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Mete B, Kurt AF, Urkmez S, Demirkiran O, Can G, Dumanli GY, Bozbay S, Arsu HY, Otlu B, Karaali R, Balkan II, Saltoglu N, Dikmen Y, Tabak F, Aygun G. The Bad Bug is Back: Acinetobacter Baumannii Bacteremia Outbreak during the COVID-19 Pandemic in an Intensive Care Unit. Niger J Clin Pract 2022; 25:702-709. [PMID: 35593616 DOI: 10.4103/njcp.njcp_2001_21] [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] [Indexed: 01/08/2023]
Abstract
Background Epidemiology of nosocomial infections may show variability because of under-estimation of infection control measures (ICMs) in coronavirus disease 19 (COVID-19) outbreak. Aim To investigate the Acinetobacter bacteremia outbreak developed in an intensive care unit (ICU) between March 20 to May 15, 2020, examine the risk factors, and re-evaluate ICM retrospectively. Material and Methods A retrospective cohort analysis was conducted to determine the risk factors, pulsed field gel electrophoresis (PFGE) was performed for analysis of the outbreak, ICM practices were observed by a team, and infection control interventions were undertaken. Results Acinetobacter bacteremia developed in 17 patients (21.5%) within 79 COVID-19 patients included in the study. The mean age of the bacteremic patients was 67.3 (SD = 14.82) years, and 82.4% of them were male; of these, 15 died, leading to 88.2% mortality. The bacteremia rate was higher compared with a 14-month period preceding the COVID-19 pandemic (17/79 versus 12/580 patients, respectively). PFGE revealed that the outbreak was polyclonal. On multi-variate analysis, the bacteremia development rate was 13.7 and 5.06 times higher with central venous catheter (CVC) use and in patients with chronic obstructive pulmonary disease (COPD), respectively. The mortality rate was higher in bacteremic patients (p = 0.0016). It was observed that ICMs were not followed completely, especially change of gloves and hand hygiene. Contamination of A. baumannii was observed in 38% of the gloves. Conclusion COPD and CVC use were determined as risk factors for Acinetobacter bacteremia development, and failures in ICM may have led to cross-contamination of endemic A. baumannii. The outbreak could be controlled within 3 weeks of interventions.
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Affiliation(s)
- B Mete
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - A F Kurt
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - S Urkmez
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - O Demirkiran
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - G Can
- Department of Public Health, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - G Y Dumanli
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - S Bozbay
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - H Y Arsu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - B Otlu
- Department of Medical Microbiology, Inonu University Medical Faculty, Elazig yolu 15. Kilometre, 44280-Battalgazi, Malatya, Turkey
| | - R Karaali
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - I I Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - N Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - Y Dikmen
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - F Tabak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - G Aygun
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
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Erturk US, Mete B, Ozaras R, Saltoglu N, Balkan II, Mert A, Kacmaz B, Saglam O, Guney B, Sayman OA, Tabak F. Plasma and Breast Milk Pharmacokinetics of Tenofovir Disoproxil Fumarate in Nursing Mother with Chronic Hepatitis B-Infant Pairs. Antimicrob Agents Chemother 2021; 65:e0111021. [PMID: 34310204 PMCID: PMC8448110 DOI: 10.1128/aac.01110-21] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
Tenofovir use is associated with lower risk of mother-to-infant transmission of the virus, and discontinuation of the treatment is not safe. However, the safety of the drug during pregnancy and breastfeeding is not clear. In this study, we aimed to determine the tenofovir concentration in plasma of mother-infant pairs along with breast milk in chronic hepatitis B patients during the lactation period. A total of 11 mother-infant pairs were enrolled in the study. All the mothers received tenofovir disoproxil fumarate (TDF) 245 mg/day for at least 1 month because of chronic hepatitis B infection. Maternal blood, breast milk, and infant blood samples were obtained concomitantly. Tenofovir concentrations were determined by liquid chromatography-tandem mass spectrometry. The median concentrations of tenofovir in maternal plasma and breast milk samples were 88.44 (interquartile range [IQR], 62.47 to 116.17) ng/ml and 6.69 (IQR, 4.88 to 7.03) ng/ml, respectively. Tenofovir concentrations were undetectable (<4 ng/ml) in all of the infant plasma samples. The ratio of tenofovir concentration in breast milk to that in maternal plasma was 0.07. Tenofovir disoproxil fumarate passes through the breast milk in a small amount. Infants had no detectable tenofovir level in their plasma. Our study suggests that tenofovir disoproxil fumarate treatment is safe during the breastfeeding period in chronic hepatitis B patients.
