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Öğe Analysis of antimicrobial consumption and cost in a teaching hospital(Elsevier Science London, 2014) Bozkurt, Fatma; Kaya, Safak; Tekin, Recep; Gulsun, Serda; Deveci, Ozcan; Dayan, Saim; Hosoglu, SalihBackground: The aim of this study is to compare the periods before and after the intervention applied using the ATC/DDD method in order to ascertain the rational use of antibiotics in a newly established hospital. Method: The appropriateness of the hospital's antibiotic use, consumption rates and the costs were calculated and compared with other hospitals. Based on these data, an intervention has been planned in order to raise the quality of antibiotic use. The periods before and after the intervention were compared. Between 16 May 2011 and 23 May 2012, data were collected from all hospital units by the infectious diseases specialists and a point prevalence survey was conducted. Anatomical therapeutic chemical classification and the defined daily dose (DDD) methodology were used to calculate the antibiotic consumption. Results: On two specific days in 2011 and 2012, 194 out of 307 patients (63.2%) and 224 out of 412 patients (54.4%) received antibiotic treatment, respectively. In 2011 and 2012, the percentage of appropriate antibiotic use was 51% and 64.3%, respectively. Both in 2011 and 2012, inappropriate antibiotic use was found to be significantly higher in surgical clinics in comparison to the internal diseases clinics and the ICU. This was caused by the high rates of inappropriate perioperative antimicrobial prophylaxis observed in surgical clinics. During both years, approximately one-third of the antibiotics were prescribed for the purposes of perioperative prophylaxis, while 88.5% and 43.7% of these, respectively, were inappropriate and unnecessary. Cephalosporins, fluoroquinolones, combinations of penicillins (including ii-lactamase inhibitors) and carbapenems were the most frequently prescribed antibiotics during the study periods. The mean total antibiotic consumption was 93.6 DDD/100 bed-days and 63.1 DDD/100 bed-days, respectively. The cost of total antibacterial consumption was (sic) 7901.33 for all the patients ((sic) 40.72 per infected patient) and sic 6500.26 ((sic) 29.01 per infected patient), respectively. Conclusion: Each hospital should follow and assess their antibiotic use expressed in DDD in order to compare their antibiotic use with national and international hospitals (WHO, 2009 [14]). (C) 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.Öğe Brucellosis in pregnancy(Royal Soc Medicine Press Ltd, 2011) Gulsun, Serda; Aslan, Selda; Satici, Omer; Gul, TalipThis study was undertaken in order to evaluate the effect of brucellosis in pregnancy. The serum agglutination test, Coombs and/or blood culture systems were used in the diagnosis of brucellosis. From July 2003 to September 2010, the clinical and delivery patterns of 40 healthy pregnant women were compared with 39 pregnant women who had brucellosis. There were no birth defects, anomalies or mortalities. We observed that brucellosis in pregnancy increases the incidence of preterm delivery (P = 0.01) and low birth weight (P = 0.001) from that seen in general deliveries. A cephtriaxone/rifampicin combination was found to be the most effective treatment in pregnant women infected with brucellosis (P = 0.004). Brucellosis in pregnancy has no effect on the incidence of congenital malformations or stillbirths. Preterm delivery and low birth weight can be seen as pregnancy outcomes in brucellosis. Appropriate antimicrobial therapy of brucellosis in pregnancy will reduce morbidity and prevent complications.Öğe Brucellosis in pregnancy: results of multicenter ID-IRI study(Springer, 2019) Inan, Asuman; Erdem, Hakan; Elaldi, Nazif; Gulsun, Serda; Karahocagil, Mustafa K.; Pekok, Abdullah U.; Ulug, MehmetBrucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p<0.001), vaginal bleeding (p<0.001), anemia (blood hemoglobin <11g/dL; p<0.001), high level of serum aspartate aminotransferase (>41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.Öğe Efficacy and safety of tenofovir disoproxil fumarate in pregnancy for the prevention of vertical transmission of HBV infection(Baishideng Publishing Group Inc, 2013) Celen, Mustafa Kemal; Mert, Duygu; Ay, Muzeyyen; Dal, Tuba; Kaya, Safak; Yildirim, Necmettin; Gulsun, SerdaAIM: To evaluate the effects of tenofovir disoproxil fumarate (TDF) use during late pregnancy to reduce hepatitis B virus (HBV) transmission in highly viremic mothers. METHODS: This retrospective study included 45 pregnant patients with hepatitis B e antigen (+) chronic hepatitis B and HBV DNA levels > 10(7) copies/mL who received TDF 300 mg/d from week 18 to 27 of gestation (n = 21). Untreated pregnant patients served as controls (n = 24). All infants received 200 IU of hepatitis B immune globulin (HBIG) within 24 h postpartum and 20 mu g of recombinant HBV vaccine at 4, 8, and 24 wk. Perinatal transmission rate was determined by hepatitis B surface antigen and HBV DNA results in infants at week 28. RESULTS: At week 28, none of the infants of TDF-treated mothers had immunoprophylaxis failure, whereas 2 (8.3 %) of the infants of control mothers had immunoprophylaxis failure (P = 0.022). There were no differences between the groups in terms of adverse events in mothers or congenital deformities, gestational age, height, or weight in infants. At postpartum week 28, significantly more TDF-treated mothers had levels of HBV DNA < 250 copies/mL and normalized alanine aminotransferase compared with controls (62% vs none, P < 0.001; 82% vs 61%, P = 0.012, respectively). CONCLUSION: TDF therapy during the second or third trimester reduced perinatal transmission rates of HBV and no adverse events were observed in mothers or infants. