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    Mortality indicators in pneumococcal meningitis: therapeutic implications
    (Elsevier Sci Ltd, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, Asuman
    Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.
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    The evaluation of exposure to hepatitis A virus in HBsAg-positive persons: A multicentre study from Turkey
    (Journal of Pure and Applied Microbiology, 2014) Celen, Mustafa Kemal; Turker, Kamuran; Oztoprak, Nefise; Sener, Alper; Tuna, Nazan; Ince, Nevin; Erdem, Ilknur
    Chronic hepatitis B is a major public health problem in our country. Hepatitis A vaccination in HBV carriers who did not encounter with Hepatitis A virus is also significant. We aimed to evaluate the rate of exposure to HAV in HBsAg-positive persons, and the distribution of seronegative individuals according to age groups. Medical records of 4793 patients from 14 centers who were positive for hepatitis B surface antigen (HBsAg). A total 3514 cases (73.3%) were male and 1279 (26.7) were female. The HBsAg positive patients who were previously tested for HAV IgG at the time of firstly admitted to a center. HBsAg positive patients who were previously not tested for HAV IgG were tested and these . patients were confirmed serologically for HAV. The distribution of cases according to age were determined. In this study, 4793 HBsAg-positive patients were evaluated. The ratio of testing of anti-HAV IgG was very low during the first visit (54.2%). Seronegativity was highest in the age group under 19 years of age (26.2%) followed by 20-25 age group (15.5%) and 26-29 age group (12.5%). Testing of HAV serology should not be ignored in especially HBsAg-positive young adults and seronegative young adults should be vaccinated.