An unusual presentation of hepatitis A virus infection: Guillain-Barré syndrome.
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Child, Preschool↗
Biomedical subjects
Serpil Erol
Publications and source records attributed to Serpil Erol.
The effect of a restriction policy on the antimicrobial consumption in Turkey: a country-wide study.
BACKGROUND: The total annual expenditure of antimicrobials in Turkey in 2002 was 24% of all drug spending. In order to reduce the cost of drug expenditure, the Turkish government introduced a new restriction policy on the prescription of antimicrobials in June 2003. This new policy is based on the justification that the physicians specializing in infectious diseases should be primarily responsible for the prescription of antimicrobials. OBJECTIVES: Compare and contrast the usage of antimicrobials at hospitals before and after the implementation of the new restriction policy. METHODS: The data was collected from the same departments in two different periods in 2003 at 15 hospitals throughout Turkey. The first set of data was collected a few days before the new policy was implemented in May 2003 and the second data set 6 months after that. Antimicrobial usage was calculated as defined daily doses (DDDs) per 100 patient days according to ATC-DDD index. The change in antimicrobial consumption was determined by comparing the mean DDD values before and after the implementation of the new policy. RESULTS: Before the intervention, the mean antimicrobial use density was 71.56 DDD/100 patients-day at the hospitals in the study. Six months after the implementation, the mean antimicrobial use density was 52.64 DDD/100 patients-day. There was a 26.4% decrease in the antimicrobial usage between that prior to and that after the intervention (P < 0.025). CONCLUSIONS: The study shows that the implementation of the new policy resulted in a significant reduction in the prescription of antimicrobials.
Anti-Bacterial Agents↗
The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit.
OBJECTIVE: This study was conducted to determine the risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa (IRPA) in the burn unit. METHODS: Patients hospitalized in the burn unit from July 2003 to November 2004 were included in this study. The features of patients with isolated IRPA were compared with those of patients with isolated imipenem-susceptible P. aeruginosa (ISPA). Demographic features, total burn surface area (TBSA), burn depth, antimicrobials used in 15-day period before isolation, and presence of IRPA in the unit at the same period were included in the risk factors analysis. RESULTS: P. aeruginosa was recovered from 133 patients in this period, 93 were IRPA and 40 were ISPA. There was no significant difference between patients with ISPA and patients with IRPA in terms of age, TBSA, and burn depth. In multivariate logistic regression analysis, hospital stay before isolation (odds ratio (OR): 3.6), carbapenem usage (OR: 7.4), broad-spectra antibiotic usage (OR: 6.5), previous presence of ISPA in the patient (OR: 1.7) and presence of IRPA in the unit at the same period (OR: 2.6) were independent risk factors for acquisition of IRPA. CONCLUSION: Long hospitalization time, previous imipenem/meropenem use, previous broad-spectra antibiotic use, previous presence of ISPA in a patient and presence of IRPA in a unit at the same period were associated with acquisition of IRPA in the burn unit. In order to decrease the incidence of IRPA isolation, the usage of broad-spectra antibiotics, especially carbapenem, should be restricted, hospitalization time should be shortened if possible, and universal isolation precautions should be strictly applied to prevention cross-contamination.
Adolescent↗
Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy.
OBJECTIVES: This study described the clinical features, factors affecting the outcome of this disease, risk factors, and efficacy of ribavirin therapy for CCHF patients in Eastern Turkey. METHODS: Between 2002 and 2004, 60 cases admitted to our hospital were included in this study. The diagnosis was confirmed through detection of IgM by ELISA and/or genomic segment of virus by RT-PCR. RESULTS: In multivariate analysis, farming (OR, 11.4), living in a rural area (OR, 10.05) and being bitten by tick (OR, 6.75) were determined as risk factors for CCHF. The rates of fever during hospitalization, confusion, neck stiffness, bleeding from multiple sites, and presence of petechia/ecchymosis were higher in the patients who died than in surviving ones. Additionally, the mean values of ALT, AST, LHD, CK, PTT, INR and urea were also higher, and the mean PLT count was lower in the patients who died. Mean recovery time was shorter in the cases treated with ribavirin than those of control. But, the need for blood and blood product, mean hospitalization duration, fatality rates, and hospital expenditure values were not significantly different between the group of patients treated with ribavirin and control groups. CONCLUSIONS: In Eastern Turkey, clinical features, factors influencing outcome of the disease, and risk factors were similar to other outbreaks of CCHF. Further studies are needed for the evaluation of ribavirin therapy in CCHF.
