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Article ; Online: Antibiotic preferences and treatment durations in community-acquired infections.

Ertunc, Baris / Yilmaz, Gurdal

2023 Volume 10, Issue 4, Page(s) 428–434

Abstract: Objective: Since Infectious diseases and Clinical Microbiology specialists (IDS) are guiding both the community and other health professionals, it is important to use antibiotics in accordance with the guidelines. In this study, it was aimed to evaluate ...

Abstract	Objective: Since Infectious diseases and Clinical Microbiology specialists (IDS) are guiding both the community and other health professionals, it is important to use antibiotics in accordance with the guidelines. In this study, it was aimed to evaluate the approaches of IDS to the use of antibiotics and treatment times in community-acquired infections. Methods: Our study was conducted as a digital survey study applied to IDS between January 2019 and December 2020. Community-acquired pneumonia, cystitis, acute tonsillopharangitis, acute otitis media, acute sinusitis, cellulitis, as well as the antibiotics they prefer and their duration of treatment, were asked by questionnaire method. A descriptive statistical analysis was performed on all the information obtained. Results: A total of 203 IDS participated in the study. About 34.7% of the participants worked as specialists for 0-5 years, 33.6% between 6 and 15 years, and 31.7% for more than 15 years. Most of the participants had problems adhering to the guidelines recommendations in their choice of antibiotics and in determining the duration of treatment. Non-compliance rates were higher among specialists who served for more than 5 years. Conclusion: By providing radical changes in both specialty training and post-specialty trainings, creating online learning environments, and encouraging trainings, problems can be solved to a significant extent and new information can be accessed more quickly.
Language	English
Publishing date	2023-08-07
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	3031921-3
ISSN	2536-4553 ; 2148-4902
ISSN (online)	2536-4553
ISSN	2148-4902
DOI	10.14744/nci.2023.55453
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Article ; Online: Evaluation of the cardio-ankle vascular index in COVID-19 patients.

Aydın, Ercan / Kant, Aydın / Yilmaz, Gürdal

Revista da Associacao Medica Brasileira (1992)

2021 Volume 68, Issue 1, Page(s) 73–76

Abstract: Objective: This study aimed to investigate the relationship and prognostic significance of cardio-ankle vascular index, which is a measure of arterial stiffness that can lead to endothelial dysfunction and poor cardiovascular issues in COVID-19 patients, ...

Abstract	Objective: This study aimed to investigate the relationship and prognostic significance of cardio-ankle vascular index, which is a measure of arterial stiffness that can lead to endothelial dysfunction and poor cardiovascular issues in COVID-19 patients, with COVID-19. Methods: The study included 115 patients, of which 65 patients in the case group with Real time reversetranscription-polymerasechainreaction test positive and diagnosed for COVID-19 and 50 volunteers in the control group. Patients with COVID-19 were classified as moderate/severe or mild COVID-19 in the subgroup analysis based on the severity of the disease. We investigated the relationship between cardio-ankle vascular index and COVID-19 by using the VaSera VS-1000 device to automatically measure each patient's cardio-ankle vascular index and ankle-brachial pressure index. Results: The mean age of participants included in the study was 65.7±10.7 years. Patients and volunteers were statistically similar in terms of age, gender, comorbidities, Charlson comorbidity index scores, and body mass index values (p>0.05). The right-cardio-ankle vascular index value was 9.6±2.4 in the case group and 8.5±1.1 in the control group (p=0.004). The left-cardio-ankle vascular index value was 9.4±2.7 in the case group and 8.5±1.2 in the control group (p=0.01). The right-cardio-ankle vascular index value was 10.8±3.4 in the moderate/severe disease group and 8.8±0.9 in the mild disease group (p=0.008). The left-cardio-ankle vascular index value was 10.7±3.6 in the moderate/severe disease group and 8.5±1.5 in the mild disease group (p<0.001). The right-cardio-ankle vascular index and left-cardio-ankle vascular index values were found to be significantly higher in COVID-19 patients in our study. When receiver operating characteristic analysis was performed to distinguish moderate/severe COVID-19 patients from mild patients, right-cardio-ankle vascular index was area under the curve 0.757 (0.630-0.884), and left-cardio-ankle vascular index was area under the curve 0.782 (0.661-0.902). Conclusion: The right-cardio-ankle vascular index and left-cardio-ankle vascular index values increased in COVID-19 patients in our study, and this was thought to be prognostically significant.
MeSH term(s)	Aged ; Ankle ; Ankle Brachial Index ; COVID-19/diagnosis ; Humans ; Middle Aged ; SARS-CoV-2 ; Vascular Stiffness
Language	English
Publishing date	2021-12-24
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	731969-1
ISSN	1806-9282 ; 0104-4230 ; 0004-5241 ; 0102-843X
ISSN (online)	1806-9282
ISSN	0104-4230 ; 0004-5241 ; 0102-843X
DOI	10.1590/1806-9282.20210781
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Zs.B 654: Show issues

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Article ; Online: Evaluation of Diarrhea in Patients with COVID-19.

