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Vogler S, Habimana K, Haasis MA, Fischer S. Pricing, Procurement and Reimbursement Policies for Incentivizing Market Entry of Novel Antibiotics and Diagnostics: Learnings from 10 Countries Globally. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:629-652. [PMID: 38837100 DOI: 10.1007/s40258-024-00888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Fostering market entry of novel antibiotics and enhanced use of diagnostics to improve the quality of antibiotic prescribing are avenues to tackle antimicrobial resistance (AMR), which is a major public health threat. Pricing, procurement and reimbursement policies may work as AMR 'pull incentives' to support these objectives. This paper studies pull incentives in pricing, procurement and reimbursement policies (e.g., additions to, modifications of, and exemptions from standard policies) for novel antibiotics, diagnostics and health products with a similar profile in 10 study countries. It also explores whether incentives for non-AMR health products could be transferred to AMR health products. METHODS This research included a review of policies in 10 G20 countries based on literature and unpublished documents, and the production of country fact sheets that were validated by country experts. Initial research was conducted in 2020 and updated in 2023. RESULTS Identified pull incentives in pricing policies include free pricing, higher prices at launch and price increases over time, managed-entry agreements, and waiving or reducing mandatory discounts. Incentives in procurement comprise value-based procurement, pooled procurement and models that delink prices from volumes (subscription-based schemes), whereas incentives in reimbursement include lower evidence requirements for inclusion in the reimbursement scheme, accelerated reimbursement processes, separate budgets that offer add-on funding, and adapted prescribing conditions. CONCLUSIONS While a few pull incentives have been piloted or implemented for antibiotics in recent years, these mechanisms have been mainly used to incentivize launch of certain non-AMR health products, such as orphan medicines. Given similarities in their product characteristics, transferability of some of these pull incentives appears to be possible; however, it would be essential to conduct impact assessments of these incentives. Trade-offs between incentives to foster market entry and thus potentially improve access and the financial sustainability for payers need to be addressed.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria.
- Department of Health Care Management, Technische Universität Berlin, 10623, Berlin, Germany.
| | - Katharina Habimana
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria
| | - Manuel Alexander Haasis
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria
| | - Stefan Fischer
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria
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Gülpınar G, Pehlivanlı A, Babaar ZUD. Pharmacy practice and policy research in Türkiye: a systematic review of literature. J Pharm Policy Pract 2024; 17:2385939. [PMID: 39139388 PMCID: PMC11321099 DOI: 10.1080/20523211.2024.2385939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
Background In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far. Objectives This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research. Methods The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC. Results In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies. Conclusions The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance.
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Affiliation(s)
- Gizem Gülpınar
- Department of Pharmacy Management, Faculty of Pharmacy, Gazi University, Ankara, Türkiye
| | - Aysel Pehlivanlı
- Department of Pharmacology, Faculty of Pharmacy, Baskent University, Ankara, Türkiye
- Clinical Pharmacy and Drug Information Center, Baskent University Ankara Hospital, Ankara, Türkiye
| | - Zaheer Ud-Din Babaar
- Medicines and Healthcare, Department of Pharmacy, University of Huddersfield, Huddersfield, UK
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Coşkun B, Ayhan M, Ulusoy S, Guner R. Bacterial Profile and Antimicrobial Resistance Patterns of Diabetic Foot Infections in a Major Research Hospital of Turkey. Antibiotics (Basel) 2024; 13:599. [PMID: 39061280 PMCID: PMC11274067 DOI: 10.3390/antibiotics13070599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Aim: Diabetic foot infection (DFI) occurs frequently in patients, followed up with diabetic foot ulcers (DFU). For this reason, antibiotic treatment is often used in patients followed with DFU. Inappropriate use of antibiotics and increasing antibiotic resistance threaten public health. We aimed to investigate the microbial spectrum and antimicrobial resistance patterns isolated from diabetic foot infections in Turkey and help clinicians to choose optimal antibiotics empirically. Materials and Methods: This study was planned as a retrospective, single-center, cross-sectional study. Two hundred sixty-two patients whose causative microorganism was isolated in culture of tissue between 1 January 2021 and 31 December 2022 were included in this study. Bacterial profile and antimicrobial resistance patterns were analyzed. Results: Four hundred thirty two isolates from 262 patients isolated in culture of tissue were evaluated. Of these microorganisms, 57.60% were Gram-negative, 41.20% were Gram-positive bacteria, and 1.2% were Candida spp. The most frequently detected Gram-positive microorganism was Staphylococcus spp. Gram-negative microorganisms were Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa). Polymicrobial infections were observed in 40.5% of the patients. Methicillin-resistant Staphylococcus spp. rate was 51.3%, while extended-spectrum beta-lactamase (ESBL) resistance for E. coli was 66.7%. Conclusions: Due to increasing antibiotic resistance rates, treatment of common infections becomes more difficult. Knowledge of the microbiological profile and antibiotic resistance patterns of patients with DFIs is useful to guide empirical therapy.
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Affiliation(s)
- Belgin Coşkun
- Ankara Bilkent City Hospital, 06700 Ankara, Turkey; (M.A.); (S.U.); (R.G.)
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Ayhan M, Coşkun B, Kayaaslan B, Hasanoğlu İ, Kalem AK, Eser F, Bilir YA, Ünlü S, Güner R. Point prevalence of antibiotic usage in major referral hospital in Turkey. PLoS One 2024; 19:e0296900. [PMID: 38295065 PMCID: PMC10830045 DOI: 10.1371/journal.pone.0296900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. MATERIALS AND METHODS A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. RESULTS Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). CONCLUSION Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.
