 survivors in the post recovery period.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ayse K Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Gamze Kaya
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Betul Kaplan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Duygu Kacar
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Belgin Coskun
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
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Ayhan M, Kalem AK, Hasanoglu I, Kayaaslan B, Ozates MO, Izdes S, Halacli B, Guner HR. Intrathecal and Intraventricular Administration of Antibiotics in Gram-Negative Nosocomial Meningitis in a Research Hospital in Turkey. Turk Neurosurg 2021; 31:348-354. [PMID: 33575996 DOI: 10.5137/1019-5149.jtn.29844-20.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the gram-negative nosocomial meningitis cases which were treated with intrathecal (IT) / intraventricular (IVT) antibiotics. MATERIAL AND METHODS Medical records were reviewed for IT/IVT antibiotherapy. Gram-negative nosocomial meningitis cases treated with IT/IVT antibiotherapy additional to systemic antibiotics were included. All patients? sex, age, SOFA scores, surgical history, cerebrospinal fluid (CSF) culture results, CSF cell counts, systemic and IT/IVT antibiotics, their dosages and duration, CSF culture sterility and sterility time, 28-day mortality due to meningitis, and all other causes were recorded and analyzed. RESULTS Thirteen patients were included between 2014 and 2018. Most common microorganism was Acinetobacter baumannii (A.baumannii) (8/13). IT/IVT antibiotics were chosen according to susceptibility. Colistin was used in eight patients, amikacin was used in four, and one patient used amikacin and colistin consecutively. Culture negativity could not be achieved in two patients. Eight patients clinically improved but five patients had no clinical response. 28-day mortality due to infection occured in 2 of 13 patients (15%). 28-day all-cause mortality occured in 3 of 13 patients (23%). CONCLUSION In our study, CSF culture negativity rate was high. IT/IVT antibiotic therapy should be considered as an effective and acceptable treatment option, especially in patients who do not respond to standard IV antibiotherapy.
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Affiliation(s)
- Muge Ayhan
- Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Erdinc FS, Dokuzoguz B, Unal S, Komur S, Inkaya AC, Inan D, Karaoglan I, Deveci A, Celen MK, Kose S, Erben N, Senturk GC, Heper Y, Kutlu SS, Hatipoglu CA, Sumer S, Kandemir B, Sirmatel F, Bayindir Y, Yilmaz E, Ersoy Y, Kazak E, Yildirmak MT, Kayaaslan B, Ozden K, Sener A, Kara A, Gunal O, Birengel S, Akbulut A, Yetkin F, Cuvalci NO, Sargin F, Pullukcu H, Gokengin D, Multicentric Hiv Study Group. Temporal Trends in the Epidemiology of HIV in Turkey. Curr HIV Res 2021; 18:258-266. [PMID: 32342820 DOI: 10.2174/1570162x18666200427223823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
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Affiliation(s)
- F S Erdinc
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - B Dokuzoguz
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Unal
- Hacettepe Universitesi Hastaneleri, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Komur
- Cukurova University, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | - A C Inkaya
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - D Inan
- Akdeniz University, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - I Karaoglan
- Gaziantep University, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey
| | - A Deveci
- Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - M K Celen
- Dicle University, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - S Kose
- Izmir Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
| | - N Erben
- Eskisehir Osmangazi University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - G C Senturk
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Y Heper
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - S S Kutlu
- Pamukkale University, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey
| | - C A Hatipoglu
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Sumer
- Selcuk University, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - B Kandemir
- Necmettin Erbakan University, Meram Medical Faculty Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - F Sirmatel
- Abant Izzet Baysal University, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - Y Bayindir