Adolescent↗
[Etiological agents in bacterial meningitis and cerebrospinal fluid shunt infections and their antibiotic susceptibilities].
Akut bakteriyel menenjit ve santral sinir sistemi sant enfeksiyonlarinda etkenler ve antibiyotik duyarliliklari
Adolescent↗
[A transfusion-transmitted malaria case].
Malaria is a rare but potentially serious complication of blood transfusion. In this report a transfusion-transmitted malaria case has been presented. A 47-years-old woman admitted to our clinic with the complaints of striking fever with chills, diarrhea and vomiting. She had history of an operation and transfusion before 10 days of admission. On physical examination jaundice, splenomegaly and abdominal tenderness were detected. Laboratory results revealed anemia, and elevated LDH and bilirubin levels. Examination of thin blood films yielded Plasmodium vivax trophozoites. Chloroquine was initiated for therapy and the patient was successfully treated. On the other hand, informations about her blood donor indicated that he had been in the military service in Southeast Anatolia of Turkey where malaria is endemic. All the efforts to reach the donor, for his diagnosis and treatment, were failed. Since our region (Northeast Anatolia) is not an endemic area for malaria and the patient had no travel history to an endemic area, it has been considered that the transmission route of malaria in this case was blood transfusion. In conclusion, as there are no available approved tests for malaria screening of donations, the transfusion-transmitted malaria can only be prevented by careful questioning of the donors.
Animals↗
Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists.
The study was designed to compare antibiotic use, cost and consumption before and after an initiation of an antibiotic-restriction policy in our hospital. The policy was applied in 2003, and the prescription of two groups of antibiotics (intravenously used and expensive antibiotics) was restricted. A prescription for the restricted antibiotics could be obtained with approval by an infectious disease specialist (IDS). All the hospitalized patients who received antibiotics were evaluated by a cross-sectional study with standard criteria. The annual cost and consumption of antibiotics were evaluated. After restriction, the rate of antibiotic use decreased from 52.7 to 36.7% (P < 0.001), and the appropriate use increased from 55.5 to 66.4% (P < 0.05). Appropriate use was higher for restricted antibiotics (88.4%) than for unrestricted ones (58.2%) (P < 0.001), and higher in the presence of ID consultation (97.5%) than in the absence of consultation (55.7%) (P < 0.001). Culture-based treatment was increased, and appropriate use in such cases (93.0%) was higher than empirical treatment (33.3%) (P < 0.001). After the restriction policy, consumption of antibiotics belonging to the restricted groups was decreased by 44.8%. Total expenditure of all antibiotics was decreased by 18.5%, and the savings were US$332,000 per year. This restriction policy was effective in promoting rational antibiotic prescription and lowering antibiotic cost and consumption in our hospital.
Anti-Bacterial Agents↗
Effects of interferon-alpha therapy on cardiac function in patients with chronic hepatitis B infection.
