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Öğe A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model(Springer, 2020) Diktas, Husrev; Uysal, Serhat; Erdem, Hakan; Cag, Yasemin; Miftode, Egidia; Durmus, Gul; Ulu-Kilic, AysegulWe aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.Öğe Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey(Mosby-Elsevier, 2022) Devrim, Ilker; Erdem, Hakan; El-Kholy, Amani; Almohaizeie, Abdullah; Logar, Mateja; Rahimi, Bilal Ahmad; Amer, FatmaBackground: Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries. Methods: The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income. Results: Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bun-dle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during cathe-ter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05). Conclusions: Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries. (c) 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.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 Brucellosis in pregnancy: results of multicenter ID-IRI study(Springer, 2019) Inan, Asuman; Erdem, Hakan; Elaldi, Nazif; Gulsun, Serda; Karahocagil, Mustafa K.; Pekok, Abdullah U.; Ulug, MehmetBrucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p<0.001), vaginal bleeding (p<0.001), anemia (blood hemoglobin <11g/dL; p<0.001), high level of serum aspartate aminotransferase (>41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.Öğe Büyüme üzerine kantitatif genetik araştırmalar: Genotip çevre etkileşimi, akrabalı yetişme ve üniformite problemi(Çanakkale Onsekiz Mart Üniversitesi, 2023) Erdem, Hakan; Savaş, TürkerBu tez projesi kantitatif genetik temelinde büyümeyi üç farklı konu ile ele almaktadır. Büyüme dönemindeki farklı yumurtacı tavuk genotiplerinde iç içe geçmiş besleme ve parazit çevrelerinde genotip çevre etkileşimi, farklı akraba çiftleştirmelerinden elde edilen akrabalı yetişmiş Japon bıldırcını palazlarının büyüme döneminde maruz kaldıkları parazit enfestasyonuna verecekleri tepkiler ve Japon bıldırcınlarında üniformite için büyümenin bir fonksiyonu olarak ele alınan canlı ağırlığın kalıntısına ait fenotiplere ilişkin genetik parametrelerin tahmin edilmesi bu tez projesinin konularıdır. Genotip çevre etkileşimi kapsamında yapılan çalışma, beslenme ortamında yapılan değişikliğin genotiplerin akar enfestasyonuna verdikleri tepkilerde değişikliklere neden olduğunu göstermektedir. Akrabalı yetişmiş bıldırcınlar ile yapılan çalışmada büyüme üzerine akrabalı yetiştirme depresyonu gözlenmiştir. Ayrıca aynı akrabalı yetiştirme depresyonunun büyüme üzerindeki şiddetinin, farklı akraba çiftleşmelerine göre farklılık gösterdiği görülmüştür. Üniform büyümenin irdelendiği çalışmada ise kalıntı varyansının içinde genetik bir varyansın olduğu ve bunun ayıklanabileceği görülmüştür.Öğe Central nervous system infections in the absence of cerebrospinal fluid pleocytosis(Elsevier B.V., 2017) Erdem, Hakan; Ozturk-Engin, Derya; Cag, Yasemin; Senbayrak, Seniha; Inan, Asuman; Kazak, Esra; Savasci, UmitPrevious multicenter/multinational studies were evaluated to determine the frequency of the absence of cerebrospinal fluid pleocytosis in patients with central nervous system infections, as well as the clinical impact of this condition. It was found that 18% of neurosyphilis, 7.9% of herpetic meningoencephalitis, 3% of tuberculous meningitis, 1.7% of Brucella meningitis, and 0.2% of pneumococcal meningitis cases did not display cerebrospinal fluid pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had a high rate of unfavorable outcomes and thus this condition should not be underestimated. © 2017 The Author(s)Öğe Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study(Springer Science and Business Media Deutschland GmbH, 2023) Erdem, Hakan; Baymakova, Magdalena; Alkan, Sevil; Letaief, Amel; Yahia, Wissal Ben; Dayyab, Farouq; Kolovani, EntelaFever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.Öğe Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study(Springer, 2023) Tanoğlu, Alpaslan; Erdem, Hakan; Friedland, Jon S.; Ankaralı, Handan; Garcia-Goez, Jose Fernando; Albayrak, Ayşe; Alkan Çeviker, SevilExisting literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 +/- 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP.