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    Factors affecting mortality in covid-19-associated pulmonary aspergillosis: an international ID-IRI study
    (2024) Şahin, Meyha; Yılmaz, Mesut; Mert, Ali; Emecen, Ahmet Naci; Rahman S. Al Maslamani, Muna A.; Mahmoud A. Hashim, Samar; Ittaman, Ajithkumar Valooparambil; Wadi Al Ramahi, Jamal; Gergely Szabo, Balint; Konopnicki, Deborah; Başkol Elik, Dilşah; Lakatos, Botond; Sipahi, Oğuz Reşat; Khedr, Reham; Jalal, Sabah; Pshenichnaya, Natalia; Magdalena, Dumitru Irina; El Kholy, Amani; Khan, Ejaz Ahmed; Alkan, Sevil; Hakamifard, Atousa; Sincan, Gülden; Esmaoğlu, Aliye; Makek, Mateja Jankovic; Gürbüz, Esra; Liskova, Anna; Albayrak, Ayşe; Stebel, Roman; Ünver Ulusoy, Tülay; Ripon, Rezaul Karim; Moroti, Ruxandra; Dascalu, Cosmin; Rashid, Naveed; Cortegiani, Andrea; Bahadır, Zeynep; Erdem, Hakan
    Background: This study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). Methods: In this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. Results: A total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ?65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ?65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). Conclusion: This study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.
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    Factors influencing mortality in covid-19-associated mucormycosis - the international ID-IRI study
    (2024) Şahin, Meyha; Yılmaz, Mesut; Mert, Ali; Naghili, Behrouz; Ravanbakhsh, Fatemeh; Varshochi, Mojtaba; Alavi Darazam, Ilad; Ebrahimi, Mohammad Javad; Moafi, Maral; Tehrani, Hamed Azhdari; Mahboob, Amjad; Rashid, Naveed; Khan, Ejaz Ahmed; Hakamifard, Atousa; Eser Karlıdağ, Gülden; Babamahmoodi, Abdolreza; El-Kholy, Amani; Mosawi, Sayed Hussain; Albayrak, Ayşe; Wadi Al Ramahi, Jamal; Addepalli, Syam Kumar; Balin, Şafak Özer; Khan, Asfandiyar; Pandya, Nirav; Gürbüz, Esra; Sincan, Gülden; Azami, Hadia; Dumlu, Rıdvan; Khedr, Reham; Ripon, Rezaul Karim; Alkan, Sevil; Köse, Şükran; Ceylan, Bahadır; Erdem, Hakan
    The emergence of COVID-19, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), triggered a global pandemic. Concurrently, reports of mucormycosis cases surged, particularly during the second wave in India. This study aims to investigate mortality factors in COVID-19-associated mucormycosis (CAM) cases, exploring clinical, demographic, and therapeutic variables across mostly Asian and partly African countries. A retrospective, cross-sectional analysis of CAM patients from 22 medical centers across eight countries was conducted, focusing on the first three months post-COVID-19 diagnosis. Data collected through the IDI-IR included demographics, comorbidities, treatments, and outcomes. A total of 162 CAM patients were included. The mean age was 54.29±13.04 years, with 54% male. Diabetes mellitus (85%) was prevalent, and 91% had rhino-orbital-cerebral mucormycosis (ROCM). Surgical debridement was performed in 84% of the cases. Mortality was 39%, with advanced age [Hazard Ratio (HR)=1.06, (p<0.001)], rituximab use (HR=21.2, p=0.05), diabetic ketoacidosis (HR=3.58, p=0.009) identified as risk factors. The mortality risk increases by approximately 5.6% for each additional year of age. Surgical debridement based on organ involvement correlated with higher survival (HR=8.81, p<0.001). The utilization of rituximab and diabetic ketoacidosis along with advancing age, has been associated with an increased risk of mortality in CAM patients. A combination of antifungal treatment and surgical intervention has demonstrated a substantial improvement in survival outcomes.
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    Mortality predictors of Staphylococcus aureus bacteremia: A prospective multicenter study
    (BioMed Central Ltd., 2016) Yılmaz, Mesut; Elaldi, Nazif; Balkan, İlker İnanç; Arslan, Ferhat; Alga Batırel, Ayşe; Bakıcı, Mustafa Zahir; Gözel, Mustafa Gökhan; Alkan, Sevil; Doğan Çelik, Aygül; Yetkin, Meltem Arzu; Bodur, Hürrem; Sinirtaş, Melda; Akalın, Halis; Aybala Altay, Fatma; Şencan, İrfan; Azak, Emel; Gündeş, Sibel; Ceylan, Bahadır; Öztürk, Recep; Leblebicioğlu, Hakan; Vahaboğlu, Haluk; Mert, Ali
    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 59years. 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 12h, 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.