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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, Ilker Inanc; Batirel, Ayse; Karabay, Oguz; Agalar, Canan; Akalin, Serife; Alici, Ozlem; Alp, EmineObjectives: 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 EFFICACY OF COLISTIN AND NON-COLISTIN MONOTHERAPIES IN MULTI-DRUG RESISTANT ACINETOBACTER BAUMANNII BACTEREMIA/SEPSIS(Carbone Editore, 2014) Karabay, Oguz; Batirel, Ayse; Balkan, Ilker Inanc; Agalar, Canan; Akalin, Serife; Alici, Ozlem; Alp, EmineObjective: 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 Healthcare workers' compliance with universal precautions in Turkey(Churchill Livingstone, 2011) Hosoglu, Salih; Akalin, Serife; Sunbul, Mustafa; Otkun, Metin; Ozturk, RecepBlood-borne pathogens (BBP) represent remarkable occupational risks for healthcare workers (HCWs). Avoiding occupational blood exposure is a basis of prevention of the blood-borne pathogens (BBP). The effectiveness of the prevention strategies depends on the compliance and adherence to the program by healthcare-facility personnel. The aim of this study was to evaluate Turkish HCWs' compliance with Universal Precautions (UP). An analytic, cross-sectional, countrywide survey study was performed in hospital settings, (n = 5145) in 30 hospitals in 19 cities. In total, 1726 of the 5143 (33.6%) participants' behaviors were accepted as satisfactory for compliance with UP. The hepatitis knowledge levels of 2,650 (51.5%) participants were found to be satisfactory. In the multivariate analysis, working at a surgical site (P = 0.004), living in a rich region (P = .007) and the existence of a health office for HCWs (p = .000) were found to be contributor factors for HCWs' compliance with UP. Conversely, being a nurse (P = .000) and HBV/HCV carrier status (P = .039) were significant preventing predictors for HCWs' compliance with UP. Along with the other well-known predictive factors, regional economic status and a health office for HCWs are contributors for compliance with UP. (C) 2011 Elsevier Ltd. All rights reserved.Öğe Impact of antimicrobial drug restrictions on doctors' behaviors(Tubitak Scientific & Technological Research Council Turkey, 2016) Karabay, Oguz; Hosoglu, Salih; Guclu, Ertugrul; Akalin, Serife; Altay, Fatma Aybala; Aydin, Emsal; Ceylan, BahadirBackground/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had <= 5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.Öğe Predictive factors for occupational bloodborne exposure in Turkish hospitals(Mosby-Elsevier, 2009) Hosoglu, Salih; Akalin, Serife; Sunbul, Mustafa; Otkun, Metin; Ozturk, RecepBackground: This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs). Methods: An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country. Results: The respondent group included 41.3% nurses. 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least I occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P =.000), being a doctor (P =.000), being a nurse (P=.000). young age (P =.025), and living in a poor region (P =.005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P =.000) and working at a university hospital (P =.003) were significant predictors of less occupational exposure, Overall, the mean number of PME incidents was 2.16/person/year. Conclusion: Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs (Am J Infect Control 2009:37:65-9.)
