Publications by authors named "Ilker Inanc Balkan"

47 Publications

Efficacy of Serum Angiotensin II Levels in Prognosis of Patients With Coronavirus Disease 2019.

Crit Care Med 2021 Feb 26. Epub 2021 Feb 26.

Cerrahpasa Faculty of Medicine, Department of Emergency Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Istanbul, Turkey. Cerrahpasa Faculty of Medicine, Department of Intensive Care, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Objectives: We aimed to determine serum angiotensin II levels in patients with coronavirus disease 2019 infection and to investigate the effect of these levels on the prognosis of the disease.

Design: The study was planned prospectively and observationally.

Setting: The study was conducted in a tertiary university hospital.

Patients: Coronavirus disease 2019 patients older than 18 years old, polymerase chain reaction test positive, with signs of pneumonia on tomography, and hospitalized were included in the study. ICU need, development of acute respiratory distress syndrome, and in-hospital mortality were considered as primary endpoints.

Interventions: Blood samples were taken from patients three times for angiotensin II levels.

Measurements And Main Results: Angiotensin II levels were studied by enzyme-linked immunosorbent assay method. The SPSS 24.0 program (Statistics Program for Social Scientists, SPSS, Chicago, IL) was used to analyze the data. A total of 112 patients were included in the study, of which 63.4% of the patients were men. The serum angiotensin II levels were statistically significantly lower in the patients with coronavirus disease 2019 compared with the healthy control group (p < 0.001). There was no statistical significance between the serum angiotensin II levels measured at three different times (p > 0.05). The serum angiotensin II levels of the patients with acute respiratory distress syndrome were found to be statistically significantly lower than those without acute respiratory distress syndrome in three samples collected at different clinical periods (p < 0.05). The angiotensin II levels of the patients who required admission to the ICU at all three times of blood sample collection were found to be statistically significantly lower than those who did not (p < 0.05). Although the serum angiotensin II levels of the patients who died were low, there was no statistically significant difference in mortality at all three times (p > 0.05).

Conclusions: The serum angiotensin II levels decrease significantly in patients with coronavirus disease 2019, and this decrease is correlated with lung damage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000004967DOI Listing
February 2021

An easy-to-use nomogram for predicting in-hospital mortality risk in COVID-19: a retrospective cohort study in a university hospital.

BMC Infect Dis 2021 Feb 5;21(1):148. Epub 2021 Feb 5.

Department of Infectious Diseases, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey.

Background: One-fifth of COVID-19 patients are seriously and critically ill cases and have a worse prognosis than non-severe cases. Although there is no specific treatment available for COVID-19, early recognition and supportive treatment may reduce the mortality. The aim of this study is to develop a functional nomogram that can be used by clinicians to estimate the risk of in-hospital mortality in patients hospitalized and treated for COVID-19 disease, and to compare the accuracy of model predictions with previous nomograms.

Methods: This retrospective study enrolled 709 patients who were over 18 years old and received inpatient treatment for COVID-19 disease. Multivariable Logistic Regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed with the possible predictors and total point were calculated.

Results: Of the 709 patients treated for COVID-19, 75 (11%) died and 634 survived. The elder age, certain comorbidities (cancer, heart failure, chronic renal failure), dyspnea, lower levels of oxygen saturation and hematocrit, higher levels of C-reactive protein, aspartate aminotransferase and ferritin were independent risk factors for mortality. The prediction ability of total points was excellent (Area Under Curve = 0.922).

Conclusions: The nomogram developed in this study can be used by clinicians as a practical and effective tool in mortality risk estimation. So that with early diagnosis and intervention mortality in COVID-19 patients may be reduced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-021-05845-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862983PMC
February 2021

An easy-to-use nomogram for predicting in-hospital mortality risk in COVID-19: a retrospective cohort study in a university hospital.

BMC Infect Dis 2021 Feb 5;21(1):148. Epub 2021 Feb 5.

