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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 associated with surgical site infections following cardiac surgery: insights from the international ID-IRI study
    (2025) Erdem, Hakan; Ankaralı, Handan; Al Tawfiq, Jaffar; Angamuthu, Kumar; Piljic, Dragan; Karahangil, Kadriye; Giammanco, Anna
    Objectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods: Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results: Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions: To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.
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    Profiles of primary brain abscesses and their impact on survival: An international ID-IRI study
    (2024) Şahin, Meyha; Mert, Ali; Emecen, Ahmet Naci; Strunjas, Natalija Planinc; Fasanekova, Lenka; Batırel, Ayşe; Erdem, Hakan
    Objectives: This study of 331 primary brain abscess (PBA) patients aimed to understand infecting agents, predisposing factors, and outcomes, with a focus on factors affecting mortality. Methods: Data were collected from 39 centers across 16 countries between January 2010 and December 2022, and clinical, radiological, and microbiological findings, along with their impact on mortality, were analyzed. Results: The patients had a mean ± SD age of 46.8 ± 16.3 years, with a male predominance of 71.6%. Common symptoms included headache (77.9%), fever (54.4%), and focal neurological deficits (53.5%). Gram-positive cocci were the predominant pathogens, with Viridans group streptococci identified as the most frequently isolated organisms. All patients received antimicrobial therapy and 71.6% underwent interventional therapies. The 42-day and 180-day survival rates were 91.9% and 86.1%, respectively. Significant predictors of 42-day mortality included intravenous drug addiction (HR: 6.02, 95% CI: 1.38-26.26), malignancy (HR: 3.61, 95% CI: 1.23-10.58), confusion (HR: 2.65, 95% CI: 1.19-5.88), and unidentified bacteria (HR: 4.68, 95% CI: 1.76-12.43). Significant predictors of 180-day mortality included malignancy (HR: 2.70, 95% CI: 1.07-6.81), confusion (HR: 2.14, 95% CI: 1.11-4.15), temporal lobe involvement (HR: 2.10, 95% CI: 1.08-4.08), and unidentified bacteria (HR: 3.02, 95% CI: 1.49-6.15). Conclusion: The risk of death in PBA extends beyond the infection phase, with different factors influencing the 42-day and 180-day mortality rates. Intravenous drug addiction was associated with early mortality, while temporal lobe involvement was associated with late mortality.
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    Prospective analysis of febrile neutropenia patients with bacteraemia: The results of an international ID-IRI study
    (NLM (Medline), 2023) Erdem, Hakan; Koçoğlu, Esra; Ankaralı, Handan; El-Sokkary, Rehab; Hakamifard, Atousa; Karaali, Rıdvan; Kulzhanova, Sholpan; Sirmatel, Fatma
    OBJECTIVES: 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.
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    Understanding clinical outcomes and factors influencing mortality in intensive care unit patients with COVID-19-associated candidemia
    (Wiley, 2024) Aydın, Selda; Mert, Ali; Yılmaz, Mesut; Al Maslamani, Muna; Rahimi, Bilal Ahmad; Ayoade, Folusakin; El-Kholy, Amani; Belitova, Maya; Erdem, Hakan
    Background: During the COVID pandemic, research has shown an increase in candidemia cases following severe COVID infection and the identification of risk factors associated with candidemia. However, there is a lack of studies that specifically explore clinical outcomes and mortality rates related to candidemia after COVID infection.Objectives: The aim of this international study was to evaluate the clinical outcomes and identify factors influencing mortality in patients who developed candidemia during their COVID infection.Patients/Methods: This study included adult patients (18 years of age or older) admitted to the intensive care unit (ICU) and diagnosed with COVID-associated candidemia (CAC). The research was conducted through ID-IRI network and in collaboration with 34 medical centres across 18 countries retrospectively, spanning from the beginning of the COVID pandemic until December 2021.Results: A total of 293 patients diagnosed with CAC were included. The median age of the patients was 67, and 63% of them were male. The most common Candida species detected was C. albicans. The crude 30-day mortality rate was recorded at 62.4%. The logistic regression analysis identified several factors significantly impacting mortality, including age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.07, p < .0005), SOFA score (OR 1.307, 95% CI 1.17-1.45, p < .0005), invasive mechanical ventilation (OR 7.95, 95% CI 1.44-43.83, p < .017) and duration of mechanical ventilation (OR 0.98, 95% CI 0.96-0.99, p < .020).Conclusions: By recognising these prognostic factors, medical professionals can customise their treatment approaches to offer more targeted care, leading to improved patient outcomes and higher survival rates for individuals with COVID-associated candidemia.