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Affiliation(s)
- Müge Ayhan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Belgin Coşkun
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Serpil Ünlü
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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Ergönül Ö, Keske Ş, Ksinzik A, Güldan M, Özbek L, Azap A, Şimşek-Yavuz S, Can F, Sakarya S. The challenges in the monitoring of infectious diseases after the earthquake in Türkiye in 2023. THE LANCET. INFECTIOUS DISEASES 2023; 23:e482-e488. [PMID: 37419128 DOI: 10.1016/s1473-3099(23)00362-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/09/2023]
Abstract
After the devastating earthquake in Türkiye and Syria in February, 2023, the long-term failure to meet the need for shelter, unfavourable living conditions in tent settlements, poor access to clean drinking water, water suitable for personal hygiene, and sanitary facilities, as well as interruptions in provision of primary health-care services, have emerged as the most important risk factors contributing to the spread of infectious diseases. 3 months after the earthquake, most of these problems persist in Türkiye. Data on the control of infectious diseases are scarce according to the reports prepared by medical specialist associations based on observations of health-care providers working in the region and statements made by the local health authorities. According to these unsystematised data, and considering the conditions in the region, faecal-oral transmissible gastrointestinal infections, as well as respiratory and vector-borne infections, are the main challenges. Vaccine-preventable diseases, such as measles, varicella, meningitis, and polio can be spread in temporary shelters due to interrupted vaccine services and crowded living conditions. In addition to controlling risk factors for infectious diseases, sharing data on the status and control of infectious diseases in the region with the community, health-care providers, and relevant expert groups should be a priority to improve the understanding of the effects of interventions and prepare for possible infectious disease outbreaks.
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Affiliation(s)
- Önder Ergönül
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye.
| | - Şiran Keske
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Apolina Ksinzik
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye; Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Mustafa Güldan
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Laşin Özbek
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Medical Faculty, Ankara, Türkiye
| | - Serap Şimşek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Medical Faculty, Istanbul, Türkiye
| | - Füsun Can
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Medical Microbiology, Koç University School of Medicine, Istanbul, Türkiye
| | - Sibel Sakarya
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Türkiye; Department of Public Health, Koç University School of Medicine, Istanbul, Türkiye
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Armitage R. General practice in the UK's response to the Türkiye and Syrian earthquakes. Br J Gen Pract 2023; 73:218-219. [PMID: 37105739 PMCID: PMC10147413 DOI: 10.3399/bjgp23x732753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Richard Armitage
- Richard is a GP and Public Health Specialty Registrar, and Honorary Assistant Professor at the University of Nottingham's Academic Unit of Population and Lifespan Sciences. @drricharmitage
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Distribution of Clinical Staphylococccus aureus Isolates and Antibiotic Resistance Profile: Three-Year Data. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1082385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: Staphylococci cause community-acquired and hospital-acquired infections, and Staphylococcus aureus is one of leading agents. In the last decades methicillin-resistant S.aureus (MRSA), vancomycin-intermediate S.aureus (VISA) and vancomycin-resistant S.aureus (VRSA) became as major concerns. Resistance to other antibiotics is also another growing issue. The aim of this study was to investigate the prevalence of S.aureus species and to evaluate susceptibilities to antimicrobial agents in a state (tertiary) hospital.
Methods: Clinical cultures from various samples (urinary tract, respiratory, wound, abscess, tissue, catheter and external auditory) obtained from January 2017 to December 2019 in XXX hospital were included in the study. Isolated S.aureus strains and their antibiotic susceptibilities were retrospectively evaluated.
Results: A total of 765 S.aureus strains were isolated. 165 S.aureus strains were found as methicillin resistant (MRSA; 21.9%). There was not any statistically significant difference in MRSA rates among evaluated years (p=0.772). There was not any strain that was resistant to vancomycin, teicoplanin and/or linezolid. The highest rate was observed in penicillin resistance (n=646/728, 88.7%). There was not any statistically significant alteration in the resistance rates of all tested antibiotics during the three-year period.
Conclusions: Despite dwindling MRSA rates in UAMDSS, CAESAR report indicates that Turkey seems to be in the beginning phase of this struggle. Local and/or national antimicrobial stewardship programs are in effect in Turkey, but further measures are required.
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Torumkuney D, Aktas Z, Unal S, van Hasselt J, Seyhun Y, Keles N. Country data on AMR in Türkiye in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77:i51-i60. [PMID: 36065733 PMCID: PMC9445858 DOI: 10.1093/jac/dkac217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. OBJECTIVES To review AMR in Türkiye and initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Türkiye and to improve patient outcomes. METHODS National AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media, acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from both a local clinician and local clinical microbiologist were sought to contextualize this information. CONCLUSIONS Türkiye developed an antibiotic stewardship programme, The Rational Drug Use National Action Plan 2014-2017, prioritizing appropriate antibiotic prescription in the community. Public campaigns discouraging inappropriate antibiotic use were also initiated. Türkiye has a high level of antibiotic resistance and a high level of consumption, however, in 2015 over-the-counter antibiotic sales were prohibited, resulting in a declining trend in overall consumption. There is still a need for physician education on current developments in antibiotic use. Several ongoing global surveillance studies provide antibiotic susceptibility data in Türkiye. Clinicians in Türkiye use several country-specific guidelines for common CA-RTIs plus a range of international guidelines. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data on isolates from community-acquired infections in Türkiye, could make guideline use more relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcome.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Zerrin Aktas
- Department of Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - James van Hasselt
- GlaxoSmithKline, The Campus, Flushing Meadows, 57 Sloane Street, Bryanston, Gauteng, 2021, South Africa
| | - Yalcin Seyhun
- GlaxoSmithKline, Buyukdere Cad. No: 173, 1. Levent Plaza B Blok 34394 Levent, Istanbul, Türkiye
| | - Nergis Keles
- GlaxoSmithKline, Buyukdere Cad. No: 173, 1. Levent Plaza B Blok 34394 Levent, Istanbul, Türkiye