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Affiliation(s)
- U. S. Erturk
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B. Mete
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - R. Ozaras
- Medilife Health Group, Department of Infectious Diseases, Istanbul, Turkey
| | - N. Saltoglu
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - I. I. Balkan
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A. Mert
- Istanbul Medipol University, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B. Kacmaz
- American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O. Saglam
- Novagenix Bioanalytical Drug R&D Center, Ankara, Turkey
| | - B. Guney
- Novagenix Bioanalytical Drug R&D Center, Ankara, Turkey
| | - O. A. Sayman
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Public Health, Istanbul, Turkey
| | - F. Tabak
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Ozaras R, Qarashova D, Balkan II, Yemisen M, Kepil N, Erzin Y. Chronic diarrhoea and repeated bowel obstruction in an 84-year-old woman. Neth J Med 2015; 73:390-391. [PMID: 26478554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R Ozaras
- Department of Infectious Diseases, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
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Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S, Tekin R, Mete B, Balkan II, Sevgi DY, Giannitsioti E, Fragou A, Kaya S, Cetin B, Oktenoglu T, Celik AD, Karaca B, Horasan ES, Ulug M, Senbayrak S, Kaya S, Arslanalp E, Hasbun R, Ates-Guler S, Willke A, Senol S, Inan D, Güclü E, Ertem GT, Koc MM, Tasbakan M, Ocal G, Kocagoz S, Kusoglu H, Güven T, Baran AI, Dede B, Karadag FY, Yilmaz H, Aslan G, Al-Gallad DA, Cesur S, El-Sokkary R, Sirmatel F, Savasci U, Karaahmetoglu G, Vahaboglu H. The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. Clin Microbiol Infect 2015; 21:1008.e9-1008.e18. [PMID: 26232534 DOI: 10.1016/j.cmi.2015.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 05/13/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 01/09/2023]
Abstract
We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.
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Affiliation(s)
- A Batirel
- Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - H Erdem
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - G Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Pehlivanoglu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - E Ramosaco
- Infectious Diseases Hospital, University Hospital Center "Mother Teresa", Tirana, Albania
| | - S Gülsün
- Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - R Tekin
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - B Mete
- Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - I I Balkan
- Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - D Y Sevgi
- Sisli Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - E Giannitsioti
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - A Fragou
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - S Kaya
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - B Cetin
- Koc University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Oktenoglu
- Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - A D Celik
- Trakya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Edirne, Turkey
| | - B Karaca
- Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - E S Horasan
- Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey
| | - M Ulug
- Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - S Senbayrak
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S Kaya
- Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - E Arslanalp
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - R Hasbun
- The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, Turkey
| | - S Ates-Guler
- Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey
| | - A Willke
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - S Senol
- Celal Bayar University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Manisa, Turkey
| | - D Inan
- Akdeniz University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - E Güclü
- Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - G T Ertem
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - M M Koc
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - M Tasbakan
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - G Ocal
- Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - S Kocagoz
- Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Kusoglu
- Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Güven
- Ankara Atatürk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A I Baran
- Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey
| | - B Dede
- Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Y Karadag
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Yilmaz
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - G Aslan
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | | | - S Cesur