Comoglu, Şenol / Öztürk, Sinan / Kant, Aydın / Arslan, Mustafa / Karakoc, Hanife Nur / Yılmaz, Gürdal

Digestive diseases (Basel, Switzerland)

2021 Volume 39, Issue 6, Page(s) 622–625

Abstract: Background/aims: The COVID-19 disease, which was declared epidemic by the WHO, is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of patients who should be considered for person-to-person transmission in the ...

Abstract	Background/aims: The COVID-19 disease, which was declared epidemic by the WHO, is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of patients who should be considered for person-to-person transmission in the community. In our study, it was aimed to investigate the characteristics of patients with COVID-19-related diarrhea symptoms. Materials and methods: The study was conducted retrospectively in CO-VID-19 rtRT-PCR-positive patients in 5 medical centers. Three or more loose/liquid stools per day or increased number of defecations compared to normal defecation were defined as diarrhea. The patients were analyzed in 2 groups as those with and without diarrhea. Results: One thousand eighty-six patients were included in the study. Seventy-eight (7.2%) of the patients had diarrhea. Diarrhea was watery in 54 (69.2%) patients while with blood and mucus in 18 (23.1%) patients. Diarrhea continued for an average of 5.2 ± 1.6 (2-11) days. The clinical and laboratory findings of patients with diarrhea were more serious than those without diarrhea. Diarrhea is more common in the elderly and people with comorbid disease, and patients with diarrhea had higher CMI score and CRP and higher complaints of fever, cough, shortness of breath, myalgia, and fatigue. Conclusions: The presence of diarrhea should indicate a suspected COVID-19 infection and suggest testing for early diagnosis of the disease. It should be kept in mind that the course of the disease may be more severe in these patients, and precautions should also be taken in terms of fecal transmission during discharge.
MeSH term(s)	Aged ; COVID-19 ; Diarrhea/virology ; Feces ; Humans ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-03-01
Publishing country	Switzerland
Document type	Journal Article ; Multicenter Study
ZDB-ID	632798-9
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000515521
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Article ; Online: The "MICE" scoring system in differentiating the identical twins leptospirosis and hantavirus infection.

Kaya, Selçuk / Yılmaz, Gürdal / Aydın, Murat / Aksoy, Firdevs / Koksal, Iftihar

Infection

2019 Volume 48, Issue 1, Page(s) 99–107

Abstract: Purpose: To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins.: Methods: The study ... ...

Abstract	Purpose: To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. Methods: The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed ("MICE" score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the "MICE" scoring system. Results: Three cut-off values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/μL): ≤ 7500, 7500-15,000, and > 15,000; total bilirubin (mg/dL): ≤ 3, 3-10, and > 10; CRP (mg/dL): ≤ 5, 5-15, and > 15; creatinine (mg/dL): ≤ 1.5, 1.5-3, and > 3; CK (U/L): ≤ 500, 500-1000, > 1000. AUC was calculated as 0.964 at ROC analysis, while the most noteworthy cut-off point was obtained when MICE score was ≥ 3, exhibiting 93.5% sensitivity, 92.9% specificity, PPV 94.5% and NPV 91.5%. A test score ≥ 3 was regarded as positive. In addition, our patients were evaluated using other current scoring systems in addition to "MICE," and our scoring system exhibited a greater diagnostic power in our subjects. Conclusions: Leptospirosis and hantavirus infections can be accurately predicted by the MICE scoring system. Early diagnosis and rational treatment will also help to lower the mortality rates in these diseases.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Diagnosis, Differential ; Diagnostic Techniques and Procedures/instrumentation ; Female ; Hantavirus Infections/diagnosis ; Humans ; Leptospirosis/diagnosis ; Male ; Middle Aged ; Turkey ; Young Adult
Language	English
Publishing date	2019-10-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	185104-4
ISSN	1439-0973 ; 0300-8126 ; 0173-2129
ISSN (online)	1439-0973
ISSN	0300-8126 ; 0173-2129
DOI	10.1007/s15010-019-01366-7
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Article: An examination of healthcare-associated infections in elderly patients

İskender, Serap / Yılmaz, Gürdal / Köksal, İftihar

Turkish journal of medical sciences

2017 Volume 47, Issue 6, Page(s) 1693–1698

Abstract: Background/aim: Healthcare-associated infections (HCAIs) are increasing due to the growing numbers of elderly people requiring long-term care and immunosuppressive therapies. The purpose of this study was to examine HCAIs occurring in elderly inpatients ... ...