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Yilmaz
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - Y Ersoy
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Kazak
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - M T Yildirmak
- Okmeydani Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Kayaaslan
- Yildirim Beyazit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - K Ozden
- Ataturk University, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - A Sener
- Canakkale Onsekiz Mart University, Department of Infectious Diseases and Clinical Microbiology, Canakkale, Turkey
| | - A Kara
- Hacettepe University Ihsan Dogramaci Children's Hospital, Department of Infectious Diseases, Ankara, Turkey
| | - O Gunal
- Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - S Birengel
- Ankara University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A Akbulut
- Firat University, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey
| | - F Yetkin
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - N O Cuvalci
- Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - F Sargin
- Medeniyet University Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Pullukcu
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - D Gokengin
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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Kayaaslan B, Eser F, Kaya Kalem A, Bilgic Z, Asilturk D, Hasanoglu I, Ayhan M, Tezer Tekce Y, Erdem D, Turan S, Mumcuoglu I, Guner R. Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients. Mycoses 2021; 64:1083-1091. [PMID: 34085319 PMCID: PMC8242769 DOI: 10.1111/myc.13332] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
Severe COVID‐19 patients in ICU are at high risk for candidemia due to exposure to multiple risk factors for candidemia. We aimed to compare the incidence of candidemia in ICU patients with and without COVID‐19, and to investigate epidemiologic and clinical characteristics of candidemia patients and risk factors for mortality in candidemia patients. This retrospective study was conducted in patients followed in the ICUs of Ankara City Hospital for 2 years, divided into pre‐pandemic and pandemic periods. The incidence (event per 1000 patient‐days) and epidemiology of candidemia, clinical and laboratory characteristics of patients were compared in COVID‐19 and non‐COVID‐19 groups. Candidemia incidence was higher in the COVID‐19 group (2.16, 95% CI 1.77–2.60) than the non‐COVID‐19 group (1.06, 95% CI 0.89–0.125) (p < .001). A total of 236 candidemia episodes (105 in COVID‐19 patients and 131 in non‐COVID‐19 patients) were detected during the study periods. COVID‐19 cases had a higher rate of corticosteroid use (63.8% vs. 9.9%, p < .001). Epidemiology of candidemia and antifungal susceptibility were similar. Candidemia developed 2 weeks earlier in COVID‐19 groups and resulted in higher mortality (92.5% vs. 79.4%, p .005). One‐third of candidemia patients died before receiving any antifungal treatment, and this rate was higher in the COVID‐19 group. In multivariate logistic regression analysis, corticosteroid use, presence of sepsis and age older than 65 years were independent risk factors for mortality in candidemia patients. Candidemia with high mortality is a more serious problem for COVID‐19 patients due to its increased incidence, earlier occurrence and a higher rate of mortality.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Zeynep Bilgic
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Dilek Asilturk
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Muge Ayhan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Yasemin Tezer Tekce
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Deniz Erdem
- Department of Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Sema Turan
- Department of Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Ipek Mumcuoglu
- Department of Medical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Okumuş N, Demirtürk N, Çetinkaya RA, Güner R, Avcı İY, Orhan S, Konya P, Şaylan B, Karalezli A, Yamanel L, Kayaaslan B, Yılmaz G, Savaşçı Ü, Eser F, Taşkın G. Evaluation of the effectiveness and safety of adding ivermectin to treatment in severe COVID-19 patients. BMC Infect Dis 2021; 21:411. [PMID: 33947344 DOI: 10.21203/rs.3.rs-224203/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation. MATERIALS AND METHODS Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated. RESULTS A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively). CONCLUSIONS According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.
