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Öğe Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: A Multicenter retrospective analysis(Wolters Kluwer Medknow Publications, 2015) Balkan, İlker İnanç; Batırel, Ayşe; Karabay, Oğuz; Ağalar, Canan; Akalın, Şerife; Alici, Özlem; Yılmaz, Hava; Doğan, MustafaObjectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A) . Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.Öğe Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections(Springer, 2014) Batırel, Ayşe; Balkan, İlker İnanç; Karabay, Oğuz; Ağalar, Canan; Akalın, Şerife; Alici, O.; Yılmaz, H.; Dogan, M.The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7 %): colistin-carbapenem (CC), 69 (32.2 %): colistin-sulbactam (CS), and 43 (20.1 %: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.Öğe Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome(Public Library Science, 2018) Çağ, Yasemin; Karabay, Oğuz; Sipahi, Oguz Resat; Aksoy, Firdevs; Durmuş, Gül; Batırel, Ayşe; Vahaboglu, Haluk; Erdem, İlknurSepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.Öğe Efficacy of Colistin and Non-Colistin Monotherapies in Multi-Drug Resistant Acinetobacter Baumannii Bacteremia/Sepsis(Carbone Editore, 2014) Karabay, Oğuz; Batırel, Ayşe; Balkan, İlker İnanç; Ağalar, Canan; Akalın, Şerife; Alici, Özlem; Yılmaz, Hava; Doğan, MustafaObjective: This retrospective study aimed to investigate the efficacies of colistin and non-colistin monotherapies in multi-drug resistant Acinetobacter baumannii bacteremia (MDR-AB). Materials and methods: Cases with MDR-AB from 27 tertiary-referral hospitals between January 2009 and December 2012 were included. Patients' data that were on either colistin monotherapy (CM) or non-colistin monotherapy (NCM) were compared. Mortality on Day 14 was the primary endpoint, whereas microbiological eradication and clinical outcome were the secondary ones. Results: Eighty-four cases were included in the study with 36 being in the CM group and 48 in the NCM group. Thirty-eight (452%) cases were male and the mean age was 602 years. The mean durations of pre-MDR-AB hospital stay and intensive care unit stay were 25.8 days and 20.9 days, respectively. All of the cases had fever (>38 degrees C). The mean Pitt bacteremia score (PBS) of the patients was calculated as 6.8, APACHE 2 score as 18.9 and the Charlson co-morbidity index (CCI) as 3.7 (CM: 3.6 vs. NCM: 3.9). Twenty (55.6%) cases in the CM group and 26 cases in the NCM group (542%) (p=0.81) died; 9 cases in the CM group (25%) and 16 cases in the NCM group (33 3%) had treatment failure (P=0.55). Bacteriological eradication was achieved in 20 (55.6%) cases in the CM group and in 36 cases (75%) in the NCM group (P=0.061). Conclusions: No significant difference could be identified between the colistin monotherapy and non-colistin monotherapy options in MDR-AB cases with respect to the results of efficacy and 14-day mortality.Öğe The Association Between Weight Loss and Hepatitis B Surface Antigen Seroclearence in Chronic Hepatitis B Patients(Brieflands, 2024) Tuna, Nazan; Utku, Aylin Çalıca; Vatan, Aslı; Ogutlu, Aziz; Guclu, Ertugrul; Karabay, OğuzBackground: In chronic hepatitis B (CHB) patients, hepatitis B surface antigen (HBsAg) seroclearance is the main target of therapy and is rarely observed. Objectives: This study aimed to investigate the factors affecting HBsAg loss by focusing especially on the relationship between weight loss and HBsAg loss. Methods: This study was designed retrospectively to assess HBsAg status and clinical and laboratory findings in CHB patients, as well as cross-sectionally to evaluate lifestyle factors. A total of 5600 hepatitis B (HB) infection patients who were treated or followed between 2008 and 2020 were evaluated retrospectively. In the HBsAg loss group, 94 CHB patients were examined based on exclusion criteria, and 95 patients without HBsAg loss were matched as controls. Patient data and laboratory findings were retrieved from patient files. All participants were surveyed using a questionnaire developed by the authors, which inquired about the lifestyle characteristics of CHB patients. The questionnaire covered topics such as the use of herbal products, coffee consumption, medication history, antiviral treatment, concurrent diseases, weight changes, and patient demographics. Statistical analysis was performed using SPSS version 25.0. The Student's t-test was used to compare quantitative variables, while the chi-square test was used for categorical variables. A paired samples t-test was used to compare dependent samples. The statistical significance level was set at a p value less than 0.05. Results: The basal mean hepatitis B virus (HBV) DNA level was significantly lower in the HBsAg loss group (P < 0.001). The prevalence of hyperlipidemia comorbidity (P = 0.008) and moderate/severe hepatosteatosis (P < 0.05) was significantly higher in the HBsAg loss group compared to the non-HBsAg loss group. Prior to HBsAg loss, 44 (47%) patients in the HBsAg loss group experienced weight loss, whereas only 22 (23%) patients in the non-HBsAg group had a history of weight loss (P < 0.001). Conversely, the incidence of weight gain was significantly lower in the HBsAg loss group (P = 0.001). A paired samples t-test was conducted to compare the baseline and last period body mass index (BMI) means of the HBsAg loss group, revealing a statistically significant decrease in mean BMI in the last period (P < 0.001). Conclusions: Weight loss was significantly associated with HBsAg seroclearance in patients with CHB infection. Conversely, weight gain was associated with HBsAg persistence. © 2024, Brieflands. All rights reserved.Öğe The efficacy of patient education in preventing urinary tract infections in multiple sclerosis(Wiley, 2017) Kaya, G.; Kotan, Dilcan; Gündoğdu, Aslı Aksoy; Karabay, Oğuz[No Abstract Available]