Abstract	Background/aim: Healthcare-associated infections (HCAIs) are increasing due to the growing numbers of elderly people requiring long-term care and immunosuppressive therapies. The purpose of this study was to examine HCAIs occurring in elderly inpatients in our hospital.Materials and methods: This study prospectively investigated HCAIs developing in all patients hospitalized over a 1-year period. Diagnosis was based on Centers for Disease Control criteria. The results were subjected to statistical analysis between patients aged over and under 65.Results: A total of 24,692 patients were evaluated and 894 HCAIs were identified. Of these infections, 214 were seen in patients aged 65 or over. The rate of HCAIs in elderly patients was 15.1, compared to 2.9 in the under-65 patient group (P < 0.001). Seventy-nine (36.9%) infections in elderly patients were urinary system infections, 60 (28.0%) were bacteremia, 43 (20.1%) were pneumonia, 29 (13.6%) were surgical site infections, and 3 (1.4%) were other infections. Forty-three of the 187 elderly patients followed with a diagnosis of HCAI died. Seventeen patients had mortality attributable to HCAI. Conclusion: Awareness that HCAIs seen in the elderly have different clinical and microbiological characteristics than those of other patients, and the appropriate precautions being taken, will reduce the problems that may result from these diseases with high mortality and morbidity.
MeSH term(s)	Aged ; Aged, 80 and over ; Bacteremia/epidemiology ; Cross Infection/epidemiology ; Female ; Health Services Research ; Humans ; Male ; Middle Aged ; Pneumonia/epidemiology ; Preventive Medicine ; Prospective Studies ; Surgical Wound Infection/epidemiology ; Turkey/epidemiology ; Urinary Tract Infections/epidemiology
Language	English
Publishing date	2017-12-19
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	1183461-4
ISSN	1303-6165 ; 1300-0144
ISSN (online)	1303-6165
ISSN	1300-0144
DOI	10.3906/sag-1706-92
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Zs.A 3242: Show issues

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Article ; Online: Individualized antibiotic therapy in patients with ventilator-associated pneumonia.

Yilmaz, Gürdal / Salyan, Sedat / Aksoy, Firdevs / Köksal, İftihar

Journal of medical microbiology

2017 Volume 66, Issue 1, Page(s) 78–82

Abstract: The optimal duration of the treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1 week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10 to 14 days. The purpose ... ...

Abstract	The optimal duration of the treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1 week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10 to 14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital's intensive care units between 1 January and 31 December 2015. Duration of antibiotic therapy was determined with 5 day clinical evaluation according to previously established criteria. Patients were divided into two groups depending on length of treatment, short (7-10 days) and long treatment (>10 days). Nineteen patients received 7 to 10 day antibiotic therapy, and 30 received >10 day antibiotic therapy. Demographic and clinical characteristics, Glasgow Coma Scale score, CPIS and the PaO2/FiO2 ratio at the time of diagnosis of VAP were statistically similar between the two groups (P>0.05). A second VAP attack occurred post-treatment in three patients receiving short-term treatment and in four receiving long-term treatment (P=0.561). The numbers of antibiotic-free days were 15.6±6.2 in the short-term treatment group and 8.3±7.5 in the long-term group (P<0.0001). One of the patients receiving short-term treatment died within 28 days after treatment, and four of the patients receiving long-term treatment (P=0.348) did so. The most commonly observed micro-organisms in both groups were Acinetobacterbaumannii and Pseudomonasaeruginosa. Short-term treatment can be administered in cases with early clinical and laboratory response started on VAP treatment by considering individual characteristics and monitoring fever, CPIS, the PaO2/FiO2 ratio, C-reactive protein and procalcitonin values.
MeSH term(s)	Acinetobacter baumannii/drug effects ; Acinetobacter baumannii/isolation & purification ; Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; C-Reactive Protein/metabolism ; Calcitonin/blood ; Enterobacter cloacae/drug effects ; Enterobacter cloacae/isolation & purification ; Escherichia coli/genetics ; Escherichia coli/isolation & purification ; Female ; Fever/drug therapy ; Humans ; Intensive Care Units ; Klebsiella pneumoniae/drug effects ; Klebsiella pneumoniae/isolation & purification ; Male ; Middle Aged ; Oxygen/blood ; Pneumonia, Ventilator-Associated/diagnosis ; Pneumonia, Ventilator-Associated/drug therapy ; Pneumonia, Ventilator-Associated/microbiology ; Prospective Studies ; Pseudomonas aeruginosa/drug effects ; Pseudomonas aeruginosa/isolation & purification ; Serratia marcescens/drug effects ; Serratia marcescens/isolation & purification ; Staphylococcus aureus/drug effects ; Staphylococcus aureus/isolation & purification
Chemical Substances	Anti-Bacterial Agents ; Calcitonin (9007-12-9) ; C-Reactive Protein (9007-41-4) ; Oxygen (S88TT14065)
Language	English
Publishing date	2017-02-22
Publishing country	England
Document type	Journal Article
ZDB-ID	218356-0
ISSN	1473-5644 ; 0022-2615
ISSN (online)	1473-5644
ISSN	0022-2615
DOI	10.1099/jmm.0.000401
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Article: Evaluation of Risk Factors for Intravenous Colistin Use-related Nephrotoxicity.