Department of Infectious Diseases, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey.

Background: One-fifth of COVID-19 patients are seriously and critically ill cases and have a worse prognosis than non-severe cases. Although there is no specific treatment available for COVID-19, early recognition and supportive treatment may reduce the mortality. The aim of this study is to develop a functional nomogram that can be used by clinicians to estimate the risk of in-hospital mortality in patients hospitalized and treated for COVID-19 disease, and to compare the accuracy of model predictions with previous nomograms.

Methods: This retrospective study enrolled 709 patients who were over 18 years old and received inpatient treatment for COVID-19 disease. Multivariable Logistic Regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed with the possible predictors and total point were calculated.

Results: Of the 709 patients treated for COVID-19, 75 (11%) died and 634 survived. The elder age, certain comorbidities (cancer, heart failure, chronic renal failure), dyspnea, lower levels of oxygen saturation and hematocrit, higher levels of C-reactive protein, aspartate aminotransferase and ferritin were independent risk factors for mortality. The prediction ability of total points was excellent (Area Under Curve = 0.922).

Conclusions: The nomogram developed in this study can be used by clinicians as a practical and effective tool in mortality risk estimation. So that with early diagnosis and intervention mortality in COVID-19 patients may be reduced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-021-05845-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862983PMC
February 2021

Evaluation of Olfactory Function With Objective Tests in COVID-19-Positive Patients: A Cross-Sectional Study.

Ear Nose Throat J 2021 Apr 25;100(2_suppl):169S-173S. Epub 2020 Nov 25.

Otorhinolaryngology-Head and Neck Surgery Department, 64298Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Avcılar/İstanbul, Turkey.

Objective: Olfactory dysfunction is relatively high in coronavirus disease 2019 (COVID-19) patients. The aim of this study is to investigate the incidence of olfactory disorder objectively in patients with laboratory-confirmed COVID-19 infection.

Material And Method: The study included 31 healthy controls and 59 COVID-19 patients who were diagnosed and treated in the COVID departments in a tertiary hospital. The patients with corona virus infection were screened by a questionnaire and were classified into 2 groups as either group 2 (patients without self-reported smell loss) or group 3 (patients with self-reported smell loss). Age and gender matched healthy controls who do not have chronic nasal condition or nasal surgery history comprised the control group (group 1). All of the patients and subjects in the control group were tested by the Sniffin' Sticks test. All of the answers and scores were recorded, and the comparisons were made.

Results: The rate of self-reported smell and taste loss in all COVID-19 patients in this study was 52.5% and 42%, respectively. There was a significant difference in threshold, discrimination, identification, and Threshold, Discrimination, Identification (TDI) scores between groups 1 and 2. When the comparisons between group 1 and 3 were made, again threshold, discrimination, identification, and TDI scores were significantly different. The comparison between groups 2 and 3 demonstrated a significant difference in discrimination, identification, and TDI scores, but threshold score was not different statistically. With questionnaire, the rate of olfactory dysfunction in COVID-19 patients was 52.5%, but with objective test, the rate was calculated as 83%.

Conclusion: Olfactory and gustatory dysfunctions are common in COVID-19 patients. According to findings with the objective test method in this study, smell disorder in COVID-19 patients was much higher than those detected by questionnaires.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0145561320975510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689254PMC
April 2021

Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience).

Eur J Clin Microbiol Infect Dis 2021 Feb 15;40(2):325-333. Epub 2020 Sep 15.

Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey.

Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10096-020-03994-6DOI Listing
February 2021

Risk factors for development of vancomycin-resistant enterococcal bacteremia among VRE colonizers : A retrospective case control study.

Wien Klin Wochenschr 2020 Sep 10. Epub 2020 Sep 10.

Department of Infectious Disease, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.

Aims: We aimed to determine the proportion of vancomycin-resistant enterococci (VRE) colonized patients among all inpatients who later developed VRE bacteremia during hospital stay and to identify the risk factors for VRE bacteremia at a tertiary hospital.