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Affiliation(s)
- Nurullah Okumuş
- Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - Neşe Demirtürk
- Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Rıza Aytaç Çetinkaya
- Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Rahmet Güner
- Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - İsmail Yaşar Avcı
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Semiha Orhan
- Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Petek Konya
- Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Bengü Şaylan
- Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ayşegül Karalezli
- Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Levent Yamanel
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Bircan Kayaaslan
- Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Gülden Yılmaz
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ümit Savaşçı
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fatma Eser
- Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Gürhan Taşkın
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Eser F, Kayaaslan B, Güner R, Hasanoğlu I, Kaya Kalem A, Aypak A, Akinci E. The Effect of prolonged PCR Positivity on patient Outcomes and Determination of Isolation period in COVID-19 patients. Int J Clin Pract 2021; 75:e14025. [PMID: 33449410 PMCID: PMC7995230 DOI: 10.1111/ijcp.14025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS The impact of ongoing PCR positivity on COVID-19 patients and the strategy and period of isolation were not fully understood. We aimed to investigate the factors that cause prolonged PCR positivity and its clinical impact on COVID-19 infection. In addition, we searched for an answer on what length of time would be best for isolation. METHODS Patients with confirmed COVID-19 infection were included in this retrospective study. Patients with PCR positivity (after symptom onset) longer than 14 days and PCR positivity less than 14 days were compared. The relationship between duration of symptoms and PCR negation time was examined. RESULTS A total of 339 patients were included in this study. Fifty (14%) patients had prolonged PCR positivity after 14 days. Demographic and clinical features, and clinical outcomes (disease severity and mortality) were similar among the two groups. Age (p 0.035) and symptom duration at admission (P < .001) were found as independent factors for prolonged PCR positivity. Median of total symptom duration was 7 days (IQR: 5-11). The duration of negative conversion of PCR test was median 9 days (IQR: 7-12) after symptom onset and PCR tests became negative 3 days (IQR: 2-5) after symptom improvement. CONCLUSIONS We found that ongoing PCR positivity has no detrimental effect on the course of the disease and clinical outcomes in COVID-19 patients. In addition, our results showed that isolation may be discontinued 10-14 days after symptom onset and/or after 2-5 days after resolution of symptoms. This results also support WHO and ECDC recommendations on this matter.
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Affiliation(s)
- Fatma Eser
- Ankara City Hospital, Faculty of Medicine, Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Bircan Kayaaslan
- Ankara City Hospital, Faculty of Medicine, Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Rahmet Güner
- Ankara City Hospital, Faculty of Medicine, Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Imran Hasanoğlu
- Ankara City Hospital, Faculty of Medicine, Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Ayse Kaya Kalem
- Ankara City Hospital, Faculty of Medicine, Infectious Disease and Clinical MicrobiologyAnkara Yildirim Beyazit UniversityAnkaraTurkey
| | - Adalet Aypak
- Ankara City Hospital, Infectious Disease and Clinical MicrobiologyUniversity of Health SciencesAnkaraTurkey
| | - Esragul Akinci
- Ankara City Hospital, Infectious Disease and Clinical MicrobiologyUniversity of Health SciencesAnkaraTurkey
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Kalem AK, Kayaaslan B, Neselioglu S, Eser F, Hasanoglu İ, Aypak A, Akinci E, Akca HN, Erel O, Guner R. A useful and sensitive marker in the prediction of COVID-19 and disease severity: Thiol. Free Radic Biol Med 2021; 166:11-17. [PMID: 33588050 PMCID: PMC7880846 DOI: 10.1016/j.freeradbiomed.2021.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Thiol-disulphide homeostasis (TDH) is a new parameter indicating oxidative stress that plays a role in the pathogenesis of various clinical disorders. Our study planned to investigate TDH in COVID-19 patients. Age and gender-matched healthy subjects (n = 70) and COVID-19 patients (n = 144) were included in the study. In addition to the routine laboratory parameters of the groups, their native thiol (NT), total thiol (TT) and disulphide levels were measured. Primarily, we compared COVID-19 patients to the healthy control group for inflammatory parameters, NT, TT and disulphide levels. Then, COVID-19 patients were divided into two groups according to the severity of the disease as mild to moderate and severe COVID-19, and the three groups were compared with each other. Predictive value of thiol parameters in the diagnosis of COVID-19 and in the determining its severity, and its correlation with presence and duration of symptoms were investigated. Severe COVID-19 patients had lower NT and TT levels compared with healthy controls and mild to moderate patients (P < 0.001 for both). The results of ROC analysis show that the greatest AUC was IL-6 and NT (AUC = 0.97, AUC = 0.96, respectively) between control and COVID-19 patients, while it was CRP and NT (AUC = 0.85, AUC = 0.83) between mild to moderate and severe patients. A negative correlation was found between duration of symptoms of dyspnoea, cough, fever, and sore throat and NT (r = -0.45, P = 0.017, r = -0.418, P < 0.001, r = -0.131, P = 0.084, r = -0.452, P = 0.040, respectively). NT and TT levels have a strong predictive value in the diagnosis of COVID-19 and in determining disease severity. Our results support that changing TDH parameters appears to have an important role in disease pathogenesis and it can be used in clinical management of patients.