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Yorgancıoğlu A, Aksu K, Naycı SA, Ediger D, Mungan D, Gül U, Beekman MJHI. Short-acting β 2-agonist prescription patterns in patients with asthma in Turkey: results from SABINA III. BMC Pulm Med 2022; 22:216. [PMID: 35655251 PMCID: PMC9161536 DOI: 10.1186/s12890-022-02008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Over-reliance on short-acting β2-agonists (SABAs) is associated with poor asthma outcomes. However, the extent of SABA use in Turkey is unclear owing to a lack of comprehensive healthcare databases. Here, we describe the demographics, disease characteristics and treatment patterns from the Turkish cohort of the SABA use IN Asthma (SABINA) III study. Methods This observational, cross-sectional study included patients aged ≥ 12 years with asthma from 24 centres across Turkey. Data on sociodemographics, disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA]) and practice type (primary/specialist care). The primary objective was to describe SABA prescription patterns in the 12 months prior to the study visit. Results Overall, 579 patients were included (mean age [standard deviation; SD]: 47.4 [16.1] years; 74.3% female), all of whom were treated by specialists. Most patients had moderate-to-severe asthma (82.7%, GINA steps 3–5), were overweight or obese (70.5%), had high school or university/post-graduate education (51.8%) and reported fully reimbursed healthcare (97.1%). The mean (SD) asthma duration was 12.0 (9.9) years. Asthma was partly controlled/uncontrolled in 56.3% of patients, and 46.5% experienced ≥ 1 severe exacerbation in the preceding 12 months. Overall, 23.9% of patients were prescribed ≥ 3 SABA canisters in the previous 12 months (considered over-prescription); 42.9% received no SABA prescriptions. As few patients had mild asthma, only 5.7% were prescribed SABA monotherapy. Therefore, most patients (61.5%) were prescribed SABA in addition to maintenance therapy, with 42.8% receiving ≥ 3 SABA canisters in the previous 12 months. Inhaled corticosteroids (ICS), ICS + a long-acting β-agonist fixed-dose combination and oral corticosteroids were prescribed to 14.5%, 88.3% and 28.5% of all patients, respectively. Additionally, 10.2% of patients purchased SABA over the counter, of whom 27.1% purchased ≥ 3 canisters in the preceding 12 months. Conclusions Despite all patients being treated by specialists and most receiving fully reimbursed healthcare, nearly a quarter of patients received prescriptions for ≥ 3 SABA canisters in the previous 12 months. This highlights a public health concern and emphasizes the need to align clinical practices with the latest evidence-based recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02008-9.
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Affiliation(s)
- Arzu Yorgancıoğlu
- Department of Pulmonology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey.
| | - Kurtuluş Aksu
- Division of Immunology and Allergy, Department of Chest Diseases, University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Sibel Atış Naycı
- Department of Pulmonology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Dane Ediger
- Division of Allergy and Immunology, Department of Pulmonology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Dilşad Mungan
- Department of Pulmonology, Division of Allergy and Immunology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Özcebe H, Üner S, Karadag O, Daryani A, Gershuni O, Czabanowska K, Brand H, Erdsiek F, Aksakal T, Brzoska P. Perspectives of physicians and pharmacists on rational use of antibiotics in Turkey and among Turkish migrants in Germany, Sweden and the Netherlands: a qualitative study. BMC PRIMARY CARE 2022; 23:29. [PMID: 35168554 PMCID: PMC8848838 DOI: 10.1186/s12875-022-01636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
Abstract
Background Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians’ and pharmacists’ experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants. Methods Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings. Results Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants’ poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries. Conclusions The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01636-8.
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Affiliation(s)
- Hilal Özcebe
- Department of Public, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sarp Üner
- Department of Public Health, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Ozge Karadag
- Columbia University, Earth Institute, Center for Sustainable Development, New York, NY, USA.,Hacettepe University, Institute of Public Health, Ankara, Turkey
| | - Achraf Daryani
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Olga Gershuni
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, The Netherlands.,Department of International Health, Maastricht University, FHML, CAPHRI, Maastricht, The Netherlands
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Helmut Brand
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Fabian Erdsiek
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Witten, Germany.,Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Epidemiology Unit, Chemnitz, Germany
| | - Tuğba Aksakal
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Witten, Germany.,Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Epidemiology Unit, Chemnitz, Germany
| | - Patrick Brzoska
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Witten, Germany. .,Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Epidemiology Unit, Chemnitz, Germany.
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Ahmadian R, Uncu Y, Ercan I, Toluk O. Knowledge and Attitudes Towards Antibiotics Use and an Examination on Patient’s Unrealistic Health Symptoms in Turkey. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/11563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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12
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Kucukyildirim S. Whole-population genomic sequencing reveals the mutational profiles of the antibiotic-treated Escherichia coli populations. Biologia (Bratisl) 2022. [DOI: 10.1007/s11756-021-00959-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Albayrak A, Karakaş NM, Karahalil B. Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18 years of age: a cross-sectional study in Turkey. BMC Pediatr 2021; 21:554. [PMID: 34872522 PMCID: PMC8647354 DOI: 10.1186/s12887-021-03020-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/19/2021] [Indexed: 08/30/2023] Open
Abstract
Background Upper respiratory tract infections (URTIs) are common in children. Antibiotics still continue to be prescribed although most URTIs are of viral origin. This is inappropriate use and this unnecessary administration contributes or may cause antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries. This study aims to evaluate the knowledge and attitudes of parents of children with upper respiratory tract infections regarding antibiotic use and their antibiotic administration practices in a tertiary care hospital in Turkey. Methods Our study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics. Results Five hundred fifty-four parents responded to the questionnaire (93.2% rate of response). A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. While 28% of the parents who thought that the use of inappropriate antibiotics would not change the effect and resistance of the treatment, 41% thought that new antibiotics could be developed continuously. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection. Conclusion According to the results of our study of parents’ lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and practices. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.