Material And Methods: Patients with positive rectal screening or any clinically significant positive culture results for VRE were included in 1‑year follow-up. Colonization with VRE was defined as a positive culture (rectal, stool, urinary) for VRE without infection and VRE bacteremia was defined as positive blood culture if the signs and symptoms were compatible with infection. To determine the risk factors for VRE bacteremia among VRE colonized patients, a retrospective case control study was performed. The two groups were compared in terms of variables previously defined as risk factors in the literature.

Results: Of 947 positive samples, 17 VRE bacteremia were included in the analysis. Cephalosporin use for more than 3 days within 3 months was a significant risk factor for bacteremia (p = 0.008). Prior use of carbapenems was found to be statistically significant for bacteremia (p = 0.007). In multivariate analyses the use of carbapenems and cephalosporins was an independent risk factor for developing bacteremia among VRE colonizers (odds ratio, OR, 6.67; 95% confidence interval, CI, 1.30-34; p = 0.022 and OR 4.32, 95% CI 1.23-15; p = 0.022, respectively).

Conclusion: A VRE colonization in patients receiving broad-spectrum beta-lactam antibiotics including carbapenems and cephalosporins may result in bacteremia. It is possible to keep mortality at very low levels in VRE bacteremia with effective infection control measures, rapid infectious diseases consultation and rational antimicrobial treatment based on current epidemiological data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00508-020-01733-7DOI Listing
September 2020

Kidney function on admission predicts in-hospital mortality in COVID-19.

PLoS One 2020 3;15(9):e0238680. Epub 2020 Sep 3.

Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey.

Background: Recent data have suggested the presence of a reciprocal relationship between COVID-19 and kidney function. To date, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19.

Methods: We recruited 336 adult consecutive patients (male: 57.1%, mean age: 55.0±16.0 years) that were hospitalized with the diagnosis of COVID-19 in a tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19.

Results: Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.2% of the patients. In-hospital mortality rate was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p: 0.005, odds ratio: 0.974, CI: 0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2.

Conclusions: On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19. We recommend that eGFR be measured in all patients on admission and used as an additional tool for risk stratification. Close follow-up should be warranted in patients with a reduced eGFR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238680PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470363PMC
September 2020

Characteristics and outcomes of Behçet's syndrome patients with Coronavirus Disease 2019: a case series of 10 patients.

Intern Emerg Med 2020 11 9;15(8):1567-1571. Epub 2020 Jul 9.

Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11739-020-02427-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344029PMC
November 2020

An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality.

Ann Hematol 2020 Aug 20;99(8):1925-1932. Epub 2020 Jun 20.

Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098, Istanbul, Turkey.

Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum β-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00277-020-04144-wDOI Listing
August 2020

A prospective pharmacovigilance study in the infectious diseases unit of a tertiary care hospital.

J Infect Dev Ctries 2019 07 31;13(7):649-655. Epub 2019 Jul 31.

Infectious Diseases and Clinical Microbiology Department, Istanbul Medipol University Medical Faculty, Istanbul, Turkey.

Introduction: The frequency, causality, severity, preventability and risk factors of ADRs (adverse drug reactions) in infectious disease units are not well defined in the literature. Thus, the aim of this study was to determine the characteristics of the ADRs encountered in an infectious disease unit of a tertiary teaching hospital.

Methodology: The patients who were admitted to the infectious disease unit of a tertiary teaching hospital longer than 24 hours between January and December of 2016 were followed prospectively. Patients were observed and questioned for any sign of ADRs. The proportion of ADRs and patient characteristics were investigated. Causality was evaluated by the Naranjo algorithm, severity was determined using the Hartwig classification, and preventability was assessed using the Schumock and Thornton scale.