Various types of cardiovascular complications, such as myocardial infarction, cardiac arrhythmias, cardiomyopathy, and myocarditis attributed to interferon therapy have been reported. The aim of this study was to evaluate the cardiac effects of interferon-alpha (IFN-alpha) in patients with chronic hepatitis B infection. Forty-five patients with chronic hepatitis B infection (41 men and 3 women; mean age 34.2 +/- 11.5 years) were included in the study, and 10MU IFN-alpha 2b was administered three times a week for 6 months to the patients. Cardiac evaluation (detailed medical history, physical examination, electrocardiography, systolic and diastolic function parameters by echocardiography) was performed at the beginning, and at the 1st, 3rd, and 6th months of therapy. No patients had any cardiac symptoms during interferon therapy, and systolic and diastolic blood pressure and heart rate were not significantly affected (P > 0.05). None of the patients revealed cardiac rhythm disturbance on electrocardiography before or during the therapy period. No significant changes were detected in systolic (ejection fraction, fractional shortening, pre-ejection period, left ventricular ejection time, the ratio of pre-ejection period/ejection time, Q-V peak) and diastolic (E peak, A peak of transmitral flow velocity, E/A ratio, deceleration time, isovolumic relaxation time by conventional echocardiography, and E peak, A peak, deceleration time of E wave at the medial and lateral corners of the mitral annulus by tissue Doppler echocardiography) left ventricular function parameters between the beginning and the 1st, 3rd, and 6th months of therapy. The results of this study suggest that IFN-alpha therapy does not cause a significant deterioration in cardiac function in patients with chronic hepatitis B infection, and it may be used safely in patients without cardiac disease.
Adult↗
Changes of microbial flora and wound colonization in burned patients.
To determine time related changes of microbial colonization of burn wounds and body flora of burned patients, a prospective study was carried out. Fifty-one patients who were hospitalized at least 3 weeks were enrolled in the study. Periodic swabs were taken from burn wound, nasal, axillary, inguinal, and umbilical regions of the patients on admission and 7th, 14th, and 21st days of hospitalization. The mean body surface area burned was 22.9%. A total of 1098 microbial isolates were detected during the study period. Coagulase-negative staphylococci (CNS, 63.0%) and Staphylococcus aureus (19.7%) were the most prevalent isolates in admission cultures. There was a gradual decrease in the number of isolates of CNS and a marked increase in the numbers of S. aureus and Pseudomonas aeruginosa from admission to 21st day. At the 21st day, the most frequent organisms were S. aureus (37.6%), CNS (34.7%), and P. aeruginosa (16.2%). Methicillin resistance of staphylococci strains were increased constantly in study period. While 35.3% of burn wounds were sterile on admission, microbial colonization reached 86.3% within the first week. Nasal carriage of methicillin resistant S. aureus increased from 3.9% to 62.7% at 21st day. The nature of microbial wound colonization and flora changes should be taken into consideration in empirical antimicrobial therapy of burned patients.
Adolescent↗
The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients.
To examine the bacterial isolates from the burn patients and to compare the antibiograms of the predominant bacteria isolated from 51 patients who were hospitalized at least 3 weeks or more over a period of 7 months, a prospective study was undertaken. Periodic swabs were taken from burn wound, nasal, axillary, inguinal, and umbilical region of the patients on admission and on 7th, 14th, and 21st days of hospitalization. Mean hospital stay was 36.5 days. A total of 1098 microbial isolates were detected during the study period. Coagulase-negative staphylococci (CNS, 63.0%) and Staphylococcus aureus (19.7%) were the most prevalent isolates in admission cultures. During the next weeks, these bacteria were superceded by mainly Pseudomonas aeruginosa. Between admission and 21st day, the rates of methicillin resistance of staphylococci strains increased steadily. There was no vancomycin resistance in any staphylococci strains, although nine of the S. aureus isolates (2.7%) were resistant to teicoplanin. There were no strains producing inducible beta lactamase (IBL) among P. aeruginosa strains. One extended-spectrum beta-lactamase (ESBL)-producing strain was recovered on admission, although strains producing IBL and ESBL were detected at rates of 79.6 and 57.1%, respectively, on the 21st day. The nature of microbial wound colonization, flora changes, and antimicrobial sensitivity profiles should be taken into consideration in using empirical antimicrobial therapy of burned patients.
Adolescent↗
A national survey of surgical antibiotic prophylaxis in Turkey.
OBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.
Antibiotic Prophylaxis↗
Intrafamilial transmission of hepatitis B virus in the eastern Anatolian region of Turkey.
