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    The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
    (W B SAUNDERS CO LTD, 2021-01-01) Kokturk, Nurdan; Babayigit, Cenk; Kul, Seval; Cetinkaya, Pelin Duru; Nayci, Sibel Atis; Baris, Serap Argun; Karcioglu, Oguz; Aysert, Pinar; Irmak, Ilim; Yuksel, Aycan Akbas; Sekibag, Yonca; Toprak, Oya Baydar; Azak, Emel; Mulamahmutoglu, Sait; Cuhadaroglu, Caglar; Demirel, Aslihan; Kerget, Bugra; Ketencioglu, Burcu Baran; Ozger, Hasan Selcuk; Ozkan, Gulcihan; Ture, Zeynep; Ergan, Begum; Oguz, Vildan Avkan; Kilinc, Oguz; Ercelik, Merve; Ciftci, Tansu Ulukavak; Alici, Ozlem; Temel, Esra Nurlu; Ataoglu, Ozlem; Aydin, Asena; Bahcetepe, Dilek Cetiner; Gullu, Yusuf Taha; Fakili, Fusun; Deveci, Figen; Kose, Neslihan; Tor, Muge Meltem; Gunluoglu, Gulsah; Altin, Sedat; Turgut, Teyfik; Tuna, Tibel; Ozturk, Onder; Dikensoy, Oner; Gulhan, Pinar Yildiz; Basyigit, Ilknur; Boyaci, Hasim; Oguzulgen, I. Kivilcim; Borekci, Sermin; Gemicioglu, Bilun; Bayraktar, Firat; Elbek, Osman; Hanta, Ismail; Okur, Hacer Kuzu; Sagcan, Gulseren; Uzun, Oguz; Akgun, Metin; Altinisik, Goksel; Dursun, Berna; Edis, Ebru Cakir; Gulhan, Erkmen; Eyuboglu, Fusun Oner; Gultekin, Okkes; Havlucu, Yavuz; Ozkan, Metin; Coskun, Aysin Sakar; Sayiner, Abdullah; Kalyoncu, Ali Fuat; Itil, Oya; Bayram, Hasan
    The COVID-19-related death rate varies between countries and is affected by various risk factors. This multi-center registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2\%). Among all cases, 1144 (76.3\%) were diagnosed with non-severe pneumonia, whereas 212 (14.1\%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5\% (95\% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age >= 65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18
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    A prospective multicenter study on the evaluation of antimicrobial resistance and molecular epidemiology of multidrug-resistant Acinetobacter baumannii infections in intensive care units with clinical and environmental features
    (BMC, 2019-01-01) Boral, Baris; Unaldi, Ozlem; Ergin, Alper; Durmaz, Riza; Eser, Ozgen Koseoglu; Zarakolu, Pinar; Ersoz, Gulden; Kaya, Ali; Haciseyitoglu, Demet; Ak, Oznur; Gencer, Serap; Sariguzel, Fatma Mutlu; Celik, Ilhami; Uyanik, Muhammet Hamdullah; Ozden, Kemalettin; Acikgoz, Ziya Cibali; Guner, Rahmet; Akcali, Alper; Sener, Alper; Adiloglu, Ali; Bulut, Cemal; Yalinay, Meltem; Dizbay, Murat; Aydemir, Sohret; Sipahi, Oguz Resat; Grp, Acinetobacter Study
    BackgroundMultidrug-resistant (MDR) Acinetobacter baumannii infections are considered as emerging nosocomial infections particularly in patients hospitalized in intensive care units (ICUs). Therefore, reliable detection of MDR strains is crucial for management of treatment but also for epidemiological data collections. The purpose of this study was to compare antimicrobial resistance and the clonal distribution of MDR clinical and environmental A. baumannii isolates obtained from the ICUs of 10 different hospitals from five geographical regions of Turkey in the context of the demographic and clinical characteristics of the patients.MethodsA multicenter-prospective study was conducted in 10 medical centers of Turkey over a 6month period. A total of 164 clinical and 12 environmental MDR A. baumannii isolates were included in the study. Antimicrobial susceptibility testing was performed for amikacin (AN), ampicillin-sulbactam (SAM), ceftazidime (CAZ), ciprofloxacin (CIP), imipenem (IMP) and colistin (COL) by microdilution method and by antibiotic gradient test for tigecycline (TIG). Pulsed-field gel electrophoresis (PFGE) was performed to determine the clonal relationship between the isolates. The detection of the resistance genes, bla(OXA-23),bla(OXA-24),bla(OXA-51,)bla(OXA-58,)bla(IMP,)bla(NDM), bla(KPC), bla(OXA-48) and bla(PER-1) was carried out using the PCR method.ResultsThe mortality rate of the 164 patients was 58.5\%. The risk factors for mortality included diabetes mellitus, liv1er failure, the use of chemotherapy and previous use of quinolones. Antimicrobial resistance rates for AN, SAM, CAZ, CIP, IMP, COL and TIG were 91.8\%, 99.4\%, 99.4\%, 100\%, 99.4\%, 1.2\% and 1.7\% respectively. Colistin showed the highest susceptibility rate. Four isolates did not grow on the culture and were excluded from the analyses. Of 172 isolates, 166 (96.5\%) carried bla(OXA-23), 5 (2.9\%) bla(OXA-58) and one isolate (0.6\%) was positive for both genes. The frequency of bla(PER-1) was found to be 2.9\%. None of the isolates had bla(IMP), bla(KPC), bla(NDM) and bla(OXA-48) genes. PFGE analysis showed 88 pulsotypes. Fifteen isolates were clonally unrelated. One hundred fifty-seven (91.2\%) of the isolates were involved in 14 different clusters.ConclusionsColistin is still the most effective antibiotic for A. baumannii infections. The gene bla(OXA-23) has become the most prevalent carbapenemase in Turkey. The distribution of invasive A. baumannii isolates from different regions of Turkey is not diverse so, infection control measures at medical centers should be revised to decrease the MDR A. baumannii infections across the country. The results of this study are expected to provide an important baseline to assess the future prophylactic and therapeutic options.