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - R El-Sokkary
- Medical Microbiology and Immunology, Infection Control Unit, Zagazig University, Zagazig, Egypt
| | - F Sirmatel
- Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - U Savasci
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - G Karaahmetoglu
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Vahaboglu
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Saltoglu N, Karali R, Yemisen M, Ozaras R, Balkan II, Mete B, Tabak F, Mert A, Hondur N, Ozturk R. Comparison of community-onset healthcare-associated and hospital-acquired urinary infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and antimicrobial activities. Int J Clin Pract 2015; 69:766-70. [PMID: 25683907 DOI: 10.1111/ijcp.12608] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to compare community-onset healthcare-associated (CO-HCA) and hospital-acquired (HA) urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in terms of epidemiology, clinical outcomes and antimicrobial activities. METHODS Patients from both groups with ESBL-producing E. coli detected by urine culture between January 2009 and January 2011 were included in this retrospective study. Relevant demographical, microbiologic and clinical data were obtained from case records. RESULTS A total of 173 patients (mean age of 58 years, 74% female) were included, of whom 75 (43.4%) had a CO-HCA UTI and 98 (56.6%) had an HA UTI. Eighty (46.2%) patients had more than one comorbid disease, of whom 57 (32.5%) had urological problems. The most common clinical manifestations were pyelonephritis (43.9%) and urosepsis (16.2%). An age of > 65 years (p = 0.005) in addition to urinary catheterisation (p = 0.001), urosepsis (p = 0.001) and mortality (p = 0.001) were significantly more common in the HA UTI group. Acute cystitis (p = 0.027), complicated cystitis (p = 0.001) and non-urologic neoplasm (p = 0.032) were significantly more common in the CO-HCA UTI group. No isolate was resistant to carbapenems or fosfomycin. Sensitivities to nitrofurantoin, amikacin, trimethoprim sulfamethoxazole-trimoxazole and quinolones were 97.6%, 89%, 29.4% and 17.9% respectively. Both groups showed similar rates of antibiotic resistance. CONCLUSION ESBL-producing E. coli should be taken into consideration in patients with a CO HCA UTI, not only in hospital settings but also in outpatient settings. We suggest ertapenem as a first-line empirical treatment for patients with an upper UTI and fosfomycin and nitrofurantoin for those with a lower UTI when ESBL-producing E. coli is suspected.
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Affiliation(s)
- N Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - R Karali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M Yemisen
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - R Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - I I Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - B Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - F Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A Mert
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - N Hondur
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - R Ozturk
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Erdem H, Stahl JP, Inan A, Kilic S, Akova M, Rioux C, Pierre I, Canestri A, Haustraete E, Engin DO, Parlak E, Argemi X, Bruley D, Alp E, Greffe S, Hosoglu S, Patrat-Delon S, Heper Y, Tasbakan M, Corbin V, Hopoglu M, Balkan II, Mutlu B, Demonchy E, Yilmaz H, Fourcade C, Toko-Tchuindzie L, Kaya S, Engin A, Yalci A, Bernigaud C, Vahaboglu H, Curlier E, Akduman D, Barrelet A, Oncu S, Korten V, Usluer G, Turgut H, Sener A, Evirgen O, Elaldi N, Gorenek L. The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study. Eur J Clin Microbiol Infect Dis 2014; 33:1591-9. [PMID: 24789652 DOI: 10.1007/s10096-014-2116-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey,
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Batirel A, Balkan II, Karabay O, Agalar C, Akalin S, Alici O, Alp E, Altay FA, Altin N, Arslan F, Aslan T, Bekiroglu N, Cesur S, Celik AD, Dogan M, Durdu B, Duygu F, Engin A, Engin DO, Gonen I, Guclu E, Guven T, Hatipoglu CA, Hosoglu S, Karahocagil MK, Kilic AU, Ormen B, Ozdemir D, Ozer S, Oztoprak N, Sezak N, Turhan V, Turker N, Yilmaz H. Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections. Eur J Clin Microbiol Infect Dis 2014; 33:1311-22. [PMID: 24532009 DOI: 10.1007/s10096-014-2070-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/24/2014] [Indexed: 02/06/2023]
Abstract
The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7%): colistin-carbapenem (CC), 69 (32.2%): colistin-sulbactam (CS), and 43 (20.1%: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.
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Affiliation(s)
- A Batirel
- Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Semsi Denizer Cd. E-5 Karayolu Cevizli Mevkii, 34890, Kartal, Istanbul, Turkey,
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