Browsing by Author "Erdem, Hakan"
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Item Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs(BMC, 2011) Erdem, Hakan; Koruk, Suda Tekin; Koruk, İbrahim; Keten, Derya Tozlu; Kılıç, Aysegül Ulu; Öncül, Oral; Güner, Rahmet; Birengel, Serhat; Mert, Gürkan; Alpat, Saygın Nayman; Tülek, Necla Eren; Demirdal, Tuna; Elaldi, Nazif; Hatipoglu, Çiğdem Ataman; Yılmaz, Emel; Mete, Bilgul; Kurtaran, Behice; Ceran, Nurgül; Karabay, Oğuz; İnan, Dilara; Cengiz, Melahat; Sacar, Suzan; Dede, Behiye Yücesoy; Yılmaz, Sibel; Agalar, Canan; Bayındır, Yaşar; Alpay, Yeşim; Tosun, Selma; Yılmaz, Hava; Bodur, Hürrem; Erdem, Hüseyin A.; Dikici, Nebahat; Dizbay, Murat; Öncu, Serkan; Sezak, Nurbanu; Sarı, Tuba; Sipahi, Oğuz R.; Uysal, Serhat; Yeniz, Esma; Kaya, Selcuk; Ulcay, Asım; Kurt, Halil; Beşirbellioğlu, Bulent A.; Vahaboğlu, Haluk; Taşova, Yeşim; Usluer, Gaye; Arman, Dilek; Diktaş, Hüsrev; Ulusoy, Sercan; Leblebicioğlu, Hakan; Yılmaz, Emel; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0002-3894-1231; 22037135100Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.Item Efficacy and tolerability of antibiotic combinations in Neurobrucellosis: Results of the Istanbul study(American Society of Microbiology, 2012-03) Erdem, Hakan; Kılıç, Ayşegül Ulu; Kılıç, Selim; Karahocagil, Mustafa; Shehata, Ghaydaa; Tülek, Necla Eren; Yetkin, Funda; Çelen, Mustafa Kemal; Ceran, Nurgül; Gül, Hanefi Cem; Mert, Gürkan; Koruk, Suda Tekin; Dizbay, Murat; İnal, Ayşe Seza; Alpat, Saygın Nayman; Bosilkovski, Mile; İnan, Dilara; Saltoğlu, Neşe; Abdel-Baky, Laila; Adeva-Bartolome, Maria Teresa; Ceylan, Bahadır; Saçar, Suzan; Turhan, Vedat; Elaldı, Nazif; Tufan, Zeliha Koçak; Uğurlu, Kenan; Dokuzoğuz, Başak; Yılmaz, Hava; Gündeş, Sibel; Güner, Rahmet; Özgüneş, Nail; Ulçay, Asım; Ünal, Serhat; Dayan, Saim; Görenek, Levent; Karakaş, Ahmet; Tasova, Yeşim; Usluer, Gaye; Bayındır, Yaşar; Kurtaran, Behice; Sipahi, Oğuz Reşat; Leblebicioğlu, Hakan; Yılmaz, Emel; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 22037135100No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 +/- 2.47 months in P1, 6.52 +/- 4.15 months in P2, and 5.18 +/- 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/ 117) and P3 (6.1%, n = 3/ 49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.Item Management of Brucella endocarditis: Results of the Gulhane study(Elsevier, 2012-08) Koruk, Suda Tekin; Erdem, Hakan; Koruk, İbrahim; Erbay, Ayşe; Tekce, Yasemin Tezer; Erbay, Ali Rıza; Dayan, Saim; Deveci, Özcan; İnan, Asuman; Engin, Derya Öztürk; Güner, Rahmet; Dikici, Nebahat; Kartal, Elif Doyuk; Kurtaran, Behice; Pehlivanoğlu, Filiz; Sipahi, Oğuz Reşat; Yalcı, Aysun; Yemişen, Mücahit; Çavuş, Sema Alp; Gençer, Serap; Güzel, Gökhan; Öncül, Oral; Parlak, Mehmet; Tülek, Necla; Ulçay, Asım; Savaşçı, Ümit; Kazak, Esra; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; AAG-8459-2021; 24921238200Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.Publication The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients(Bmc, 2020-10-23) Sulaiman, Tarek; Medi, Sai; Erdem, Hakan; Şenbayrak, Seniha; Öztürk-Engin, Derya; İnan, Asuman; Civljak, Rok; Nechifor, Mihai; Akbulut, Ayhan; Crisan, Alexandru; Özgüler, Müge; Namiduru, Mustafa; Savic, Branislava; Dulovic, Olga; Pehlivanoğlu, Filiz; Şengöz, Gönül; Yaşar, Kadriye; İnal, Ayşe Seza; Parlak, Emine; Johansen, Işık Somuncu; Kurşun, Ebru; Parlak, Mehmet; Yılmaz, Emel; Yılmaz, Gülden; Gül, Hanefi Cem; Öncül, Oral; Simeon, Soline; Tattevin, Pierre; Ulu-Kılıç, Ayşegül; Alabay, Selma; Beovic, Bojana; Catroux, Melanie; Hansmann, Yves; Harxhi, Arjan; Şener, Alper; Özkaya, Hacer Deniz; Cağ, Yasemin; Agalar, Canan; Vahaboğlu, Haluk; Uğur, Berna Kaya; Hasbun, Rodrigo; YILMAZ, EMEL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; HJZ-6992-2023Background Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The "Thwaites' system" and "Lancet consensus scoring system" are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. Methods A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The "Thwaites' system" and "Lancet consensus scoring system" scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The "Thwaites' system" and "Lancet consensus scoring system" suggest a high probability of TBM with scores <= 4, and with scores of >= 12, respectively. Results A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. Conclusion Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.