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Öğe Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study(Biomed Central Ltd, 2015) Senbayrak, Seniha; Ozkutuk, Nuri; Erdem, Hakan; Johansen, Isik Somuncu; Civljak, Rok; Inal, Ayse Seza; Kayabas, UnerBackground: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any firstline drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0: 34-13: 42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.Öğe Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs(Bmc, 2011) Erdem, Hakan; Tekin-Koruk, Suda; Koruk, Ibrahim; Tozlu-Keten, Derya; Ulu-Kilic, Aysegul; Oncul, Oral; Guner, RahmetBackground: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.Öğe Efficacy and Tolerability of Antibiotic Combinations in Neurobrucellosis: Results of the Istanbul Study(Amer Soc Microbiology, 2012) Erdem, Hakan; Ulu-Kilic, Aysegul; Kilic, Selim; Karahocagil, Mustafa; Shehata, Ghaydaa; Eren-Tulek, Necla; Yetkin, FundaNo data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 +/- 2.47 months in P1, 6.52 +/- 4.15 months in P2, and 5.18 +/- 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/ 117) and P3 (6.1%, n = 3/ 49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.Öğe Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study(Springer Heidelberg, 2015) Erdem, Hakan; Ozturk-Engin, Derya; Tireli, Hulya; Kilicoglu, Gamze; Defres, Sylviane; Gulsun, Serda; Sengoz, GonulPredicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.Öğe Mortality indicators in pneumococcal meningitis: therapeutic implications(Elsevier Sci Ltd, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, AsumanBackground: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.Öğe Subperiostal abse safhasında tanı konulan akut osteomyelitlerin tedavisi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 1997) Kapukaya, Ahmet; Erdem, Hakan; Turgut, Mehmet; Arslan, Hüseyin; Necnıioğlu, Serdar; Kaya, Halil; Sarı, İbrahim; Kesemenli, CumhurAcute osteomyelitis produced on rats was diagnosed in early period by Tc 99 MDP and Ga- 67 citrate combined with scintigraphic methods after direct inoculation of pathogen staphylococcus aureus into metaphysis of tibia. Then, rats were examined daily by ultrasonography. Twenty rats with subperiosteal abscess diagnosed by ultrasonography were divided into two groups and they were treated with two different methods. The first group, consisting of 10 rats was given only antibiotics other group of rats was treated by antibiotics and surgical drainage. In both groups, same antibiotics were administered and antibiotics were continued for three weeks. Rats were controlled periodically by clinical, radiological and scintigraphic methods for three months. The material obtained from the sacrificed rats at the end of this period was investigated histopathologically. As a result of this examinations, there was significant superiority in the group that treated with surgical drainage and antibiotics.Öğe Syme amputasyonu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 1997) Kapukaya, Ahmet; Erdem, Hakan; Arslan, Hüseyin; Kesemenli, Cumhur1990-1994 yılları arasında Dicle Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji servisine başvuran 19 hastaya syme amputasyonu yapıldı. Bu hastalardan diabetik ve vasküler nedenli 9 hastaya Wagner'in iki aşamalı (two- stage teknik) operasyonu uygulandı. 6'sı bayan, 13'ü erkek olan bu hastaların yaş ortalaması 33 (4-63) idi. Bu hastaların 7'sinde (%>36)ateşli silah yaralanması, 5'inde(%26) diabet, 4'ünde (%21) vasküler hastalık, 2'sinde (%12) iş kazası ve l'inde (%5) fibular hemimelia (tipli) etyolojik faktördü. Ortalama 11 (3-36) ay takiplerimiz neticesinde 19 hastanın 15'de (%78) erken yada geç dönemde hiçbir komlikasyonla karşılaşılmazken, diğer hastaların l'inde topuk kayması, l'inde ise topuk ağrısı gelişti. Bunların haricinde diabetik hastaların 2'sinde postoperatif ilk 14 gün içinde enfeksiyon gelişti. Bu hastaların enfeksiyonları, kontrol altına alınamıyarak topuk nekrozu gelişti. Bu hastalara diz altı amputasyon uygulandı.Öğe Withdrawal of Staphylococcus aureus from intensive care units in Turkey(Mosby-Elsevier, 2013) Erdem, Hakan; Dizbay, Murat; Karabey, Selma; Kaya, Selcuk; Demirdal, Tuna; Koksal, Iftihar; Inan, AsumanBackground: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value <=.01 was considered significant. Results: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). Conclusions: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