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Affiliation(s)
- Aslınur Albayrak
- Faculty of Pharmacy, Department of Clinical Pharmacy, Gazi University, Ankara, Turkey.
| | - Nazmi Mutlu Karakaş
- Faculty of Medicine Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Bensu Karahalil
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Gazi University, Ankara, Turkey
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14
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Community Use of Antibiotics in Turkey: The Role of Knowledge, Beliefs, Attitudes, and Health Anxiety. Antibiotics (Basel) 2021; 10:antibiotics10101171. [PMID: 34680752 PMCID: PMC8532753 DOI: 10.3390/antibiotics10101171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 12/29/2022] Open
Abstract
Turkey has been among the leading countries in antibiotic consumption. As a result of the 4-year National Action Plan for Rational Drug Use, antibiotic prescriptions had declined from 34.9% in 2011 to 24.6% in 2018. However, self-medication with antibiotics without prescription is common, which is not reflected in official statistics. The present study aims at investigating antibiotic use in the community and the factors related to it. A web-based survey was conducted among 945 Turkish-speaking respondents (61.3% female). The questionnaire included questions about antibiotic use for different illnesses, ways to obtain and handle leftover antibiotics, knowledge, beliefs of the antibiotic effectiveness, attitudes, health anxiety, and background factors. According to the results, 34.2% of the sample had self-medicated themselves with antibiotics without a valid prescription. The most common way to self-medicate was to use leftover antibiotics. While 80.4% knew that antibiotics are used to treat bacterial infections, 51.4% thought that antibiotics are effective for viral diseases. The most important predictor of antibiotic use frequency was the belief in their efficiency for various illnesses and symptoms, followed by negative attitudes to antibiotics, health anxiety, knowledge level, positive attitudes, and health status. The results underline the importance of targeting misbeliefs about antibiotics in future campaigns.
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15
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SİG AK, KULA ATİK T, ÇETİN DURAN A. Antibiotic resistance of Enterococcus species: 3-year data. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.949498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Gönen M, Aksoy M, İşli F, Gürpınar UE, Göbel P, Gürsöz H, Ergönül Ö. Assessment of quarter billion primary care prescriptions from a nationwide antimicrobial stewardship program. Sci Rep 2021; 11:14621. [PMID: 34272465 PMCID: PMC8285383 DOI: 10.1038/s41598-021-94308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
We described the significance of systematic monitoring nationwide antimicrobial stewardship programs (ASPs) in primary care. All the prescriptions given by family physicians were recorded in Prescription Information System established by the Turkish Medicines and Medical Devices Agency of Ministry of Health. We calculated, for each prescription, “antibiotics amount” as number of boxes times number of items per box for medicines that belong to antiinfectives for systemic use (i.e., J01 block in the Anatomical Therapeutic Chemical Classification System). We compared the antibiotics amount before (2015) and after (2016) the extensive training programs for the family physicians. We included 266,389,209 prescriptions from state-operated family healthcare units (FHUs) between January 1, 2015 and December 31, 2016. These prescriptions were given by 26,313 individual family physicians in 22,518 FHUs for 50,713,181 individual patients. At least one antimicrobial was given in 37,024,232 (28.31%) prescriptions in 2015 and 36,154,684 (26.66%) prescriptions in 2016. The most common diagnosis was “acute upper respiratory infections (AURI)” (i.e., J00-J06 block in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) with 28.05%. The average antibiotics amount over prescriptions with AURI decreased in 79 out of 81 provinces, and overall rate of decrease in average antibiotics amount was 8.33%, where 28 and 53 provinces experienced decreases (range is between 28.63% and −3.05%) above and below this value, respectively. In the most successful province, the highest decrease in average amount of “other beta-lactam antibacterials” per prescription for AURI was 49.63% in January. Computational analyses on a big data set collected from a nationwide healthcare system brought a significant contribution in improving ASPs.
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Affiliation(s)
- Mehmet Gönen
- Department of Industrial Engineering, College of Engineering, Koç University, İstanbul, Turkey. .,School of Medicine, Koç University, İstanbul, Turkey.
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency (TMMDA) of Ministry of Health, Ankara, Turkey
| | - Fatma İşli
- Turkish Medicines and Medical Devices Agency (TMMDA) of Ministry of Health, Ankara, Turkey
| | - Umut Emre Gürpınar
- Turkish Medicines and Medical Devices Agency (TMMDA) of Ministry of Health, Ankara, Turkey
| | - Pınar Göbel
- Turkish Medicines and Medical Devices Agency (TMMDA) of Ministry of Health, Ankara, Turkey
| | - Hakkı Gürsöz
- Turkish Medicines and Medical Devices Agency (TMMDA) of Ministry of Health, Ankara, Turkey
| | - Önder Ergönül
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, İstanbul, Turkey
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17
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Esen FH, Secilmis Y, Dogan M, Tubas F, Esen A, Bayram A, Gökahmetoglu S, Ozturk MA. Influenza A as a Common Viral Cause of Complex Febrile Seizures. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1731408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Objective The most common childhood convulsive disorder happens to be febrile seizure (FS), which is an important health problem leading to economic burden and parental anxiety. Further investigation into the etiological causes of FS will guide us for appropriate measures during the follow-up period. The aim of study was to identify the percentage of viral and bacterial pathogens in the etiological causes of children with FS, and also if there is any difference between simple and complex FSs.
Methods This prospective study randomly enrolled 100 pediatric patients with FS between January 2017 and July 2017. Nasopharyngeal swabs were obtained from all children at presentation. The respiratory panel was performed with a multiplex real-time polymerase chain reaction method to detect the 21 most common viruses. A complete blood count, absolute neutrophil count, absolute lymphocyte count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, blood culture, throat culture, urine analyses, urinary culture, and stool tests analysis were performed in all the patients.
Results During the study period, at least one virus was detected in 87% of patients. Bacterial agents were detected in only 13% of patients. Coinfections of the viruses and bacterial pathogens were found in 24% of patients. The most frequently detected virus was influenza A (Inf A) (18%), followed by rhinovirus (12%). Coinfections of the viruses and bacterial pathogens, mixed viral infections, and Inf A were common in children who experienced complex FS. Inf A was detected in 16% of patients with simple FSs and 30% of patients with complex FSs and a significant difference between them (p < 0.01).