Öğe Edremit Kelebek Güvercinlerinin Morfolojik Karakterizasyonu(Çanakkale Onsekiz Mart Üniversitesi, 2018-12-25) Savaş, Türker; Erdem, Hakan; Konyalı, CoşkunGüvercinler, yüzyıllardır insanoğlunun en çok ilgi duyduğu hayvan türlerinden biridir. Bir ırk zengini olan güvercin türünün ülke, bölge hatta bir yöreye ait lokal ırkları bulunmaktadır. Bölgenin sahip olduğu ve kültürel mirasın bir parçası olan hayvan tür veya ırklarının devamlılığı muhafaza stratejilerinin geliştirilmesi ile mümkün olmaktadır. Bu çalışmada, Edremit ve civarında yetiştirildiği bilinen Edremit Kelebek güvercin ırkının bazı özelliklerinin tanımlanması amaçlanmıştır. Çalışmanın materyalini Edremit’te yetiştirilen 83 Edremit Kelebek güvercini oluşturmuştur. Güvercinlerde kantitatif ve kalitatif gözlemler gerçekleştirilmiştir. Renklerine göre Siyah Tel-Kuyruk, Mavi Tel-Kuyruk, Siyah Boyun, Sarı Boyun, Kırmızı Boyun, Mavi Boyun, Şeş ve Siyah olmak üzere çeşitli varyeteleri bulunan Edremit Kelebek güvercini uçuş stili, dönüş hareketi ve renk özellikleri nedeniyle yetiştirilmektedir. Edremit Kelebek güvercinlerinde boynun arka kısmı siyah, mavi veya kırmızı renkte olabileceği gibi tüm vücut aynı renkte de olabilir. Orta uzunlukta bir kuyruğa sahip olan Edremit Kelebek güvercini 13 ile 17 arasında değişen kuyruk teleğine sahiptir. Edremit Kelebekleri solo uçucu olarak bilinirler. Çoklu uçuşlarda ise arı oğluna benzer şekilde karmakarışık uçarlar. Kanat vuruşları bir kelebeğin kanat vuruşlarını andırır. Uçuşları esnasında dönüş, kuşların gaga-kuyruk ekseninde kendi etraflarında dönmeleri ile gerçekleşir. Tanınması, muhafazası, devamlılığı bakımından Edremit Kelebek güvercinlerinin tescilli bir ırk haline gelmesi ülkemiz ve uluslar arası alanda lokal ırklarımızın yer edinmesi açısından önemli olacaktır.Öğe Effects of kinship matings on embryo losses and hatch-weight in japanese quails(2022) Erdem, Hakan; Savaş, TürkerInbreeding, which is the mating of related individuals, increases homozygosity and leads to depression, especially in traits with low heritability. In this study, parent-offspring, full-sibling and half-sibling mating groups were formed and their effects on embryo loss and hatch weight were investigated. In the study, a total of 2130 fertile Japanese quail eggs were used. Embryo losses were divided into three periods; early period (first 5-day), middle period (6-12th days) and late period (13-17th days). It was observed that mating groups affect all traits subject of this study (P?0.0001). The lowest hatchability of fertile eggs was observed in dam-male offspring mating (DM), while the highest was observed in half-sibling (HS) and control (C) matings (P?0.05). However, the highest hatch-weight were found in eggs of DM matings (P?0.05). DM has also the highest embryo losses for all periods (P?0.05). Most of the embryo losses, except the half-sibling group, occurred in the early period.Öğe Genotype-environment interaction in layer chickens in the growing stage: comparison of three genotypes at two different feeding levels with or without red mite (Dermanyssus gallinae) infestation(Copernicus GmbH, 2021) Erdem, Hakan; Savaş, TürkerThis study investigated how early growth was affected in various chicken genotypes, which were fed ad libitum or restricted and with or without poultry red mite (PRM) infestation. Atak-S (AS), New Hampshire Red (NHR), and Light Sussex (LS) genotypes were used in the study. In total, 120 chicks were used from each genotype. Four groups were formed: feed-restricted (FR) and infested with parasite (P+), FR only, fed ad libitum and P+ , and fed ad libitum only. Feed restriction was applied as 20ĝ€¯% of the feed consumption of the group fed ad libitum the day before for each genotype. The study was conducted between 2 to 12 weeks of age. Weekly live weights and feed consumption were recorded, and the feed conversion ratio was calculated. Traps were placed in cages to count parasites. Regarding the live weight, NHR tolerated the PRM infestation in the ad libitum feed conditions better than other genotypes. While the infested NHR and AS birds had lower live weights than the non-infested ones under FR conditions, there was no difference between infested and non-infested birds of NHR and AS genotypes when they fed ad libitum. The feed consumption of infested AS and NHR birds was higher than that of non-infested counterparts when fed ad libitum. By contrast, the LS chicks consumed less food in the infested environment. In conclusion, the genotypes responded differently to PRM infestation in different feeding environments.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 Identifying risk factors for blood culture negative infective endocarditis: An international ID-IRI study(Elsevier Sci Ltd, 2024) Filiz, Mine; Erdem, Hakan; Ankaralı, Handan; Puca, Edmond; Ruch, Yvon; Santos, Lurdes; Fasciana, Teresa; Şener, AlperBackground: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963-0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970-4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564-6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012-2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599-4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC +/- SE = 0.707 +/- 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. Conclusion: Caution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.