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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(Medknow Publications, 2015) İnanç Balkan, İlker; Batırel, Ayşe; Karabay, Oğuz; A?alar, Canan; Akalın, Şerife; Alıcı, Özlem; Alp, Emine; Altay, Fatma Aybala; Altın, Nilgün; Arslan, Ferhat; Aslan, Turan; Bekiroğlu, Nural; Cesur, Salih; Do?an Çelik, Aygül; Do?an, Mustafa; Durdu, Bülent; Duygu, Fazilet; Engin, Aynur; Öztürk Engin, Derya; Gönen, İbak; Güçlü, Ertuğrul; Güven, Tümer; Hatipo?lu, Çi?dem; Hoşo?lu, Salih; Karahocagil, Mustafa Kasım; Ulu Kılıç, Ayşegül; Örmen, Bahar; Özdemir, Davut; Özer, Serdar; Öztoprak, Nefise; Sezak, Nur Banu; Turhan, Vedat; Türker, Nesrin; Yılmaz, HavaObjectives: 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) Batirel, Ayşe; Balkan, İlker İnanç; Karabay, Oğuz; Ağalar, Canan; Akalın, Şerife; Alıcı, Özlem; Alp, Emine; Altay, Fatma Aybala; Altın, Nilgün; Arslan, Ferhat; Aslan, Turan; Bekiroğlu, Nuray; Cesur, Salim; Çelik, Aygül Dogan; Doğan, Mustafa; Durdu, Bülent; Duygu, Fazilet; Engin, Aynur; Engin, Derya Öztürk; Gönen, İbak; Güçlü, Ertuğrul; Güven, Tümer; Hatipoğlu, Çiğdem Ataman; Hoşoğlu, Salih; Karahocagil, Mustafa Kasım; Ulu Kılıç, Aysegül; Örmen, Bahar; Özdemir, Davut; Özer, Serdar; Öztoprak, Nefise; Sezak, Nurbanu; Turhan, Vedat; Türker, Nesrin; Yılmaz, HavaThe 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 Efficacy of colistin and non-colistin monotherapies in multi-drug resistant acinetobacter baumannii bacteremia/sepsis(Acta Medica Mediterranea, 2014) Karabay, Oğuz; Batırel, Ayşe; Balkan, İlker İnanç; Ağalar, Canan; Akalın, Şerife; Alıcı, Özlem; Alp, Emine; Aybala Alta, Fatma; Altın, Nilgün; Arslan, Ferhat; Aslan, Turan; Bekiroğlu, Nural; Cesur, Salim; Doğan Çelik, Aygül; Doğan, Mustafa; Durdu, Bülent; Duygu, Fazilet; Engin, Aynur; Öztürk Engin, Derya; Gönen, İbak; Güçlü, Ertuğrul; Güven, Tümer; Ataman Hatipoğlu, Çiğdem; Hoşoğlu, Salih; Karahocagil, Mustafa; Ulu Kılıç, Ayşegül; Örmen, Bahar; Özdemir, Davut; Özer, Serdal; Öztoprak, Nefise; Sezak, Nurbanu; Turhan, Vedat; Türker, Nesrin; Yılmaz, HavaObjective: 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 (45.2%) cases were male and the mean age was 60.2 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°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 (54.2%) (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 efficacy of ribavirin in Crimean-Congo hemorrhagic fever-randomized trials are urgently needed(Elsevier, 2014) Ceylan, Bahadır; Turhan, VedatThe only antiviral drug used today in Crimean-Congo hemorrhagic fever (CCHF) is ribavirin; however, its efficacy is controversial due to the lack of randomized controlled trials. The studies examining the efficacy of ribavirin in CCHF have generally been retrospective studies including insufficient numbers of patients, resulting in low power. We think that ribavirin should not be used in CCHF until randomized controlled studies have been conducted, and that only supportive treatment should be used.Öğe Urinary tuberculosis: A cohort of 79 adult cases(Taylor and Francis, 2015) Altıparmak, Mehmet Rıza; Trabulus, Sinan; Balkan, İlker İnanç; Yalın, Serkan Feyyaz; Denizli, Nazım; Aslan, Gönül; Doruk, Hasan Erdal; Engin, Aynur; Tekin, Recep; Birengel, Serhat; Çetin, Birsen Durmaz; Arslan, Ferhat; Turhan, Vedat; Mert, AliWe aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 +/- 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 +/- 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 +/- 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.Öğe Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin(Elsevier Science Bv., 2017) Ceylan, Bahadır; Arslan, Ferhat; Sipahi, Oğuz Reşat; Sünbül, Mustafa; Örmen, Bahar; Hakyemez, İsmail N.; Turunç, Tuba; Yıldız, Yeşim; Karsen, Hasan; Karagöz, Gül; Tekin, Recep; Hizarcı, Burcu; Turhan, Vedat; Şenol, Şebnem; Öztoprak, Nefise; Yılmaz, Mesut; Özdemir, Kevser; Mermer, Sinan; Kökoüğlu, Ömer F.; Mert, AliAim: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. Materials and methods: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. Results: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (Cl), 1.004-1.067; p = 0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p = 0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. Conclusions: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.