Koksal, Iftihar / Kaya, Selcuk / Gencalioglu, Eda / Yilmaz, Gurdal

Oman medical journal

2016 Volume 31, Issue 4, Page(s) 318–321

Abstract: Objectives: We investigated the incidence of and risk factors for nephrotoxicity in patients using intravenous colistin.: Methods: This retrospective, observational study was conducted at Karadeniz Technical University, Faculty of Medicine, clinics ... ...

Abstract	Objectives: We investigated the incidence of and risk factors for nephrotoxicity in patients using intravenous colistin. Methods: This retrospective, observational study was conducted at Karadeniz Technical University, Faculty of Medicine, clinics and intensive care unit between 1 January 2009 and 1 January 2013. Intravenous colistin was administered to 133 patients at a dose of 2.5-5.0 mg/kg/day. Results: The patients mean age was 54.3±19.1 years and the mean duration of treatment was 13.5±3.6 days. Nephrotoxicity developed in 5.0±2.8 days in 38 (28.6%) patients. Based on RIFLE (risk, injury, failure, loss of kidney function, and end-stage kidney disease) criteria, 15 (39.5%) patients were class 1, 17 (44.7%) were class 2, six (15.8%) were class 3, and none were class 4. The mean duration of development of nephrotoxicity was 5.0±2.8 days. Hemodialysis requirement was observed in two (5.2%) of the 38 patients who developed nephrotoxicity. In these cases, colistin therapy was not discontinued. Nephrotoxicity was correlated with advanced age, high pretreatment serum creatinine levels, diabetes mellitus, and chronic obstructive pulmonary disease. Conclusions: The use of colistin is relatively safe for patients that have normal renal functions. However, better standardization of the definition of nephrotoxicity in those patients with the use of scoring systems and close monitoring are necessary.
Language	English
Publishing date	2016-06-29
Publishing country	Oman
Document type	Journal Article
ZDB-ID	2571431-4
ISSN	2070-5204 ; 1999-768X
ISSN (online)	2070-5204
ISSN	1999-768X
DOI	10.5001/omj.2016.62
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Article: An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit.

Karatas, Mevlut / Saylan, Sedat / Kostakoglu, Ugur / Yilmaz, Gurdal

Pakistan journal of medical sciences

2016 Volume 32, Issue 4, Page(s) 817–822

Abstract: Objectives: Ventilator-associated pneumonia (VAP) is a significant cause of hospital-related infections, one that must be prevented due to its high morbidity and mortality. The purpose of this study was to evaluate the incidence and risk factors in ... ...