Conclusion The results of this study showed that respiratory viral and bacterial pathogens are important in the etiology of FS in children. It is considered that complex FSs may be triggered by Inf A. The fact is viral pathogens are very common; therefore, antibiotics must be carefully prescribed. These results also draw attention to the use of the quadrivalent influenza vaccine in the prevention of FS related to the flu.
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Affiliation(s)
| | - Yılmaz Secilmis
- Department of Pediatric Emergency, Erciyes University, Kayseri, Turkey
| | - Murat Dogan
- Department of Pediatric Emergency, City Hospital, Kayseri, Turkey
| | - Filiz Tubas
- Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Aydın Esen
- Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Ayse Bayram
- Department of Pediatric Neurology, Kayseri City Hospital, Kayseri, Turkey
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18
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Bostan H, Sencar ME, Calapkulu M, Hepsen S, Duger H, Ozturk Unsal I, Ozbek M, Cakal E. Two Important Issues in Subacute Thyroiditis Management: Delayed Diagnosis and Inappropriate Use of Antibiotics. Eur Thyroid J 2021; 10:323-329. [PMID: 34395304 PMCID: PMC8314756 DOI: 10.1159/000513745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subacute thyroiditis (SAT) is a rare inflammatory disease of the thyroid gland. It has been noticed that patients with a diagnosis of SAT visit more other clinics and receive antibiotics unnecessarily. Therefore, the aim of this study was to reveal the degree of delay in the diagnosis of SAT, prediagnosis antibiotic use rates, and the awareness of clinics for the diagnosis of SAT. METHODS A total of 121 patients with SAT were enrolled in the study. A retrospective analysis was made of the history of patient symptoms during the diagnosis, which physicians they visited, antibiotic use, laboratory test results, and ultrasonographic findings. RESULTS The median age of the patients was 41 years. Neck pain radiating to the jaw/ear was seen in most patients (71.1%). The median time from symptom onset to a diagnosis of SAT was 23 days (range, 6-70 days). Antibiotics were erroneously prescribed to 71 patients (58.7%) before the diagnosis. The median time to diagnosis was 28 days in patients using antibiotics and 20 days in the group not using antibiotics (p < 0.001). Two or more physicians had been visited before SAT diagnosis by 89 (73.6%) patients, and more antibiotics were prescribed to these patients than the group who visited fewer physicians (p < 0.05). The frequency of prescribing antibiotics by physicians was 73.7% by emergency physicians, 53.1% by family doctors, 51.1% by ENT specialists, and 35.4% by internal medicine specialists. CONCLUSION The diagnosis of SAT is often delayed, and misdiagnosis leads to erroneous antibiotic overuse. Physicians should increase their awareness of the diagnosis of SAT in patients with neck pain.
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Affiliation(s)
- Hayri Bostan
- *Hayri Bostan, Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, Altındağ/Ankara 06110 (Turkey),
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19
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Antimicrobial usage and the pediatrics population: a need for the implementation of antimicrobial stewardship programs in Turkey. Turk Arch Pediatr 2021; 56:92-93. [PMID: 34013240 DOI: 10.14744/turkpediatriars.2020.34341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 11/20/2022]
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20
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Akdemir Kalkan İ, Çınar G, Pehlivanlı A, Ürkmez F, Topaloğlu İE, Akyol B, Onay Beşikçi A, Azap A, Memikoğlu KO. Pattern of systemic antibiotic use and potential drug interactions: Evaluations through a point prevalence study in Ankara University Hospitals. Turk J Med Sci 2021; 51:523-529. [PMID: 32927931 PMCID: PMC8203144 DOI: 10.3906/sag-2004-164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/08/2020] [Indexed: 01/01/2023] Open
Abstract
Background/aim Most of the hospitalized patients are on a number of drugs for comorbidities and/or to prevent nosocomial infections. This necessitates a careful consideration of drug interactions not only to avoid possible toxicities but also to reach the highest efficiency with drug treatment. We aimed to investigate drug interactions related to systemic antibiotic use and compare three different databases to check for drug interactions while characterizing the main differences between medical and surgical departments. Materials and methods This point prevalence study covered data on 927 orders for patients hospitalized between June 3 and 10, 2018 in Ankara University Hospitals. Systemic antibiotic use and related drug interactions were documented using UptoDate, Drugs, and Medscape and comparisons between the departments of medical and surgical sciences were made. Results The number of orders, or the number of drugs or antibiotics per order were not different between the medical and surgical sciences departments. A total of 1335 antibiotic-related drug interactions of all levels were reported by one, two, or all three databases. UptoDate reported all common and major interactions. Pantoprazole was the most commonly prescribed drug and appeared in 63% of all orders. Among 75 different molecules, ceftriaxone and meropenem were the two most prescribed antibiotics by the surgical and medical departments, respectively. Conclusion A dramatic variance existed amongst antibiotics prescribed by different departments. This indicated the requirement for a centralized role of an infectious diseases specialist. Especially for the hospitalized patient, prophylactic coverage with at least one antibiotic brought about a number of drug interactions. A precise evaluation of orders in terms of drug interactions by a clinical pharmacist (currently none on duty) will reduce possible drug-related hazards.
