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Erdem H, Ak O, Elaldi N, Demirdal T, Hargreaves S, Nemli SA, Cag Y, Ulug M, Naz H, Gunal O, Sirmatel F, Sipahi OR, Alpat SN, Ertem-Tuncer G, Sozen H, Evlice O, Meric-Koc M, Dogru A, Koksaldi-Motor V, Tekin R, Ozdemir D, Ozturk-Engin D, Savasci U, Karagoz E, Cekli Y, Inan A. Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study. Eur J Clin Microbiol Infect Dis 2016; 35:903-10. [PMID: 26964538 PMCID: PMC7087946 DOI: 10.1007/s10096-016-2614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
Mass gatherings pooling people from different parts of the world—the largest of which is to Mecca, Saudi Arabia, for Hajj—may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3–7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - O Ak
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - T Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK
| | - S A Nemli
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Y Cag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - M Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - H Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - O Gunal
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - F Sirmatel
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Bolu, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - S N Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - G Ertem-Tuncer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - H Sozen
- Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - O Evlice
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - M Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - A Dogru
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - V Koksaldi-Motor
- Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - D Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Konuralp, Duzce, Turkey
| | - D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - U Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - E Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Military Hospital, Van, Turkey
| | - Y Cekli
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Saltoglu N, Yemisen M, Ergonul O, Kadanali A, Karagoz G, Batirel A, Ak O, Eraksoy H, Cagatay A, Vatan A, Sengoz G, Pehlivanoglu F, Aslan T, Akkoyunlu Y, Engin D, Ceran N, Erturk B, Mulazimoglu L, Oncul O, Ay H, Sargin F, Ozgunes N, Simsek F, Yildirmak T, Tuna N, Karabay O, Yasar K, Uzun N, Kucukardali Y, Sonmezoglu M, Yilmaz F, Tozalgan U, Ozer S, Ozyazar M. Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey. Clin Microbiol Infect 2015; 21:659-64. [PMID: 25861844 DOI: 10.1016/j.cmi.2015.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 03/08/2015] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
Abstract
We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum β-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.
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Affiliation(s)
- N Saltoglu
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
| | - M Yemisen
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O Ergonul
- Koc University, School of Medicine, Infectious Diseases, Istanbul, Turkey
| | - A Kadanali
- Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - G Karagoz
- Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A Batirel
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O Ak
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Eraksoy
- Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A Cagatay
- Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A Vatan
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - G Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Pehlivanoglu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Aslan
- Bezmialem University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Y Akkoyunlu
- Bezmialem University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - D Engin
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Ceran
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Erturk
- Marmara University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - L Mulazimoglu
- Marmara University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O Oncul
- Gulhane Military Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Ay
- Gulhane Military Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Sargin
- Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Ozgunes
- Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Simsek
- Okmeydani Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Yildirmak
- Okmeydani Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Tuna
- Sakarya University Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - O Karabay
- Sakarya University Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - K Yasar
- Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Uzun
- Sisli Etfal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Y Kucukardali
- Yeditepe University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - M Sonmezoglu