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Affiliation(s)
- Ayse Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Department of Biochemistry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoglu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Adalet Aypak
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - H Nisa Akca
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ozcan Erel
- Department of Biochemistry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Guner R, Hasanoglu I, Kayaaslan B, Aypak A, Akinci E, Bodur H, Eser F, Kaya Kalem A, Kucuksahin O, Ates I, Bastug A, Tezer Tekce Y, Bilgic Z, Gursoy FM, Akca HN, Izdes S, Erdem D, Asfuroglu E, Hezer H, Kilic H, Cıvak M, Aydogan S, Buzgan T. Comparing ICU admission rates of mild/moderate COVID-19 patients treated with hydroxychloroquine, favipiravir, and hydroxychloroquine plus favipiravir. J Infect Public Health 2021; 14:365-370. [PMID: 33647553 PMCID: PMC7771901 DOI: 10.1016/j.jiph.2020.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. METHODS Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. RESULTS Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18-93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. CONCLUSIONS HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.
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Affiliation(s)
- Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Imran Hasanoglu
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Adalet Aypak
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Esragul Akinci
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Hurrem Bodur
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ayse Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Orhan Kucuksahin
- Department of Rheumatology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Aliye Bastug
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Yasemin Tezer Tekce
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Zeynep Bilgic
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Fahriye Melis Gursoy
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Nisa Akca
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
| | - Seval Izdes
- Department of Anaesthesiology and Reanimation, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Deniz Erdem
- Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey.
| | - Emra Asfuroglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Habibe Hezer
- Department of Pulmonary Diseases, Ankara City Hospital, Ankara, Turkey.
| | - Hatice Kilic
- Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
| | - Musa Cıvak
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | - Sibel Aydogan
- Department of Virology, Ankara City Hospital, Ankara, Turkey.
| | - Turan Buzgan
- Department of Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey.
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Hasanoglu I, Korukluoglu G, Asilturk D, Cosgun Y, Kalem AK, Altas AB, Kayaaslan B, Eser F, Kuzucu EA, Guner R. Higher viral loads in asymptomatic COVID-19 patients might be the invisible part of the iceberg. Infection 2020; 49:117-126. [PMID: 33231841 PMCID: PMC7685188 DOI: 10.1007/s15010-020-01548-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/28/2020] [Indexed: 01/01/2023]
Abstract
Purpose SARS-CoV-2 virus dynamics in different hosts and different samples and their relationship with disease severity have not been clearly revealed. The aim of this study is to evaluate the viral loads of 6 different sample types (nasopharyngeal/oropharyngeal combined, oral cavity, saliva, rectal, urine, and blood) of patients with different ages and clinics, to reveal the relationship between disease course and SARS-CoV-2 viral load, and differences in viral loads of asymptomatic and symptomatic patients. Methods Nasopharyngeal/oropharyngeal, oral cavity, saliva, rectal, urine, and blood samples are collected from patients who were hospitalized with diagnosis of COVID-19 on admission. Laboratory analysis were carried out at Public Health Institute of Turkey Virology Reference and Research Laboratory. Results A total of 360 samples from 60 patients were obtained on admission. Fifteen (25%) of the patients were asymptomatic while 45 (75%) were symptomatic. A significant difference was found between mean ages of asymptomatic vs symptomatic patients (26.4 and 36.4, respectively, p = 0.0248). No PCR positivity were found in blood. Only one asymptomatic patient had positive PCR result for urine sample. Viral loads of asymptomatic patients were found to be significantly higher (p = 0.0141) when compared with symptomatic patients. Viral load had a significant negative trend with increasing age. A significant decrease in viral load was observed with increasing disease severity. Conclusion In conclusion, this study demonstrates that asymptomatic patients have higher SARSCoV-2 viral loads than symptomatic patients and unlike in the few study in the literature, a significant decrease in viral load of nasopharyngeal/oropharyngeal samples was observed with increasing disease severity. Factors associated with poor prognosis are found to be significantly correlated with low viral load.