Öğe Japon bıldırcını palazlarında kum banyosunun kırmızı kanatlı akarına (Dermanyssus gallinae) karşı etkilerinin araştırılması(Çanakkale Onsekiz Mart Üniversitesi, 2017) Erdem, Hakan; Savaş, TürkerDermanyssus gallinae kanatlılarda görülen bir dış parazittir. Bu çalışmada Japon bıldırcını palazlarına etkileri ve bu etkilerin kum banyosu ile giderilip giderilemeyeceği araştırılmıştır. Çalışma enfestasyon yoğunluğu hariç aynı koşullarda iki farklı denemeyle gerçekleştirilmiştir. İlk denemede enfestasyon yoğunluğu düşük ikinci denemede yüksektir. Denemelerde 1 haftalık yaşta 80'er palaz kullanılmıştır. Palazlara adlibitum yem ve su sağlanmış, 16A:8K aydınlatma programı uygulanmıştır. Davranış gözlemi, canlı ağırlık ve yem tüketimi takibi yapılmıştır. Deneme sonunda eritrosit, lökosit, hemoglobin ve hematokrit değerleri tespit edilmiş, lökosit formülü için yayma preparatlar hazırlanmıştır. Bilateral uzuvların ölçümleri yapılıp taşlık, kalp, karaciğer ve dalak ağırlıkları alınmıştır. İlk denemede kontrol ve enfeste grupların deneme sonu canlı ağırlıkları sırasıyla 249,2 g ve 242,3 g 'dır (P?0,05). Enfeste grup kontrol grubuna göre %96 daha fazla kaşınma davranışı göstermiştir (P?0,05). Hematolojik değerler bakımından kontrol ve enfeste grupta sırasıyla eozinofil oranı %5,8 ve %18,5, hemoglobin miktarı 9,6 g/dl ve 7,7 g/dl 'dir (P?0,05). Bilateral uzuvlardan tibia uzunluğuna ilşikin asimetrinin enfeste bıldırcınlarda önemli derecede yüksek olduğu belirlenmiştir (P?0,05). İkinci denemede deneme sonu canlı ağırlık enfeste grupta 205,0 g kontrol grubunda 231,8 g 'dır (P?0,05). Enfeste grup kontrol grubuna göre %98 daha fazla kaşınmıştır (P?0,05). Hemoglobin, eritrosit ve hematokrit değerleri sırasıyla enfeste grup için 5,5 g/dl, 1,8x106/1mm3 ve %29,4, kontrol grubu için 11,3 g/dl, 3,8x106/1mm3 ve %43,5 olup gruplar arasındaki farklılaşma önemlidir (P=0,0001). İkinci denemede bilateral karakterler bakımından önemli bir farklılaşma yoktur (P?0,05). Dalak oransal ağırlığı kontrol grubunda %0,8 enfeste grupta %0,10 'dur (P=0,0595). İlk denemede kontrol ve enfeste grup arasında mortalite farkı önemsizken, ikinci denemede mortalite oranı enfeste grupta daha yüksektir (P?0,05). Dermanyssus gallinae 'in düşük enfestasyon yoğunluğunda bile enfeste edilen grupta gerek düşük hemoglobin seviyesi gerekse kaşınma oranındaki fazlalık akarın kuşlar üzerindeki etkisini göstermektedir. Banyo uygulamasının ele alınan parametrelere karşı bir etkisinin olmadığı görülmüştür.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 Portraying infective endocarditis: results of multinational ID-IRI study(Springer, 2019) Erdem, Hakan; Puca, Edmond; Ruch, Yvon; Santos, Lurdes; Ghanem-Zoubi, Nesrin; Argemi, Xavier; Hansmann, YvesInfective 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).Öğe Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study(Springer, 2019) Ozturk-Engin, Derya; Erdem, Hakan; Hasbun, Rodrigo; Wang, Shu-Hua; Tireli, Hulya; Tattevin, Pierre; Argemi, XavierNeurosyphilis (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.Öğe Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study(Elsevier, 2023) Erdem, Hakan; Kocoglu, Esra; Ankarali, Handan; El-Sokkary, Rehab; Hakamifard, Atousa; Karaali, Ridvan; Kulzhanova, SholpanObjectives: Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management.Methods: The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). Results: A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120- 3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. Conclusions: Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.& COPY; 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.Öğe Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey(BMC, 2016) Karacaer, Zehra; Cakir, Banu; Erdem, Hakan; Ugurlu, Kenan; Durmus, Gul; Ince, Nevin Koc; Ozturk, CinarBackground: 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.Öğe Sexual Dimorphism in Body Size and Some Exterior Traits of Pigeon Breed Groups(2022) Savaş, Türker; Erdem, HakanIn this study, sexual dimorphism in pigeons was investigated. Rensch's rule was evaluated across pigeon breeds. Body weight, body length, beak length, wingspan, tail length, and tarsus length were used for the analysis. We have divided the breeds in the five groups (form, frills and owls, tumbler and rollers, homer and highflyer, feral). The allometric relation in the traits between female and male measures were analyzed. The measure of sexual size dimorphism was measured for each trait as a simple male size divided by female size (Sexual Size Index, SSI). On average across traits, male birds have higher values than female birds, both across breed groups and overall. No deviation from isometric allometry can be observed except the tail length. No trends towards logarithmic female values according to the SSI could be identified. According to the results, the rules of Rensch for pigeon breeds are rejected. Sexual dimorphism exists between breeds and traits, mainly in favor of the male birds. In most cases, allometric relationships between breeds change, as do traits.