- Yeditepe University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Yilmaz
- Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - U Tozalgan
- Samatya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S Ozer
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - M Ozyazar
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Erdem H, Elaldi N, Ak O, Gulsun S, Tekin R, Ulug M, Duygu F, Sunnetcioglu M, Tulek N, Guler S, Cag Y, Kaya S, Turker N, Parlak E, Demirdal T, Ataman Hatipoglu C, Avci A, Bulut C, Avci M, Pekok A, Savasci U, Kaya S, Sozen H, Tasbakan M, Guven T, Bolukcu S, Cesur S, Sahin-Horasan E, Kazak E, Denk A, Gonen I, Karagoz G, Haykir Solay A, Alici O, Kader C, Senturk G, Tosun S, Turan H, Baran A, Ozturk-Engin D, Bozkurt F, Deveci O, Inan A, Kadanali A, Sayar M, Cetin B, Yemisen M, Naz H, Gorenek L, Agalar C. Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect 2014; 20:O847-53. [DOI: 10.1111/1469-0691.12680] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 01/15/2023]
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Abstract
AIM Infectious complications after renal transplantation (RT) are associated with significant morbidity. They continue to be the most frequent cause of mortality. We investigated the incidence of infections, the causative pathogens, and risk factors contributing to this complication during the first year. PATIENTS AND METHODS We included demographic and clinical data of the 124 patients who underwent RT in our hospital from December 2004 to June 2010. for statistical analysis. RESULTS Fifty (40.3%) RT recipients developed 80 episodes of infection: urinary tract (n = 68; 85%), intraabdominal (n = 4; 5%), surgical wound (n = 3; 3.8%), or central venous catheter (n = 3; 4%). Eight (10%) were bacteremic. The most commonly isolated bacteria scene (76/80) was Escherichia coli (n = 43; 56.5%) followed by Klebsiella spp. (n = 10; 13.2%) and Pseudomonas spp. (n = 10; 13.2%). Cytomegalovirus infection was detected in 2 recipients; fungal and mycobacterial infections, in no case. It was noteworthy that 52.8% of E. coli and Klebsiella spp. produced extended-spectrum beta-lactamase. Ninety percent of infections developed within 6 months after transplantation. When we compared infected versus noninfected cases, the presence of a double J catheter was the most significant risk factor (P = .018; odds ratio [OR] = 0.234; 95% confidence interval [CI] = 0.070-0.781). In contrast to the initial years after the start of RT in our hospital the incidence of infection decreased over time together with a decrease number and durations of catheterization (P = .008; OR = 2.707; 95% CI = 1.292-5.672). CONCLUSIONS Urinary tract infections were the predominant problem with most isolates resistant to extended-spectrum antibiotics. Therefore, invasive catheters and prophylactic antibiotics should not be used for longer than necessary and infection control measures implemented to decrease the incidence of infections and bacterial resistance.
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Affiliation(s)
- O Ak
- Clinic of Infectious Diseases, Kartal Research and Education Hospital, Istanbul, Turkey
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Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, Turan H, Kazak E, Inan A, Duygu F, Demiraslan H, Kader C, Sener A, Dayan S, Deveci O, Tekin R, Saltoglu N, Aydın M, Horasan ES, Gul HC, Ceylan B, Kadanalı A, Karabay O, Karagoz G, Kayabas U, Turhan V, Engin D, Gulsun S, Elaldı N, Alabay S. Update on treatment options for spinal brucellosis. Clin Microbiol Infect 2013; 20:O75-82. [PMID: 24118178 DOI: 10.1111/1469-0691.12351] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/26/2013] [Accepted: 07/27/2013] [Indexed: 12/14/2022]
Abstract
We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.
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Affiliation(s)
- A Ulu-Kilic
- Department of Infectious Disease and Clinical Microbiology (IDCM), Erciyes University School of Medicine, Kayseri, Turkey
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Abstract
Parasitic infestations of the galdbladder and biliary tract are quite rare. Taenia saginata is an intestinal helmint and patients harbouring adult T.saginata tapeworms are mostly asymptomatic and discharge only fecal proglottids. In some cases there might be nonspecific symptoms like vomiting, nausea, epigastric pain, diarrhea and weight loss. Tenia saginata is a also rare cause of ileus, pancreatitis, cholecystitis and cholangitis. We report a case of acute cholangitis caused by T. saginata presenting with fever, nausea, vomiting, jaundice and right upper quadrant pain. Although parasites are not an uncommon cause of cholangitis especially in diseaseendemic areas like the Far East, this is not true for T. saginata causing acute cholangitis.
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Affiliation(s)
- O Uygur-Bayramiçli
- Department of Gastroenterology Maltepe Universit School of Medicine, Istanbul
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