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Affiliation(s)
- Imran Hasanoglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey.
| | - Gulay Korukluoglu
- Virology Reference Laboratory, Public Health Institutions of Turkey, Ankara, Turkey
| | - Dilek Asilturk
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey
| | - Yasemin Cosgun
- Virology Reference Laboratory, Public Health Institutions of Turkey, Ankara, Turkey
| | - Ayse Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey
| | - Ayşe Basak Altas
- Virology Reference Laboratory, Public Health Institutions of Turkey, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey
| | - Esra Akkan Kuzucu
- Virology Reference Laboratory, Public Health Institutions of Turkey, Ankara, Turkey
| | - Rahmet Guner
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey
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Yagci-Caglayik D, Kayaaslan B, Yapar D, Kocagul-Celikbas A, Ozkaya-Parlakay A, Emek M, Baykam N, Tezer H, Korukluoglu G, Ozkul A. Monitoring Crimean-Congo haemorrhagic fever virus RNA shedding in body secretions and serological status in hospitalised patients, Turkey, 2015. ACTA ACUST UNITED AC 2020; 25. [PMID: 32183931 PMCID: PMC7078823 DOI: 10.2807/1560-7917.es.2020.25.10.1900284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
IntroductionCrimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease in Africa, Asia, the Balkan peninsula, the south-east of Europe and the Middle East, with mortality rates of 3-30%. Transmission can also occur through contact with infected animals or humans.AimThis observational, prospective case series aimed to investigate detectable viral genomic RNA in whole-body fluids and antibody dynamics in consecutive daily samples of patients diagnosed with CCHF until discharge from hospital.MethodsWe tested 18 patients and 824 swabs and sera with RT-PCR and 125 serum samples serologically.ResultsThe longest duration until clearance of viral RNA was 18 days from serum collection and 18, 15, 13, 19 and 17 days, respectively, from nasal, oral, genital (urethral or vaginal) and faecal swab, and urine. In seven patients, viral load decreased in serum at the same time as it increased in urine or persisted at the same logarithmic values. Despite clearance in serum, viral RNA was detected in faeces and genital swabs in two and three patients, respectively. Viral clearance from body fluids occurred earlier than from serum in eight patients on ribavirin treatment. The shortest seroconversion time was 3 days after symptom onset for IgM and IgG. Seroconversion of IgG occurred until Day 14 of symptoms.ConclusionWe report persistence of viral RNA in urine, faeces and genital swabs despite serum clearance. This may indicate a need for extending isolation precautions, re-evaluating discharge criteria and transmission risk after discharge, and considering oral swabs as a less invasive diagnostic alternative.
