Browsing by Author "Erdogan, Haluk"

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Acute Respiratory Distress Syndrome Associated with Legionnaires' Disease: Two Case Reports
(2018) Erdogan, Haluk; Arslan, Hande; 0000-0002-9033-4236; 0000-0002-5708-7915; O-2247-2015; ABG-7034-2021
Introduction: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of illness, bilateral chest radiographic infiltrates consistent with pulmonary edema, and poor systemic oxygenation. ARDS has severe morbidity and mortality. The most common risk factor for the development of community-acquired ARDS is severe sepsis with a pulmonary source of infection. The first step in the therapy of ARDS is identification and treatment of the underlying disease. Here, we report two cases of ARDS associated with Legionnaires disease. Case 1: A 54-year-old male tourist with diabetes mellitus apply to our institution with diarrhea and high fever. At the time of admission, the patient had a temperature of 39.5 degrees C, a blood pressure of 140/70 mmHg, a heart rate of 102 beats/min and a respiratory rate of 24 breaths/min. His oxygen saturation was 93% while breathing room air. Chest examination revealed rales and the chest x-ray showed right-lower zone infiltrates. Legionella urinary antigen was positive on admission day. Treatment with levofloxacin (1000 mg/day) was started in the first 4 hours of admission after taking cultures. The patient had progressive dyspnea and cyanosis was developed. Analysis of arterial blood gas revealed a pH of 7.29, CO2 pressure of 30 mmHg, O-2 pressure of 37 mmHg and oxygen saturation of 62%. Roentgenogram of the chest worsened and showed bilateral infiltration, indicating ARDS. Thirty-two hours after admission, the patient was admitted to intensive care unit for ventilator support. The patient's clinical status continued to deteriorate. He was hypotensive and required dopamine infusions for blood pressure support. Legionella pneumophila serogroup 1 was isolated on sputum culture. Five days after hospitalization, chlarithromycin (1000 mg/day) and ciprofloxacin (1200 mg/day) were substituted for the initial antibiotics. The patient had nosocomial pneumonia caused by methicilline resistant Staphylococcus aureus during subsequent days. Vancomycine 2 gr/days was added to treatment. Clinical status improved and the body temperature fell below 37.5 degrees C on the eleventh day. On the patient's relatives' request, he was flown back to his country by air ambulance. One year later, the patient came back again as a tourist and had fully recovered from the illness. Case 2: A 82-year-old female with diabetes mellitus applied to our institution with high fever, dyspnea and mental change. She had been treated for pulmonary edema without any response to this therapy in a private hospital. She had been hospitalized in another hospital due to gastrointestinal bleeding approximately two weeks prior to her application. Chest examination revealed diffuse rales and the chest x-ray showed bilateral infiltrates. Analysis of arterial blood gas revealed pH of 7.31, CO2 pressure of 41.7 mm Hg, O-2 pressure of 21.9 mmHg and oxygen saturation of 33.6%. The patient was admitted to intensive care unit for ventilator support. Legionella urinary antigen was positive on admission day. Treatment with ciprofloxacin (1200 mg/day) and chlarithromycin (1000 mg/day) was started on admission after taking cultures. Legionella pneumophila serogroup 1 was isolated on endotracheal aspirate culture. The patient died on the 7th day. Conclusions: The clinicians should be aware of Legionnaires disease in etiology of ARDS. Early diagnosis and treatment are important factors in determining prognosis.
Antimicrobial Resistance of Salmonella Isolates in A Holiday Center on the South of Turkey
(2016) Erdogan, Haluk; Erdogan, Askin; Arslan, Hande; 0000-0002-9033-4236; 0000-0002-5708-7915; O-2247-2015; AAD-5420-2020; ABG-7034-2021
Objective: Salmonella is an important pathogen that causes food-borne infection in children and adults worldwide. The aim of this study is to evaluate the antimicrobial activity of antimicrobial agents against Salmonella isolates in Alanya, an important holiday center in Turkey. Material and Method: The study was carried out at Baskent University Alanya Research and Teaching Hospital between January 2004 and September 2013. Salmonella spp. were isolated from stool samples and stored at -80 degrees C for antimicrobial susceptibility. Antimicrobial susceptibility was determined according to the Clinical and Laboratory Standards Institute (CLSI) criteria. The antimicrobial agents tested against Salmonella spp. included ampicillin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol, nalidixic acid, ciprofloxacine and ceftriaxone. Quality control was ensured by testing Escherichia coli ATCC 25922. Results: A total of 63 consecutive Salmonella spp. were assessed for their antimicrobial susceptibility patterns, 21 of which were obtained from travellers. Serogroup D1 was the most common serotype (65.1%), followed by B (22.2%), A (7.9%), C1 (1.6%) and C2-C3 (3.2%). The resistances against ampicillin, tetracycline, trimethoprim-sulfamethoxazole and chloramphenicol were found to be 15.9%, 15.9%, 14.3%, and 11.1%, respectively. None of the strains was resistant to ciprofloxacin and ceftriaxone, while 14.3% were nalidixic acid-resistant. Antimicrobial resistance rates of Salmonella isolates obtained from travellers and local residents were not significantly different (p>0.05). Conclusion: This study suggests that ciprofloxacin and ceftriaxone can be used as empirical therapies in patients who are suspected to have salmonellosis with predisposing factors to severe infection and a history of travel to Alanya, Turkey. However, the nalidixic acid resistance of Salmonella isolates may be a cause for concern.