OBJECTIVE: To determine the possible route of hepatitis B virus (HBV) transmission throughout a family setting. METHOD: Two hundred and forty family members (42 spouses, 32 offspring, 34 mothers, 35 fathers and 97 siblings) of 84 HBsAg carriers attending the Ataturk University Medical Faculty Hospital between July 2000 and May 2001, and 384 first time blood donors (control group) were screened prospectively for markers of HBV by using an ELISA. The chi-squared and Fisher's exact tests were used for statistical analysis. RESULTS: The prevalence of HBsAg and HBV infection among the family members (29.6% and 43.8%, respectively) was significantly higher than in the control group (9.6%, and 29.7%), P < 0.001. Among family members, the highest prevalences of HBsAg and HBV infection were in the husbands (70.0% and 90.0%, respectively), offspring (66.7% and 100.0%) of female index cases, and siblings (40.2% and 49.5%, respectively) of all index cases. Transmission of HBV to offspring was high in cases where both the parents were positive, but there was no difference in cases where only the mother or father was positive. Despite a high prevalence of HBsAg in the offspring of female index cases, HBsAg and anti-HBs seroprevalences in the mothers of index cases were not higher than the control group (P < 0.05). Thus, it appears that mothers do not have an important role in the acquisition of HBV infection. CONCLUSION: In the area studied, in addition to the sexual route, both parents-to-child and sibling-to-sibling horizontal transmission might be the main route of intrafamilial spread of HBV infection.
Adolescent↗
[Streptococcal toxic shock syndrome: a case report].
Streptococcal toxic shock syndrome (STSS) is the most severe form of invasive infections caused by group A streptococci. In this report, a 36-years-old man who was admitted to our clinic with the complaints of fever, rash, skin lesions, abdominal pain, weakness and anuria for 2 days, has been presented. His body temperature was 39.5 degrees C and blood pressure was 50/20 mmHg. In physical examination, diffuse erythematous rash on the body, cellulitis on left leg and foot, fungal lesions on the toes, and abdominal tenderness were noted. Laboratory results revealed a dramatic increase in leukocyte count, increased sedimentation rate, elevated blood urea nitrogen, cretinine, liver enzymes and bilirubin levels. Group A streptococci were isolated from the blood culture of the patient. Despite supportive (intravenous saline, dopamine) and antibiotic (clindamycin-ceftriaxone combination) therapies, adult respiratory distress syndrome has developed in two days, and he died on the third day. This case was presented to draw attention to STSS, which was a rare clinical entity with rapid progression to mortality despite aggressive medical therapy.
Adult↗
[Activity of frequently used disinfectants and antiseptics against nosocomial bacterial types].
In this study, bactericidal activity of widely used disinfectants and antiseptics (glutaraldehyde, laurylbispropylidentriamin 5 g and benzalkoniumchlorid 20 g, polyvinylpyrolidon iodine, benzalkonium chloride and sodium hypochloride) against some nosocomial bacterial isolates were investigated by qualitative and quantitative suspension test methods. One methicillin-resistant Staphylococcus aureus (MRSA), 6 multi drug-resistant Gram-negative hospital isolates (Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloaca, Klebsiella pneumoniae, Citrobacter diversus, Serratia marcescens) and 3 standard strains of American Type Culture Collection (ATCC) bacteria (S. aureus, P. aeruginosa, E. coli) were tested against three different concentrations of disinfectants of which, manufacturer's recommended use-dilution, 1/2 and 1/4 of those recommended dilutions. All tested disinfectants were found effective in all three concentrations against nosocomial isolates in five minutes, by using both qualitative and quantitative suspension methods. When the test was repeated with albumine, bactericidal activities of disinfectants were found the same. Our findings showed that these disinfectants can be still used in safe for the sterilization in hospital, and routine disinfection protocols do not need to be alerted.
Anti-Infective Agents, Local↗
[Hepatitis A virus and coronary artery disease: serologic relationship absent].
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Case-Control Studies↗