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Affiliation(s)
- Dilek Yagci-Caglayik
- Ankara University Faculty of Veterinary Medicine, Department of Virology, Ankara, Turkey.,Public Health General Directorate of Turkey, Virology Laboratory, Ankara, Turkey.,Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Bircan Kayaaslan
- Yıldırım Beyazıt University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Derya Yapar
- Hitit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Aysel Kocagul-Celikbas
- Hitit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Aslinur Ozkaya-Parlakay
- Health Sciences University, Ankara Children's Hematology Oncology Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Mestan Emek
- Akdeniz University Faculty of Medicine, Department of Public Health, Antalya, Turkey
| | - Nurcan Baykam
- Hitit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Hasan Tezer
- Gazi University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Gulay Korukluoglu
- Public Health General Directorate of Turkey, Virology Laboratory, Ankara, Turkey
| | - Aykut Ozkul
- Ankara University, Biotechnology Institute, Ankara, Turkey.,Ankara University Faculty of Veterinary Medicine, Department of Virology, Ankara, Turkey
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Kayaaslan B, Korukluoglu G, Hasanoglu I, Kalem AK, Eser F, Akinci E, Guner R. Semen Does Not Cause Additional Risk for SARS-CoV-2 Transmission during Sexual Contact. Urol Int 2020; 104:1003-1004. [PMID: 33070138 PMCID: PMC7649694 DOI: 10.1159/000511618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Bircan Kayaaslan
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey,
| | - Gulay Korukluoglu
- Clinical Microbiology, Virology, National Virology Laboratory, Turkish Public Health Institution, Ankara, Turkey
| | - Imran Hasanoglu
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ayse Kaya Kalem
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Kayaaslan B, Kalem AK, Eser F, Hasanoglu I, Guner R. The Additional Contribution of Second Nasopharyngeal PCR to COVID-19 Diagnosis in Patients with Negative Initial Test. Infect Dis Now 2020; 51:194-196. [PMID: 33038445 PMCID: PMC7540190 DOI: 10.1016/j.medmal.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 10/01/2020] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The World Health Organization (WHO) recommends performing a second test in patients with a high suspicion of novel coronavirus disease (COVID-19) whose first PCR test is negative. However, the additional contribution of the second PCR test to the diagnosis is unknown. PATIENTS AND METHODS In this study, we aimed to investigate the contribution of second SARS-CoV-2 PCR to diagnosis in patients with a suspicion of COVID-19 whose initial test was negative. RESULTS A total of 1449 patients were hospitalized in infectious disease clinics with the suspicion of COVID-19 infection during the study period. We performed the second PCR test (697 nasopharyngeal sample, 5 tracheal aspirate) in 702/766 (91.6%) patients whose first tests were negative and detected as positive in only 6.6% (46) of samples. CONCLUSIONS The strategy of using the second nasopharyngeal PCR test to confirm or exclude the diagnosis seems to cause the loss of labor and time, and is costly, because its additional contribution to the first test is very low.
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Affiliation(s)
- Bircan Kayaaslan
- Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey.
| | - Ayse Kaya Kalem
- Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey.
| | - Fatma Eser
- Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey.
| | - Imran Hasanoglu
- Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey.
| | - Rahmet Guner
- Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey.
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Kayaaslan B, Korukluoglu G, Hasanoglu I, Kalem AK, Eser F, Akinci E, Guner R. Investigation of SARS-CoV-2 in Semen of Patients in the Acute Stage of COVID-19 Infection. Urol Int 2020; 104:678-683. [PMID: 32781456 PMCID: PMC7490499 DOI: 10.1159/000510531] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022]
Abstract
Introduction The presence of new coronavirus (SARS-CoV-2) in semen and the possibility of sexual transmission have become new subjects of curiosity. There is a discrepancy regarding this issue in the literature. The presence of SARS-CoV-2 in semen has been investigated in a limited number of studies, and mostly in recovering patients. We aimed to investigate the presence of SARS-CoV-2 RNA in semen of patients with a positive nasopharyngeal swab test for SARS-CoV-2 in the acute stage. Methods We enrolled adult male patients who were hospitalized with confirmed SARS-COV-2 infection in the study. In addition to routine laboratory and radiological tests, semen sample was obtained from volunteers and transferred to the Turkish Public Health Institution, National Virology Laboratory. The samples were processed for the detection of SARS-CoV-2 RNA on the day of collection. Results Sixteen patients were included in the study. The median age was 33.5 years (18–54). All but one had respiratory symptoms. None of the patients had a history or symptoms of urogenital disease. All semen samples were obtained during hospitalization and in the acute stage of the infection. The median time to obtain a semen sample after positive nasopharyngeal test was 1 day (0–7). All semen samples were detected as negative for SARS-CoV-2 PCR. Discussion/Conclusion Although all semen samples were obtained in acute stage of the infection when the nasopharyngeal swab test was positive, we did not detect SARS-CoV-2 in semen. The results of our study support the thought that sexual transmission via semen does not have an important role in the person-to-person transmission of SARS-CoV-2. We think that our study will provide new information to fill the gap in the literature.
