Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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-2247-2015This 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.Item 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-7034-2021Introduction: 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.Item 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-7034-2021Objective: 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.Item West Nile Virus Encephalitis in Alanya, Turkey: A Case Report(2015) Erdogan, HalukWest 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.Item Domestically Acquired Legionnaires' Disease: Two Case Reports and a Review of the Pertinent Literature(2016) Erdogan, Haluk; Arslan, Hande; 27308081Background: 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.Item Is Nurse Workforce Sufficient in Intensive Care Units in Turkey. Results of the Multicenter Karia Study(2017) Erdogan, Haluk; 0000-0002-9033-4236; O-2247-2015Introduction: 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.Item 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; 30256855Sepsis 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.