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    Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study
    (Springer Heidelberg, 2019) Sipahi, Oguz Resat; Kahraman, Hasip; Erdem, Huseyin Aytac; Yetkin, Funda; Kaya, Selcuk; Demirdal, Tuna; Tunccan, Ozlem Guzel
    PurposeIn this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin).MethodsData and outcomes of adult (aged>18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status.ResultsOverall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72h antibiotic treatment (p=0.25). There was no significant difference in cured, improved and (cured+improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p>0.05). There was also no significant difference (p>0.05), in terms of persistent response in the (D) versus (G) cohorts,ConclusionsThese findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.
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    Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis
    (Mosby-Elsevier, 2009) Cetin, Emel Sesli; Durmaz, Riza; Tetik, Tulay; Otlu, Baris; Kaya, Selcuk; Caliskan, Ahmet
    Background: Although members of the Acinetobacter genus are not commonly part of the human flora, their relatively high prevalence in hospital environment frequently results in colonization of the skin and respiratory tract. Objectives: The present investigation was carried out to elucidate epidemiologic characteristics of nosocomial Acinetobacter baumannii infections in a teaching hospital. Methods: Epidemiologic, clinical, and demographic features of the 66 patients with A baumannii infection during a 14-month period were recorded. Antibiotic susceptibilities of the isolates were determined by the standardized disk-diffusion method, and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis (PFGE). Results: The incidence of A baumannii infection was especially high in January, April, May and June 2006. The isolates were most frequently obtained from blood and tracheal aspirates sent from the intensive care unit and neurosurgery ward. Although the most frequently identified predisposing factors were cerebrovascular disease and surgical operation, the main risk factors identified in these patients were catheterization and mechanical ventilation. Genotype analysis of the 66 A baumannii strains by PFGE revealed the circulation of 36 different PFGE types. of which type A (12) and K (17) accounted for 44% of the isolates. We found high clonal relationship (80.3%) among the typed strains. Thirteen antibiotypes were observed. Most of the isolates were multidrug resistant. Resistance to imipenem, meropenem, gentamicin, amikacin, tobramycin, netilmicin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, cefoperazone-sulbactam, ciprofloxacin, and levofloxacin were found in 44%, 47%, 47%, 84.8%, 21.2%, 3%, 62.1%, 57.6%, 94%, 62.1%, 95.5%, and 95.5% of the isolates, respectively. Conclusion: The epidemiologic data obtained suggested that the increase in the number of A baumannii infections in our hospital was caused by the interhospital spread of especially 2 epidemic clones. We determined that clonally related strains can survive for a long time in our hospital and cause nosocomial infections in the predisposed patients. (Am J Infect Control 2009;37:56-64.)
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    Microorganisms isolated from external ear cultures and their antimicrobial susceptibility in patients with chronic suppurative otitis media: A six years experience
    (2020) Balci, Mustafa Koray; Ozdemir, Rahim; Muderris, Tuba; Gul Yurtsever, Sureyya; Kaya, Selcuk
    Aim: Chronic suppurative otitis media (CSOM) continues to be a major health issue in developing countries. The goal of this study was to establish the microorganisms causing CSOM and their susceptibility to antimicrobials.Materials and Methods: External ear tract swab that came to our laboratory between 2014-2019 were evaluated retrospectively. The data were obtained from the hospital medical records. Data was collected using an electronic database. Results: The analysis included 185 ear swab samples. These patients 55.1% male and 44.9% female, and average age was 44.29 ± 1.6 (2-86) years. Forty (21.6%) of the patients included in the study were diagnosed with cholesteatoma as having chronic suppurative otitis media. The first three bacteria species isolated from the samples included in the study; Pseudomonas aeruginosa (31.9%), Staphylococcus aureus (11.9%) and Escherichia coli (9.7%). In addition, in 10.8% of the samples Candida spp. and in 5.4% of the samples Aspergillus spp. were isolated. The first three species isolated from the patients with cholesteatoma; P. aeruginosa (6.5%),S. aureus (4.3%) and Candida spp. (3.2%), the first three species isolated in patients without cholesteatoma; P. aeruginosa (25.4%), E. coli (8.1%), S. aureus and Candida spp. (7.6%) was detected. Ciprofloxacin (68.8%) and gentamicin (46.7%) in P. aureginosa isolates, amoxicillin-clavulonic acid (66.7%) and trimethoprim-sulfamethoxazole (42.9%) in E. coli isolates were found to be the most resistant antimicrobials.Conclusion: In conclusion, antimicrobial therapy should not be initiated in CSOM patients without waiting for the culture result. However, in cases where empirical antimicrobial therapy is mandatory, the first choice has been determined as amikacin. Good awareness of microorganisms’ antimicrobial sensitivity can lead to appropriate antibiotic usage and treatment success for CSOM. We think that multicenter prospective studies are needed to organize effective treatments of these infections.
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    Mortality indicators in pneumococcal meningitis: therapeutic implications
    (Elsevier Sci Ltd, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, Asuman
    Background: 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.
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    Prognostic significance of systemic inflammatory markers in rectal cancer
    (2021) Sari, Ramazan; Kaya, Selcuk; Tuzun, Sabah; Altuntas, Yunus Emre; Kucuk, Hasan Fehmi
    Aim: The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR), which is indicators of systemic inflammatory response, have been demonstrated to be prognostic factors in many types of cancer. The aim of this study was to investigate importance of NLR and PLR in rectal cancer.Materials and Methods: The data of 114 patients who underwent curative resection after neoadjuvant chemoradiotherapy (NACRT) for rectal cancer (RC) between January 2012 to June 2017 and 113 healthy subjects were retrospectively analyzed. Blood samples obtained prior to NACRT were examined. The NLR and PLR in RC patients were compared with the results of healthy individuals.Results: The distribution of NLR and PLR results was significantly different between the RC patients and the control group (p0.001 for both). According to the ROC curve, the cut-off value for NLR was 2.70 and for PLR it was 151.18 in estimating the survival of the patients. NLR and PLR only correlated significantly with tumor wall involvement (T stage). The Kaplan-Meier method of predicting survival revealed no significant difference between groups with increased or decreased NLR and PLR in terms of overall survival (OS) and disease-free survival (DFS).Conclusion: The NLR and PLR of the study group treated with NACRT and those of the control group were significantly different. However, elevated NLR and PLR before NACRT were not found to be significant prognostic biomarkers for OS and DFS in surgically treated RC patients.
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    Withdrawal of Staphylococcus aureus from intensive care units in Turkey
    (Mosby-Elsevier, 2013) Erdem, Hakan; Dizbay, Murat; Karabey, Selma; Kaya, Selcuk; Demirdal, Tuna; Koksal, Iftihar; Inan, Asuman
    Background: 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.