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Affiliation(s)
- Bircan Kayaaslan
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey,
| | - Gulay Korukluoglu
- Clinical Microbiology, Virology, National Virology Laboratory, Turkish Public Health Institution, Ankara, Turkey
| | - Imran Hasanoglu
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Ayse Kaya Kalem
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Esragul Akinci
- Infectious Disease and Clinical Microbiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Guner
- Infectious Disease and Clinical Microbiology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Sarıcaoğlu EM, Kayaaslan B, Güner R. The Impact of COVID-19 Pandemic on Treatment, Follow-up and Behavioral Characteristics of Chronic Viral Hepatitis Patients. Egypt J Immunol 2020. [DOI: 10.4274/vhd.galenos.2020.2019.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hasanoglu I, Bilgic Z, Olcucuoglu E, Karakan MS, Demirci BG, Kalem AK, Kayaaslan B, Eser F, Guner R. Do Lifestyle Changes of Renal Transplant Recipients During the Pandemic Reduce the Risk of Coronavirus Disease 2019? Transplant Proc 2020; 52:2667-2670. [PMID: 32782108 PMCID: PMC7837155 DOI: 10.1016/j.transproceed.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
Introduction There is no published study regarding the effects of preventive measures on coronavirus disease 2019 (COVID-19) frequency in renal transplantation recipients. The aim of this study is to reveal the preventive measures taken by renal transplant recipients during the COVID-19 pandemic and whether these measures influence the prevalence of the disease. Materials and Methods After detecting the first COVID-19 case in Turkey, we briefed all of our renal transplant recipients on preventive measures regarding COVID-19. Two months afterward, a questionnaire was prepared regarding the preventive measures practiced by renal transplant recipients, and patients were asked whether they had any COVID-19 symptoms or had received a COVID-19 diagnosis. Results Among 132 patients, 68 were surveyed through telephone calls. During this time, 95.5% of patients were in isolation at home except for when seeing to their essential needs. Two (2.9%) patients were hospitalized due to increases in creatinine level and urinary tract infection. All patients have worn masks when going out and stated that they washed their hands more frequently. There was a decrease in the frequency of hospital controls in 79.4% of patients. Although 2 (2.9%) patients had complaints of dysuria and fever, they did not apply to the hospital because they thought hospitals carried risk during the pandemic. One patient had a cough with fever and was admitted to the hospital with suspicion of COVID-19 but tested negative. Discussion It was determined that renal transplant recipients in our study population meticulously complied with preventive measures and increased the use of masks and hand hygiene practices. As a result, none were infected with severe acute respiratory syndrome coronavirus 2. Transplant recipients are thought to have higher mortality and morbidity for COVID-19. We found that 95.5% of renal transplant recipients complied with the isolation rules. They complied with preventive measures, increasing the use of masks and hand hygiene practices. None of the renal transplant recipients were infected with SARS-CoV-2.
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Affiliation(s)
- Imran Hasanoglu
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey.