Colonization of Legionella Species in Turkish Baths in Hotels in Alanya, Turkey
(2015) Erdogan, Haluk; Arslan, Hande; 0000-0002-5708-7915; 0000-0002-9033-4236; 25850992; ABG-7034-2021; O-2247-2015
This study evaluated the prevalence of Legionella species in water samples collected from Turkish baths in hotels in Alanya, Turkey, from August 2003 to September 2013. Water samples were collected in 100-mL sterile containers and then concentrated by filtration. Heat treatment was used to eliminate other microorganisms from the samples, which were then spread on Legionella-selective-buffered charcoal yeast extract alpha (BCYE-alpha) agar and on BCYE-alpha agar supplemented with glycine, vancomycin, polymyxin, and cycloheximide. Cysteine-dependent colonies were identified by latex agglutination. In total, 135 samples from 52 hotels with Turkish baths were evaluated. Legionella species were identified in 11/52 (21.2 %) hotels and 18/135 (13.3%) samples. The most frequently isolated species was Legionella pneumophila, with most isolates belonging to serogroups 6 (55.6 %) and 1 (22.2 %). The colony count was <100 colony-forming units (CFU) mL(-1) in nine samples, from 100 to 1000 CFU mL(-1) in six samples, and >1000 CFU mL(-1) in three samples. These findings suggest that the hot water systems of Turkish baths in hotels must be viewed as a possible source of travel-associated Legionnaires' disease, and preventative measures should be put in place.
Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome
(2018) Erdogan, Haluk; Cag, Yasemin; Karabay, Oguz; Sipahi, Oguz Resat; Aksoy, Firdevs; Durmus, Gul; Batirel, Ayse; Ak, Oznur; Kocak-Tufan, Zeliha; Atilla, Aynur; Piskin, Nihal; Akbas, Turkay; Erol, Serpil; Ozturk-Engin, Derya; Caskurlu, Hulya; Onal, Ugur; Demirel, Aslihan; Dogru, Arzu; Harman, Rezan; Hamidi, Aziz Ahmad; Karasu, Derya; Korkmaz, Fatime; Korkmaz, Pinar; Eser, Fatma Civelek; Onem, Yalcin; Cesur, Sinem; Salmanogiu, Musa; Erdem, Ilknur; Diktas, Husrev; Vahabaroglu, Haluk; 30256855
Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.
Domestically Acquired Legionnaires' Disease: Two Case Reports and a Review of the Pertinent Literature
(2016) Erdogan, Haluk; Arslan, Hande; 27308081
Background: Legionella species may colonize in home water systems and cause Legionnaires' disease (LD). We herein report two cases of sporadic LD associated with the solar energy-heated hot water systems of the patients' houses. Case Report: A 60-year-old woman with chronic bronchitis and diabetes mellitus presented with a high fever, abdominal pain, and diarrhea. Physical examination revealed rales, and her chest radiograph showed a homogeneous density in the left lung. The Legionella urinary antigen test was positive, and an indirect fluorescent antibody test revealed a serum antibody titer of 1/520 for L. pneumophila serogroup 1. In the second case, a 66-year-old man with diabetes mellitus was treated for pneumonia at another hospital. After the patient's general condition worsened and he required mechanical ventilation, he was referred to our hospital. The Legionella urinary antigen test was positive. Neither of the patients had been hospitalized or travelled within the previous month. Both patients used hot water storage tanks heated by solar energy; both also used an electrical device in the bathroom to heat the water when solar energy alone was insufficient. The hot water samples from the residences of both patients were positive for L. pneumophila serogroup 1. Conclusion: These cases show that domestic hot water systems heated by solar energy must be considered a possible source of community-acquired LD.