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Affiliation(s)
- İrem Akdemir Kalkan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aysel Pehlivanlı
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Fatih Ürkmez
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - İzel Ezgi Topaloğlu
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Büşra Akyol
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Arzu Onay Beşikçi
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Kemal Osman Memikoğlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
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21
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Khan Z, Karataş Y, Rahman H. Antimicrobial Practices and Geriatrics: Need for Periodic Surveillance Studies in Turkey. Asia Pac J Public Health 2021; 33:999-1000. [PMID: 33829874 DOI: 10.1177/10105395211007643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zakir Khan
- Department of Pharmacology, Faculty of Medicines, Cukurova University, Saricam, Adana, Turkey.,Department of pharmacy practice, faculty of bilogical sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Yusuf Karataş
- Department of Pharmacology, Faculty of Medicines, Cukurova University, Saricam, Adana, Turkey.,Pharmacovigilance specialist, Balcali hospital, Faculty of Medicines, Cukurova University, Saricam, Adana, Turkey
| | - Hazir Rahman
- Department of Microbiology, Faculty of Chemical and Life Sciences, Abdul Wali Khan University Mardan (AWKUM), Mardan, KPK, Pakistan
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22
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Selcuk A. The point prevalence and inappropriateness of antibiotic use at hospitals in Turkey: a systematic review and meta-analysis. J Chemother 2021; 33:390-399. [PMID: 33618610 DOI: 10.1080/1120009x.2021.1888031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Inappropriate antimicrobial use is a key problem causing antimicrobial resistance and increased health care costs. Although global point prevalence surveys on antimicrobial prescribing in hospitals were described, there is lack of data from Turkish hospitals. Here, we aimed to perform systematic review and meta-analysis for the point prevalence surveys on antimicrobial prescribing in Turkish hospitals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline was used to identify studies for the review. Articles published between January 2004 and September 2020 by Turkish investigators were included if they used the point prevalence survey method. The Joanna Briggs Institute's critical appraisal tool and the World Health Organization's point prevalence survey tool were used to the evaluate studies. Results were combined using random effects meta-analysis. The pooled point prevalence of antimicrobial use in Turkish hospitals was 48% (95% confidence interval 43-54). There was considerable heterogeneity in prevalence among the studies (I2= 98.75 %, 95 % CI 98.49-98-97). The most commonly prescribed antimicrobial and indication for antimicrobial use were third generation cephalosporins (36%) and respiratory tract infections (88%), respectively. More than two thirds of the antimicrobials were prescribed empirically (median: 71% [interquartile range: 56-80]) in hospitals. The point prevalence and inappropriateness of antimicrobial use are high in Turkish hospitals. Turkey is one of the biggest consumers of antimicrobials. There is an urgent need for antimicrobial stewardship programmes at Turkish hospitals to improve antimicrobial prescribing. Our study findings can contribute to improving antimicrobial prescribing, and thereby control antimicrobial resistance.
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Affiliation(s)
- Aysu Selcuk
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ankara University, Yenimahalle, Ankara, Turkey
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23
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Aydın M, Azak E, Bilgin H, Menekse S, Asan A, Mert HTE, Yulugkural Z, Altunal LN, Hatipoğlu ÇA, Tuncer Ertem G, Altunok ES, Demirkaya MH, Çeviker SA, Akgul F, Memis Z, Konya P, Azap A, Aydin G, Korkmaz D, Karakoç ZÇ, Yapar D, Karakecili F, Gunal O, Keske S, Kapmaz M, Kader C, Demirel A, Ergönül Ö. Changes in antimicrobial resistance and outcomes of health care-associated infections. Eur J Clin Microbiol Infect Dis 2021; 40:1737-1742. [PMID: 33586014 DOI: 10.1007/s10096-020-04140-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.
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Affiliation(s)
- Mehtap Aydın
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Research and Training Hospital University of Health Science, Elmalıkent, Adem Yavuz Cd., 34764, Ümraniye/İstanbul, Turkey.
| | - Emel Azak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Hüseyin Bilgin
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Marmara University, Istanbul, Turkey
| | - Sirin Menekse
- Department of Infectious Diseases and Clinical Microbiology, Kartal Koşuyolu Research and Training Hospital, Istanbul, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Bursa, Turkey
| | - Habibe Tülin Elmaslar Mert
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trakya University, Edirne, Turkey
| | - Zerrin Yulugkural
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trakya University, Edirne, Turkey
| | - Lutfiye Nilsun Altunal
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Research and Training Hospital University of Health Science, Elmalıkent, Adem Yavuz Cd., 34764, Ümraniye/İstanbul, Turkey
| | - Çiğdem Ataman Hatipoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Ankara Research and Training Hospital, Ankara, Turkey
| | - Gunay Tuncer Ertem
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Ankara Research and Training Hospital, Ankara, Turkey
| | - Elif Sargın Altunok
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa Research and Training Hospital, Istanbul, Turkey
| | - Melike Hamiyet Demirkaya
- Department of Infectious Diseases and Clinical Microbiology, Baskent University School of Medicine, Ankara, Turkey
| | - Sevil Alkan Çeviker
- University of Health Science Kütahya Evliya Çelebi Research and Training Hospital, Kütahya, Turkey
| | - Fethiye Akgul
- Department of Infectious Diseases and Clinical Microbiology, Batman State Hospital, Batman, Turkey
| | - Zeynep Memis
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Petek Konya
- Department of Infectious Diseases and Clinical Microbiology, Afyonkarahisar University of Health Science, Afyon, Turkey
| | - Alpay Azap
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara University, Ankara, Turkey
| | - Gule Aydin
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara University, Ankara, Turkey
| | - Derya Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Afyonkarahisar State Hospital, Afyon, Turkey
| | - Zehra Çagla Karakoç
- Department of Infectious Diseases and Clinical Microbiology, Istinye University, Istanbul, Turkey
| | - Derya Yapar
- Department of Infectious Diseases and Clinical Microbiology School of Medicine, Hitit University, Corum, Turkey
| | - Faruk Karakecili
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ozgur Gunal
- University of Health Science Samsun Research and Training Hospital, Samsun, Turkey
| | - Siran Keske
- School of Medicine Department of Infectious Diseases and Clinical Microbiology, Koc University, Istanbul, Turkey
| | - Mahir Kapmaz
- School of Medicine Department of Infectious Diseases and Clinical Microbiology, Koc University, Istanbul, Turkey
| | - Cigdem Kader
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bozok University, Yozgat, Turkey
| | - Aslıhan Demirel
- Department of Infectious Diseases and Clinical Microbiology, Florans Nightingale Hospital, Istanbul, Turkey
| | - Önder Ergönül
- School of Medicine Department of Infectious Diseases and Clinical Microbiology, Koc University, Istanbul, Turkey
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Antibiotic consumption in the hospital during COVID-19 pandemic, distribution of bacterial agents and antimicrobial resistance: A single-center study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.834535] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ozdemirel HO, Ulusal D, Kucukyildirim Celik S. Streptomycin and nalidixic acid elevate the spontaneous genome-wide mutation rate in Escherichia coli. Genetica 2021; 149:73-80. [PMID: 33502702 DOI: 10.1007/s10709-021-00114-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/13/2021] [Indexed: 11/27/2022]
Abstract
Since antibiotic resistance is a growing public health problem worldwide, it is important to understand how antibiotics and spontaneous mutations cooperate and shape the genome-wide mutation rate and spectrum. Here, we quantitatively evaluate genome-wide mutational profiles of Escherichia coli after long-term subinhibitory exposure to a broad-spectrum (streptomycin) and a narrow-spectrum antibiotic (nalidixic acid), using a mutation accumulation design combined with whole-genome resequencing of replicate lines as a mutagenicity test. We determined that, while the genome-wide mutation rate is slightly higher in the streptomycin-treated lines compared to the control lines, there is a significant increase in the nalidixic acid-treated lines. Our findings suggest that both broad and narrow-spectrum antibiotics may elevate the mutation rates in E. coli, but mechanisms of action may affect the consequence, thus contribute to accelerating the rate of adaptation and conferring antibiotic resistance.