Results: 210 patients were admitted to the unit during the study period, of whom 44 patients (20.9%) experienced 51 ADRs. 5.9% of ADRs were found to be serious according to the Hartwig severity classification. In addition, 88.1% of ADRs were not preventable. The most frequently detected ADR was skin and subcutaneous tissue reactions (33.3%), and systemic antimicrobials were the most common type of drugs that caused an ADR. Prolonged hospitalization (p < 0.001) and usage of an increased number of drugs (p < 0.001) were found to be significant risk factors for ADR development.

Conclusions: Prolonged hospital stay and polypharmacy are significant risk factors that increase the incidence of ADRs in infectious disease units. The likelihood of unavoidable ADRs should arouse the attention of clinicians when prescribing antimicrobials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3855/jidc.11503DOI Listing
July 2019

Reducing blood culture contaminations by use of hair nets and face masks.

Diagn Microbiol Infect Dis 2020 03 21;96(3):114947. Epub 2019 Nov 21.

Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098 Istanbul, Turkey.

We have read the article by Sanders et al. with great interest. We appreciate the authors for their stewardship to decrease blood culture contamination rate. We would like to address the etiological distribution before and after the addition of hair nets and masks in the study. We would expect oral streptococci to decrease proportionally by using masks, but this rate did not decrease (4.7% versus 6.3%). We think that if a control group was formed in which face masks and hair nets were not used during the intervention 2 and 3 phase, similar low contamination rates would have been obtained. Strict hand hygiene, proper use of gloves, proper skin antisepsis, and nonpalpation of the disinfected area are crucial to prevent contamination. In conclusion, skin contamination constitutes a significant proportion of false culture positivity rates and is still a major problem.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.diagmicrobio.2019.114947DOI Listing
March 2020

Clinicopathological profile of gastrointestinal tuberculosis: a multinational ID-IRI study.

Eur J Clin Microbiol Infect Dis 2020 Mar 22;39(3):493-500. Epub 2019 Nov 22.

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10096-019-03749-yDOI Listing
March 2020

Portraying infective endocarditis: results of multinational ID-IRI study.

Eur J Clin Microbiol Infect Dis 2019 Sep 11;38(9):1753-1763. Epub 2019 Jun 11.

Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.

Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulase-negative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10096-019-03607-xDOI Listing
September 2019

Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study.

Eur J Clin Microbiol Infect Dis 2019 Jan 27;38(1):125-134. Epub 2018 Oct 27.

Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10096-018-3403-7DOI Listing
January 2019

Association between biofilm and multi/extensive drug resistance in diabetic foot infection.

Int J Clin Pract 2018 Mar 30;72(3):e13060. Epub 2018 Jan 30.

Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Purpose: We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI).

Methods: Demographic, clinical, laboratory and outcome data of 165 patients, prospectively recorded and followed between January 2008 and December 2015 by a multidisciplinary committee, were analysed. Standard microbiological methods were adopted. Risk factors associated with biofilm were determined by univariate and multivariate analyses.

Results: The overall rate of biofilm production among 339 wound isolates was 34%. The biofilm production rate was significantly higher in Gram-negative micro-organisms (39%) in comparison with Gram positives (21%) (P = .01). A. baumannii presented the highest biofilm production (62%), followed by P. aeruginosa (52%) and Klebsiella spp. (40%). On univariate analysis, significant factors associated with biofilm were antibiotic use within last 3 months (OR:2.94, CI: 1.5-5.75, P = .002), recurrent DFI within last 6 months (OR:2.35, CI: 1.23-4.53, P = .01), hospitalisation within last 3 months due to ipsilateral recurrent DFI (OR:2.44, CI: 1.06-5.58, P = .03), presence of amputation history (OR: 2.20, CI: 1.14-4.24, P = .01), multidrug-resistant (MDR) micro-organism (OR: 7.76, CI: 4.53-13.35, P<.001) and extensively drug-resistant (XDR) micro-organism (OR:11.33, CI:4.97-26.55, P<.001). Multivariate regression analysis revealed two variables to be significant factors associated with biofilm: MDR micro-organism (OR: 3.63, CI: 1.58-8.33, P = .002) and XDR micro-organism (OR:4.06, CI: 1.25-13.1, P = .01).