Is Nurse Workforce Sufficient in Intensive Care Units in Turkey. Results of the Multicenter Karia Study
(2017) Erdogan, Haluk; 0000-0002-9033-4236; O-2247-2015
Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was <1 year, was; 19% in level 1 ICUs, 25% in level 2 ICUs and 24% in level 3 ICUs. The number of patients per nurse was mostly <5 in level 1 ICUs whereas the number of patients per nurse in level 3 ICUs was generally >2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was <0.0001 at all time points except summer weekend night shift (p=0.002). Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing.
Legionnaires' disease
(2018) Erdogan, Haluk; 0000-0002-9033-4236; O-2247-2015
Legionnaires disease is a severe from of pneumonia caused by Legionella species which arc ubiquitious in both natural and man-made environments. It has high morbidity and case fetality rates. The disease is acquired by aspiration of water or inhalation of aerosols containing the bactena from environmental sources. Early diagnosis and appropriate treatment are important factors in determining prognosis. Clinical and laboratory predictors will not reliably identify cases of legionnaires disease, therefore the diagnosis of Legionnaires' disease requires specific diagnostic tests. The diagnosis of Legionnaires' disease is made by culture, Legionella urinary antigenaria, polymeras ion, or serologic analyses. Isolation of Legionella from clinical samples is the gold standart for diagnosing Legioimaire's disease. Legionella urinary antigen tests are easy and useful for early diagnosis of Legionnaires' disease. Flouroquinolones, macrolides and doxycicline are drugs of choice. Legionnaires' disease is considered a preventable illness since it is possible to control and remove the bacteria in reserviors. In Turkey, travel-associated Legionnaires' disease has a specific surveillance programe since 1996. After the year of 2015, it became mandatory to take environmental cultures for Legionella from the hospital water systems. The aim of this review is to raise awereness for legionollosis and to summarize the current literature.
A Patient with Suspected Myocarditis Associated with Legionnaires' Disease: A Case Report and Review of the Literature
(2017) Erdogan, Haluk; Eldem, Halil Olcay; 0000-0002-9033-4236; O-2247-2015; AAE-6201-2021
Legionnaires' disease (LD) is a systemic infectious disease caused by Legionella species. It mainly presents with lung involvement. Herein, we present a case with suspected myocarditis associated with LD and review of the relevant literature. An 81-year-old male tourist patient with high fever, cough, imbalance while walking, and confusion presented to the emergency department. The patient was diagnosed with LD based on increased density in the left lower zone on chest x-ray and a positive Legionella urine antigen test. He was administered a combination of claritromycin and levofloxacine on the day of admission. The diagnosis of acute myocarditis was made after worsening of the cardiac functions, ST elevation and troponin I positivity. The patient's symptoms regressed with antibiotic therapy and the patient was transferred to his home country by ambulance plane ten days after admission. A search of PubMed and Web of Science using the keywords "Legionella and myocarditis" revealed 15 case reports, nine of which were in English and were reviewed. There were three female and six male patients with a mean age of 44 years (range: 32-56 years). Seven were diagnosed with LD by urine antigen testing, one by serological testing and culture, and one by direct fluorescent-antibody staining and culture. Myocarditis was diagnosed by biopsy in two patients and by clinical and laboratory findings in the rest. Myocarditis without existing pneumonia was detected in one case. Electrocardiography abnormalities such as atrial flutter, atrioventricular block, torsade de pointes, sinus tachycardia, QT prolongation, ST elevation, and T wave inversion were detected in seven patients. Ventricle dysfunction on echocardiography and cardiac marker abnormality were detected in all but one of the patients (not tested in one patient). Antimicrobial monotherapy was chosen for three of the cases. One patient died due to myocarditis. In conclusion, myocarditis may develop rarely during the course of LD. Clinical suspicion is essential for the diagnosis. Early diagnosis and appropriate treatment may be life-saving.
West Nile Virus Encephalitis in Alanya, Turkey: A Case Report
(2015) Erdogan, Haluk
West Nile virus (WNV) serologic evidence has been well demonstrated throughout Turkey. A 43-year-old male patient who presented to emergency service with high fever, rash, muscle weakness, altered mental status and was diagnosed as WNV encephalitis is reported. The patient survived after supportive treatment. This case shows that WNV encephalitis should be considered in the differential diagnosis of patients with aseptic meningitis or encephalitis of unknown etiology especially in summer and early fall in Turkey.