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Affiliation(s)
| | - Dilara Ulusal
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
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BAYRAM D, VIZDIKLAR C, AYDIN V, İŞLİ F, AKICI A. Birinci basamakta reçeteleme trendi ve sık karşılaşılan tanılara ait reçetelerin incelenmesi: Türkiye verisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.681368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Bilgiç Ç, Keske Ş, Sobutay E, Can U, Zenger S, Gürbüz B, Ergönül Ö, Bilge O. Surgical site infections after pancreaticoduodenectomy: Preoperative biliary system interventions and antimicrobial prophylaxis. Int J Infect Dis 2020; 95:148-152. [PMID: 32278107 DOI: 10.1016/j.ijid.2020.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The rate of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is high and insertion of preoperative bile duct catheterization (PBDC) predispose a high risk of SSI with multidrug resistant (MDR) microorganisms. AIM To describe the effects of PBDC and the prophylaxis in development of SSI. METHODS We conducted a retrospective study between January 01, 2010 and December 2018 including the patients with PD and total pancreatectomy. FINDINGS In total 214 consecutive patients were included. The PBDC was inserted to 63 (29%) patients. The rate of intraoperative bile fluid culture positivity was higher among the patients with PBDC (84% vs. 17% respectively, p<0.001). The SSI was detected in 52 patients (24%). In multivariate analysis, the rate of SSI was found to be higher among the patients with PBDC (OR: 2.33, 95% Cl: 1.14-4.76, p=0.02). As the etiologic agents of SSI, Pseudomonas spp. and MDR pathogens were mainly detected in PBDC group. The resistance to ampicillin-sulbactam was significantly higher in the PBDC group (87.5% vs. 25%, p=0.012). The similar bacterial species both in bile fluid and the surgical site were detected in 11 (21%) patients with SSI. Among 8 patients (15%), antimicrobial susceptibility was the same. Only in five out of 52 (10%) patients, the SSI pathogens was susceptible to the agent that was used for surgical prophylaxis. CONCLUSION Unnecessary catheterizations should be avoided. By considering the increasing prevalence of resistant bacteria as the cause of SSI, the clinicians should closely follow-up their patients for choosing the proper antimicrobials.
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Affiliation(s)
- Çağrı Bilgiç
- American Hospital, General Surgery, Istanbul, Turkey
| | - Şiran Keske
- American Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Erman Sobutay
- American Hospital, General Surgery, Istanbul, Turkey
| | - Uğur Can
- American Hospital, General Surgery, Istanbul, Turkey
| | - Serkan Zenger
- American Hospital, General Surgery, Istanbul, Turkey
| | - Bülent Gürbüz
- American Hospital, General Surgery, Istanbul, Turkey
| | - Önder Ergönül
- Koç University, School of Medicine, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
| | - Orhan Bilge
- Koç University, School of Medicine, General Surgery, Istanbul, Turkey
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Bilici K, Atac N, Muti A, Baylam I, Dogan O, Sennaroglu A, Can F, Yagci Acar H. Broad spectrum antibacterial photodynamic and photothermal therapy achieved with indocyanine green loaded SPIONs under near infrared irradiation. Biomater Sci 2020; 8:4616-4625. [DOI: 10.1039/d0bm00821d] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Antimicrobial photodynamic therapy (aPDT) and antimicrobial photothermal therapy (aPTT) are promising local and effective alternative therapies for antibiotic resistant bacterial infections and biofilms.