Conclusions: Multi/extensive drug resistance and previous recurrent DFIs were significantly associated with biofilm formation in patients with diabetic foot.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijcp.13060DOI Listing
March 2018

Reactivation of Hepatitis B Virus Following Treatment of Hepatitis C Virus Infection in Coinfected Patients.

Clin Infect Dis 2017 05;64(10):1461-1462

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/cix211DOI Listing
May 2017

Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country.

Medicine (Baltimore) 2017 Feb;96(5):e5875

Department of Internal Medicine, Istanbul Medipol University Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical Faculty, Adana Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey Department of Infectious Diseases and Clinical Microbiology, LutfiKirdar Training and Research Hospital, Istanbul, Turkey Department of Infectious Diseases and Clinical Microbiology, Atatürk University Faculty of Medicine, Erzurum, Turkey Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital, Ankara, Turkey Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Faculty of Medicine, Department of Public Health, Medipol University, Istanbul, Turkey Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey.

The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB).We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion.The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases.Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000005875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293426PMC
February 2017

Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey.

Health Qual Life Outcomes 2016 Nov 3;14(1):153. Epub 2016 Nov 3.

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.

Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors.

Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant.

Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided.

Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12955-016-0557-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095975PMC
November 2016

Prejudice and reality about infection risk among Syrian refugees.

Lancet Infect Dis 2016 11;16(11):1222-1223

Infection Department, Cerrahpasa Medical School, Istanbul University, Cerrahpasa 34098, Istanbul, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1473-3099(16)30400-5DOI Listing
November 2016

A case of central nervous system infection due to Cladophialophora bantiana.

Rev Iberoam Micol 2016 Oct - Dec;33(4):237-241. Epub 2016 Jul 21.

Department of Infectious Disease and Clinical Bacteriology, Cerrahpasa Medical Faculty, 34098 Cerrahpasa, Istanbul, Turkey.

Background: Cladophialophora bantiana is a melanised mold with a pronounced tropism for the central nervous system, almost exclusively causing human brain abscesses.

Case Report: We describe a case of cerebral infection by this fungus in an otherwise healthy 28-year-old coal-miner. Environmental occurrence, route of entry, and incubation period of this fungus are unknown, but our case is informative in that the first symptoms occurred about eight weeks after known traumatic inoculation. Lesions were compatible with tuberculous granulomas, and the patient initially received antitubercular treatment. Melanised fungal cells were seen in a brain biopsy and abscess materials. Therapy was switched from empirical antitubercular treatment to amphotericin B (0.5mg/kg/d), but was changed to voriconazole 200mg/d, i.v. on the basis of antifungal susceptibility test results. The patient responded clinically, and gradually improved. The isolate was identified by sequencing of the Internal Transcribed Spacer domain of rDNA.

Conclusions: Given the non-specific clinical manifestations of C. bantiana cerebral abscesses, clinicians and laboratory workers should suspect infections caused by C. bantiana, particularly in immunocompromised patients with a trauma history.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.riam.2016.01.004DOI Listing
November 2017

The Syrian conflict and infectious diseases.

Expert Rev Anti Infect Ther 2016 06 27;14(6):547-55. Epub 2016 Apr 27.

a Department of Infectious Diseases and Clinical Microbiology , Istanbul University, Cerrahpasa Medical School , Istanbul , Turkey.