Abstract	Objectives: Ventilator-associated pneumonia (VAP) is a significant cause of hospital-related infections, one that must be prevented due to its high morbidity and mortality. The purpose of this study was to evaluate the incidence and risk factors in patients developing VAP in our intensive care units (ICUs). Methods: This retrospective cohort study involved in mechanically ventilated patients hospitalized for more than 48 hours. VAP diagnosed patients were divided into two groups, those developing pneumonia (VAP(+)) and those not (VAP(-)).\. Results: We researched 1560 patients in adult ICUs, 1152 (73.8%) of whom were mechanically ventilated. The MV use rate was 52%. VAP developed in 15.4% of patients. The VAP rate was calculated as 15.7/1000 ventilator days. Mean length of stay in the ICU for VAP(+) and VAP(-) patients were (26.7±16.3 and 18.1±12.7 days (p<0.001)) and mean length of MV use was (23.5±10.3 and 12.6±7.4 days (p<0.001)). High APACHE II and Charlson co-morbidity index scores, extended length of hospitalization and MV time, previous history of hospitalization and antibiotherapy, reintubation, enteral nutrition, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus and organ failure were determined as significant risk factors for VAP. The mortality rate in the VAP(+) was 65.2%, with 23.6% being attributed to VAP. Conclusion: VAPs are prominent nosocomial infections that can cause considerable morbidity and mortality in ICUs. Patient care procedures for the early diagnosis of patients with a high risk of VAP and for the reduction of risk factors must be implemented by providing training concerning risk factors related to VAP for ICU personnel, and preventable risk factors must be reduced to a minimum.
Language	English
Publishing date	2016-09-15
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2032827-8
ISSN	1681-715X ; 1682-024X ; 1017-4699
ISSN (online)	1681-715X
ISSN	1682-024X ; 1017-4699
DOI	10.12669/pjms.324.10381
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Article ; Online: Umbilical venous catheter complications in newborns: a 6-year single-center experience.

Mutlu, Mehmet / Aslan, Yakup / Kul, Sibel / Yılmaz, Gürdal

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

2016 Volume 29, Issue 17, Page(s) 2817–2822

Abstract: Objective: Umbilical venous catheter (UVC) insertion is frequently performed in critically ill neonates. Various mild or serious complications of umbilical venous catheterization can be observed associated with this procedure. In this study, newborns ... ...

Abstract	Objective: Umbilical venous catheter (UVC) insertion is frequently performed in critically ill neonates. Various mild or serious complications of umbilical venous catheterization can be observed associated with this procedure. In this study, newborns that have undergone UVC and developed complications were evaluated. Methods: This retrospective observational study was carried out in newborns that have undergone UVC and developed complications were evaluated between June 2008 and November 2014. Results: Umbilical venous catheter were inserted to 974 (22.4%) newborn and followed for 7402/catheter days. UVC-related complications developed at 198 patients (20.3%). The most common UVC-related complications were malposition (n = 189), catheter-related bloodstream infection (n = 6) and remnant of catheter in the umbilicus (n = 3), respectively. Remnant of catheter in the umbilicus was removed by pediatric surgeon. Except one patient, all patients were discharged. Conclusion: Although UVC is a common and easy vascular access, this process is not without complications. UVC may be inappropriate position because the catheter is inserted by the pediatrician without imaging guidance and may occasionally be associated with complications. Inappropriate positioning of the catheter may observe during the follow-up and maintained care. Therefore, newborns particularly in premature and very low birth-weight newborn should be followed in terms of catheter complications during insertion, following and just after removing of the catheter.
MeSH term(s)	Central Venous Catheters/adverse effects ; Female ; Humans ; Infant, Newborn ; Infant, Premature, Diseases/etiology ; Male ; Retrospective Studies
Language	English
Publishing date	2016-09
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2077261-0
ISSN	1476-4954 ; 1057-0802 ; 1476-7058
ISSN (online)	1476-4954
ISSN	1057-0802 ; 1476-7058
DOI	10.3109/14767058.2015.1105952
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Article ; Online: Changing trend of microbiologic profile and antibiotic susceptibility of the microorganisms isolated in the neonatal nosocomial sepsis: a 14 years analysis.

Mutlu, Mehmet / Aslan, Yakup / Aktürk Acar, Filiz / Kader, Şebnem / Bayramoğlu, Gülçin / Yılmaz, Gürdal

2019 Volume 33, Issue 21, Page(s) 3658–3665

Abstract: Objective: ...

Abstract	Objective:
MeSH term(s)	Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Cross Infection/drug therapy ; Cross Infection/epidemiology ; Drug Resistance, Microbial ; Humans ; Infant, Newborn ; Microbial Sensitivity Tests ; Neonatal Sepsis/drug therapy ; Sepsis/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-03-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2077261-0
ISSN	1476-4954 ; 1057-0802 ; 1476-7058
ISSN (online)	1476-4954
ISSN	1057-0802 ; 1476-7058
DOI	10.1080/14767058.2019.1582633
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