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    Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey
    (Elsevier Sci Ltd, 2017) Turktan, Mediha; Ak, Oznur; Erdem, Hakan; Ozcengiz, Dilek; Hargreaves, Sally; Kaya, Safak; Karakoc, Emre
    Objectives: Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. Methods: Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. Results: 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n = 31, 83.8%). Mean (SD) age of the patients was 45.92 +/- 20.16 years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. Conclusions: Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients' influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients. (C) 2017 International Society for Infectious Diseases. Published by Elsevier Ltd.
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    Mortality indicators in pneumococcal meningitis: therapeutic implications
    (Elsevier Sci Ltd, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, Asuman
    Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.