The conflict in Syria is a big humanitarian emergency. More than 200,000 Syrians have been killed, with more than half of the population either having been displaced or having immigrated. Healthcare has been interrupted due to the destruction of facilities, a lack of medical staff, and a critical shortage of life-saving medications. It produced suitable conditions leading to the re-emergence of tuberculosis, cutaneous leishmaniasis, polio, and measles. Lebanon and Jordan reported increased rates of tuberculosis among Syrian refugees. Cutaneous leishmaniasis outbreaks were noted not only in Syria but also in Turkey, Jordan, and Lebanon. After a polio-free 15 years, Syria reported a polio outbreak. Ongoing measles outbreaks in the region was accelerated by the conflict. Iraq declared a cholera outbreak among the Syrian refugees. The healthcare facilities of the countries hosting immigrants, mainly Turkey, Lebanon, Jordan, Iraq, and Egypt, are overburdened. The majority of the immigrants live in crowded and unsanitary conditions. Infectious diseases are big challenges for Syria and for the countries hosting immigrants. More structured support from international organizations is needed for the prevention, control, diagnosis, and treatment of infectious diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14787210.2016.1177457DOI Listing
June 2016

Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study.

Ann Clin Microbiol Antimicrob 2016 Feb 9;15. Epub 2016 Feb 9.

Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.

Background: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals.

Methods: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis.

Results: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality.

Conclusions: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12941-016-0122-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748515PMC
February 2016

Elimination of mother-to-child transmission of hepatitis B.

Lancet Infect Dis 2016 Jan;16(1):20-21

Istanbul University, Cerrahpasa Medical School, Infectious Diseases Department, TR-34098 Istanbul, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1473-3099(15)00473-9DOI Listing
January 2016

More on hepatic granulomas.

Diagn Pathol 2015 Nov 19;10:203. Epub 2015 Nov 19.

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, TR-34098, Cerrahpasa, Istanbul, Turkey.

We have read the case report of Nihon-Yanagi et al. The patient they described developed hepatic granuloma two times and the granulomatous lesion was surrounding metal staples/clips suggesting that the granuloma was due to surgical staples/clips. Hepatic granulomas (HGs) are reported in around 5% of patient who undergo a liver biopsy and caused by several diseases including sarcoidosis, tuberculosis, hydatid cyst, brucellosis, typhoid fever, chronic hepatitis B and C and primary biliary cirrhosis (PBC). Chronic hepatitis B and C infections are the most common and serious causes of liver damage in patient with renal failure. Their prevalence is a higher than people without renal failure. We have previously reported that the prevalences of HGs in patients with chronic hepatitis B and C are 1.5 and 1.3% respectively. The described patient was on hemodialysis for 12 years. The other causes of HG seem excluded; however hepatitis B and C infections and PBC should have been tested and excluded before ascribing the HGs to surgical staples/clipping material.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13000-015-0442-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653883PMC
November 2015

Successful treatment of post-transplant hepatitis C virus cirrhosis with daclatasvir and asunaprevir.

J Gastrointestin Liver Dis 2015 Sep;24(3):393-4

Infectious Diseases Dept., Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
September 2015

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study".

Spine J 2015 Dec 16;15(12):2509-17. Epub 2015 Sep 16.

Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Background Context: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature.

Purpose: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD.

Study Design: A retrospective, multinational, and multicenter study was used.

Patient Sample: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included.

Outcome Measures: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out.

Methods: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels.

Results: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1).

Conclusions: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.spinee.2015.09.024DOI Listing
December 2015

Early Changes of Mannose-Binding Lectin, H-Ficolin, and Procalcitonin in Patients with Febrile Neutropenia: A Prospective Observational Study.

Turk J Haematol 2016 Dec 6;33(4):304-310. Epub 2015 Aug 6.

İstanbul University Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey, Phone: +90 212 414 30 00, E-mail:

Objective: The significance of mannose-binding lectin (MBL) and H-ficolin deficiency in febrile neutropenic (FN) patients and the correlation of these markers along with consecutive C-reactive protein (CRP) and procalcitonin (PCT) levels during the infectious process are investigated.