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Affiliation(s)
- K. Bilici
- Koc University
- Department of Chemistry
- Istanbul
- Turkey
| | - N. Atac
- Koç University School of Medicine
- Department of Infectious Diseases and Clinical Microbiology
- Istanbul
- Turkey
| | - A. Muti
- Koc University
- Departments of Physics and Electrical-Electronics Engineering
- Istanbul
- Turkey
| | | | - O. Dogan
- Koç University School of Medicine
- Department of Infectious Diseases and Clinical Microbiology
- Istanbul
- Turkey
| | - A. Sennaroglu
- Koc University
- Departments of Physics and Electrical-Electronics Engineering
- Istanbul
- Turkey
- Koc University
| | - F. Can
- Koç University School of Medicine
- Department of Infectious Diseases and Clinical Microbiology
- Istanbul
- Turkey
| | - H. Yagci Acar
- Koc University
- Department of Chemistry
- Istanbul
- Turkey
- Koc University
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29
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Menekşe Ş, Çağ Y, Işık ME, Şahin S, Hacıseyitoğlu D, Can F, Ergonul O. The effect of colistin resistance and other predictors on fatality among patients with bloodstream infections due to Klebsiella pneumoniae in an OXA-48 dominant region. Int J Infect Dis 2019; 86:208-211. [PMID: 31402295 DOI: 10.1016/j.ijid.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/14/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the effect of colistin resistance and other predictors on fatality among patients with Klebsiella pneumoniae bloodstream infections (Kp-BSI) and to describe the effect of amikacin and tigecycline on the outcome in an OXA-48 dominant country. METHOD This was a retrospective study performed among patients >16 years of age in a tertiary hospital with 465 beds. All cases had ≥1 positive blood culture for K. pneumoniae 48 h after admission. RESULTS Among 210 patients with Kp-BSI, the 30-day mortality rate after isolation of the microorganism was 58%. The rate of carbapenem resistance was higher (64% vs. 38%, p < 0.001) and the colistin minimum inhibitory concentration (MIC) was elevated (7 vs. 4, p < 0.029) among the patients who died. Among the colistin-resistant K. pneumoniae, the rates of OXA-48, ST101, and NDM-1 were 78%, 67%, and 35%, respectively. Amikacin was added to the treatment of 13 patients with carbapenem and colistin-resistant Kp-BSI and 77% survived (p < 0.001). Tigecycline was added to the treatment of 24 patients with carbapenem and colistin-resistant Kp-BSI, and the 30-day mortality rate was 71% (p = 0.576). In the multivariate analysis, carbapenem resistance (odds ratio (OR) 5.2, 95% confidence interval (CI) 2.47-10.9, p < 0.001) and increasing APACHE II score (OR 1.19, 95% CI 1.12-1.26, p < 0.001) were significantly associated with 30-day mortality. The addition of amikacin to the treatment regimen (OR 0.05, 95% CI 0.01-0.23, p < 0.001) was significantly beneficial. CONCLUSIONS Carbapenem resistance, increasing MIC of colistin, and the lungs as the source of the infection were significantly associated with 30-day mortality. The empirical use of combined active aminoglycosides was found to be beneficial in the treatment of colistin-resistant K. pneumoniae infections.
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Affiliation(s)
- Şirin Menekşe
- Infectious Diseases and Clinical Microbiology Department, Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey.
| | - Yasemin Çağ
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Mehmet Emirhan Işık
- Infectious Diseases and Clinical Microbiology Department, Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey
| | - Suzan Şahin
- Infectious Diseases and Clinical Microbiology Department, Lütfü Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Demet Hacıseyitoğlu
- Clinical Microbiology Department, Lütfü Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Fusun Can
- Infectious Diseases and Clinical Microbiology Department, Koç University School of Medicine, Istanbul, Turkey
| | - Onder Ergonul
- Infectious Diseases and Clinical Microbiology Department, Koç University School of Medicine, Istanbul, Turkey
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Ergönül Ö, Tülek N, Kayı I, Irmak H, Erdem O, Dara M. Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees. Clin Microbiol Infect 2019; 26:307-312. [PMID: 31284037 PMCID: PMC7129060 DOI: 10.1016/j.cmi.2019.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
Background Since 2011, the conflict in Syria has led to over five million refugees. Turkey hosts the highest number of Syrian refugees in the world. By February 2019 over 3.6 million people had fled to Turkey to seek safety. Only 6.1% of Syrian refugees live in temporary shelters. Owing to the disrupted healthcare services, many children coming from the conflict zones are less likely to have received vaccination. In temporary shelters immunization coverage is >95% and the refugee population is receptive to vaccination. Aims The objective of this study was to review the infectious diseases situation among Syrian refugees in Turkey. Sources We have reviewed the reports and studies provided by the governmental and non-governmental organizations and obtained more detailed data from the Ministry of Health in Turkey. Content Between 2012 and 2016, 1 299 209 cases of respiratory tract infection and 158 058 episodes of diarrhoea with 59 bloody diarrhoeas were reported; 1354 hepatitis A cases and 108 active tuberculosis cases were detected and treated in the temporary shelters for Syrian refugees. Overall in Turkey, 7794 cutaneous leishmaniasis have been reported. Implications Since the influx of Syrian refugees, there has been an increase in cases of leishmaniasis and measles. No significant increase was detected for tuberculosis, other vector-borne infections, and healthcare associated or sexually transmitted infections. The Syrian refugees can be considered as a vulnerable group in Turkey due to their living and working conditions. Based on available data and our detailed analysis, the numbers show a stable situation regarding infectious diseases.
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Affiliation(s)
- Ö Ergönül
- Koç University, School of Medicine, Infectious Diseases Department, Istanbul, Turkey.
| | - N Tülek
- Atılım University, Faculty of Medicine, Ankara, Turkey
| | - I Kayı
- Koç University, School of Medicine, Department of Public Health, Istanbul, Turkey
| | - H Irmak
- Ministry of Health, Public Health Institute, Ankara, Turkey
| | - O Erdem
- Ministry of Health, Public Health Institute, Ankara, Turkey
| | - M Dara
- Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
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Effectiveness of clinical pathway for upper respiratory tract infections in emergency department. Int J Infect Dis 2019; 83:154-159. [PMID: 31051280 DOI: 10.1016/j.ijid.2019.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE We aimed to demonstrate the benefits of implementing a clinical pathway to decrease the inappropriate use of antibiotics in upper respiratory tract infections (URTI) in an emergency department (ED). METHODS The study was performed in a hospital with 300 beds. All patients who applied with URTI from 1st to 30th of April 2017 were included and the appropriateness of the antibiotics were compared with the patients in the same period in 2016. A checklist for the clinical pathway of URTI was completed by the ED physicians. RESULTS 351 patients were included, 176 these patients were in pre-ASP period and 175 patients were in post-ASP period. The rate of prescriptions including antibiotics was 49% in pre-ASP period and has decreased to 29% in post-ASP period (p < 0.001). Adherence to clinical pathway has increased from 50% to 80% (p < 0.001). In the post-ASP period, clinical pathway was used in 133 out of 175 patients (76%) and the consequently rate of appropriate antibiotic use was 82%. CONCLUSION The implementation of clinical pathway for URTI has decreased inappropriate antibiotic use in ED. As the secondary effect, using clinical pathway in ED also has increased the awareness of ED physicians who did not adhere to clinical pathway.
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