| | - Zeynep Bilgic
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey
| | - Erkan Olcucuoglu
- Ankara City Hospital, Department of Urology, Bilkent, Ankara, Turkey
| | - Mine Sebnem Karakan
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Nephrology, Ankara, Turkey
| | - Bahar Gurlek Demirci
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Nephrology, Ankara, Turkey
| | - Ayse Kaya Kalem
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey
| | - Bircan Kayaaslan
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey
| | - Fatma Eser
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey
| | - Rahmet Guner
- Yildirim Beyazit University School of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey
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Hasanoğlu İ, Bilgiç Z, Kaya Kalem A, Kayaaslan B, Eser F, Güner R. An Important Disease for Our Country in Lymphadenopathy Etiology: Tularemia. Ankara Med J 2020. [DOI: 10.5505/amj.2020.32967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Argüder E, Kılıç H, Civak M, Kacar D, Kaya G, Yılmaz A, Kayaaslan B, Karakaş Uğurlu G, Ateş İ, Güner R, Karalezli A. Anxiety and Depression Levels in Hospitalized Patients due to Covid-19 Infection. Ankara Med J 2020. [DOI: 10.5505/amj.2020.80775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ertugrul Mercan M, Arslan F, Ozyavuz Alp S, Atilla A, Seyman D, Guliyeva G, Kayaaslan B, Sari S, Mutay Suntur B, Isik B, Mert A. Non-HACEK Gram-negative bacillus endocarditis. Med Mal Infect 2019; 49:616-620. [PMID: 30940412 DOI: 10.1016/j.medmal.2019.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/16/2018] [Accepted: 03/12/2019] [Indexed: 11/25/2022]
Abstract
PATIENTS AND METHODS Retrospective analysis of clinical data using 26 diagnosed non-HACEK Gram-negative infective endocarditis cases from nine hospitals in Turkey. RESULTS Mean age of patients was 53 (28-84) years, with a 23% case fatality. Nineteen (73%) of the 26 patients had at least one predisposing factor. The presence of a central venous catheter was the most common predisposing factor (7/26 patients). Pseudomonasaeruginosa (7/26 patients) and Escherichiacoli (7/26 patients) were the most common pathogens. The median duration of the antibiotic therapy was 42 days (range 3-84 days). Surgical procedures were performed in 10 patients. The case fatality was similar in patients who did or did not undergo surgery (20% vs. 25%).
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Affiliation(s)
- M Ertugrul Mercan
- Department of Cardiology, Faculty of Medicine, Istanbul Acibadem University, Istanbul, Turkey
| | - F Arslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - S Ozyavuz Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - A Atilla
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - D Seyman
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Antalya Education and Training Hospital, Antalya, Turkey
| | - G Guliyeva
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - B Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - S Sari
- Department of Intensive Care Unit, Health Sciences University, Turkiye Yüksek İhtisas Taining and Research Hospital, Ankara, Turkey
| | - B Mutay Suntur
- Department of Infectious Disease and Clinical Microbiology, Health Sciences University, Adana Numune Taining and Research Hospital, Adana, Turkey
| | - B Isik
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - A Mert
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Kalem AK, Ayhan M, Hasanoğlu I, Kayaaslan B, Tasyaran M, Guner R. Improper usage of antimicrobials: an issue of prophylaxis. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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50
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Arslan F, Ceylan B, Riza Sahin A, Günal Ö, Kayaaslan B, Uğurlu K, Tanoğlu A, Iskender G, Tosun S, Atilla A, Sargin F, Batirel A, Karagöz E, Sonsuz A, Mert A. Risk factors for recurrences in patients with hepatitis C virus after achieving a sustained virological response: a multicentre study from Turkey. Infez Med 2018; 26:133-138. [PMID: 29932085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy. The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6% of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.
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Affiliation(s)
- Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bahadir Ceylan
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Riza Sahin
- Department of Infectious Diseases and Clinical Microbiology, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Özgür Günal
- Department of Infectious Diseases and Clinical Microbiology, Samsun Education and Training Hospital, Samsun, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine,Yildirim Bayazit University, Istanbul, Turkey
| | - Kenan Uğurlu
- Department of Infectious Diseases and Clinical Microbiology, Aralik State Hospital, Gaziantep, Turkey
| | - Alpaslan Tanoğlu
- Department of Gastroenterology, GATA Haydarpasa Education and Training Hospital, Istanbul, Turkey
| | - Gülsen Iskender
- Department of Infectious Diseases and Clinical Microbiology, Dr. Abdurrahman Yurtaslan Oncology Education and Training Hospital, Ankara, Turkey
| | - Selma Tosun
- Department of Infectious Disease and Clinical Microbiology, Bozyaka Education and Training Hospital, Izmir, Turkey
| | - Aynur Atilla
- Department of Infectious Diseases and Clinical Microbiology, Samsun Education and Training Hospital, Samsun, Turkey
| | - Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Goztepe Education and Training Hospital, Istanbul, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, Dr. LutfiKirdar Education and Training Hospital, Istanbul, Turkey
| | - Ergenekon Karagöz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Sancaktepe Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey
| | - Abdullah Sonsuz
- Department of Gastroenterology and Hepatology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Mert
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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