Materials And Methods: Patients with any hematological malignancies who were defined to have "microbiologically confirmed infection", "clinically documented infection", or "fever of unknown origin" were included in this single-center prospective observational study. Serum levels of CRP, PCT, MBL, and H-ficolin were determined on 3 separate occasions: at baseline (between hospital admission and chemotherapy), at the onset of fever, and at the 72nd hour of fever.

Results: Forty-six patients (54% male, mean age 41.7 years) with 61 separate episodes of FN were evaluated. Eleven patients (23.9%) had "microbiologically confirmed infection", 17 (37%) had "clinically documented infection", and 18 (39.1%) had "fever of unknown origin". Fourteen (30.4%) patients had low (<500 ng/mL) initial MBL levels and 7 (15.21%) had low (<12,000 ng/mL) H-ficolin levels. Baseline MBL and H-ficolin levels did not significantly change on the first and third days of fever (p=0.076). Gram-negative bacteremia more frequently occurred in those with low initial MBL levels (p=0.006). PCT levels were significantly higher in those with microbiologically documented infections. Mean and median PCT levels were significantly higher in cases with bacteremia. There was no significant difference between hemoculture-positive and-negative patients in terms of CRP levels.

Conclusion: Monitoring serum H-ficolin levels was shown to be of no benefit in terms of predicting severe infection. Low baseline MBL levels were correlated with high risk of gram-negative bacteremia; however, no significant correlation was shown in the follow-up. Close monitoring of PCT levels is warranted to provide more accurate and specific data while monitoring cases of bacteremia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/tjh.2014.0385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204185PMC
December 2016

Urinary tuberculosis: a cohort of 79 adult cases.

Ren Fail 2015 Aug 30;37(7):1157-63. Epub 2015 Jun 30.

j Department of Internal Medicine, Division of Infectious Diseases, Medical Faculty , Medipol University , Istanbul , Turkey , and.

We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/0886022X.2015.1057460DOI Listing
August 2015

Linezolid-induced complex partial seizure in a patient without epilepsy.

Int J Infect Dis 2015 Jun 11;35:120. Epub 2015 May 11.

Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijid.2015.05.007DOI Listing
June 2015

The Changing Epidemiology of Bloodstream Infections and Resistance in Hematopoietic Stem Cell Transplantation Recipients.

Turk J Haematol 2016 Sep 4;33(3):216-22. Epub 2015 May 4.

İstanbul University Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey Phone : +90 212 414 30 95 E-mail:

Objective: Patients receiving hematopoietic stem cell transplantation (HSCT) are exposed to highly immunosuppressive conditions and bloodstream infections (BSIs) are one of the most common major complications within this period. Our aim, in this study, was to evaluate the epidemiology of BSIs in these patients retrospectively.

Materials And Methods: The epidemiological properties of 312 patients with HSCT were retrospectively evaluated.

Results: A total of 312 patients, followed between 2000 and 2011, who underwent autologous (62%) and allogeneic (38%) HSCT were included in the study. The most common underlying malignancies were multiple myeloma (28%) and Hodgkin lymphoma (21.5%). A total of 142 (45%) patients developed at least 1 episode of BSI and 193 separate pathogens were isolated from the blood cultures. There was a trend of increase in the numbers of BSIs in 2005-2008 and a relative increase in the proportion of gram-positive infections in recent years (2009-2011), and central venous catheter-related BSI was found to be most common source. Coagulase-negative staphylococci (49.2%) and Acinetobacter baumannii (8.8%) were the most common pathogens. Extended-spectrum beta-lactamase-producing strains were 23% and 22% among Escherichia coli and Klebsiella spp. isolates, respectively. Quinolone resistance was detected in 10% of Enterobacteriaceae. Resistance to carbapenems was not detected in Enterobacteriaceae, while it was seen at 11.1% and 23.5% in Pseudomonas and Acinetobacter strains, respectively.

Conclusion: A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/tjh.2014.0378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111467PMC
September 2016