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Öğe Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study(Springer Heidelberg, 2015) Erdem, Hakan; Ozturk-Engin, Derya; Tireli, Hulya; Kilicoglu, Gamze; Defres, Sylviane; Gulsun, Serda; Sengoz, GonulPredicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.Öğe The levels of copper, zinc and magnesium in type II diabetic patients complicated with foot infections(Springer India, 2013) Bozkurt, Fatma; Tekin, Recep; Gulsun, Serda; Satici, Omer; Deveci, Ozcan; Hosoglu, SalihChanges in levels of trace elements and magnesium (Mg) may contribute to progression of diabetes mellitus (DM) and development of the complications. The aim of this study was to measure the levels of Copper (Cu), Zinc ( Zn), Mg and Cu/Zn ratios in diabetic foot infected patients (DFI) compared to controlled diabetic patients and healthy controls. 50 patients complicated with DFI, 50 controlled diabetic patients without any complications and 100 age and sex matched healthy subjects were enrolled in the study. Fasting plasma glucose, HbA1c, Cu, Zn and Mg were measured. One-Way ANOVA test was used to compare three different groups. Correlations between different variables were analysed using Pearson's correlation coefficients(r). The mean values of Cu and Zn were higher in patients with DFI and DM compared to controls (P < 0.001). Cu/Zn ratios were higher in DM compared to DFI and control groups (P < 0.001). Serum Mg levels were lower in all diabetic patients. Elevation of Cu in DFI and DM groups was positively correlated with Cu/Zn ratios and elevation of Zn is negatively correlated. Our findings indicate an association between increased Zn concentrations and DFI.Öğe Pregnancy Associated with Brucellosis and Acute Viral Hepatitis: Course and Outcome (Co-infections in Pregnancy)(Kuwait Medical Assoc, 2011) Gulsun, Serda; Dorman, Vedat; Aslan, Selda; Gul, TalipObjective: To assess the outcome and course of pregnancies complicated by Brucellosis (BCS) and acute viral hepatitis (AVH) infections Design: Prospective study Setting: Diyarbakir State Hospital, Turkey Subjects: Eighty-eight pregnant women admitted to Diyarbakir State Hospital, Turkey Intervension: Serum agglutination test (SAT), Coombs anti-Brucella test and / or blood culture system were used in the diagnosis of BCS. Enzyme-linked immunosorbent assays (ELISA) and polymerase chain reaction (PCR) was used in the diagnosis of viral hepatitis. Main Outcome Measures: The clinical course and delivery pattern of 32 healthy pregnant women was compared with that of 32 pregnant women who had BCS and 24 pregnant women who were concurrently infected with BCS and AVH. Results: There was no maternal mortality. Preterm delivery occurred in 18.75% of the 32 pregnant women with BCS and 37.5% of 24 pregnant women with BCS and AVH (p = 0.004). The incidence of low birth weight was also significant between the two groups (p < 0.0001). Antepartum hemorrhage might be a warning sign of the occurrence of complications in pregnant women with BCS and AVH (p < 0.001). An important observation from the present study is that maternal BCS and AVH (even concurrent) had no effect on the incidence of congenital malformations or stillbirths; it did increase the incidence of prematurity and low birth weight over that seen in the general delivery population. Conclusion: In spite of the high complication rates, BCS and AVH in pregnancy are well-tolerated diseases even when they occur together.Öğe Respiratory System Involvement in Brucellosis The Results of the Kardelen Study(Elsevier, 2014) Erdem, Hakan; Inan, Asuman; Elaldi, Nazif; Tekin, Recep; Gulsun, Serda; Ataman-Hatipoglu, Cigdem; Beeching, NicholasBackground: Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis. Methods: This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement. Results: Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as, 2 months), with an overall mean +/- SD duration of symptoms of 33.9 +/- 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 +/- 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients. Conclusions: Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.Öğe The Role of Trace Elements in Helicobacter Pylori Infected Patients(Kuwait Medical Assoc, 2011) Bozkurt, Fatma; Gulsun, Serda; Ustun, Cemal; Geyik, Mehmet Faruk; Hosoglu, SalihObjective: To evaluate the effect of trace elements in patients with Helicobacter pylori associated chronic gastritis Design: Prospective study Settings: Clinical services of the clinical microbiology and infectious diseases and gastroenterology clinics at Dicle University, Turkey Subjects:A total of 92 patients with variable severity of chronic gastritis (45 Helicobacter pylori positive and 47 Helicobacter pylori negative gastritis) and 90 age and sex matched healthy subjects were included in the study conducted between October 2006 and November 2008. Intervention: Histopathologic examination, culture of Helicobacter pylori and urease tests were performed for each patient. The atomic absorption spectrophotometer was used in the measurement of trace elements in the serum. Main Outcome Measures: Serum copper and zinc levels were significantly elevated in patients with Helicobacter pylori associated gastritis compared to Helicobacter pylori negative gastritis and healthy controls (p < 0.0001). Serum copper, zinc and Cu / Zn levels in patients with Helicobacter pylori negative chronic gastritis was not significantly different from the serum levels in healthy controls (p > 0.05). Conclusions: Our results suggest a relationship between Helicobacter pylori associated chronic gastritis and the elevation of trace element levels in serum. This study confirms that the elevation of trace element levels in serum (Cu and Zn levels) will be helpful in the diagnosis of Helicobacter pylori associated chronic gastritis in the abscence of invasive procedures, and is useful in predicting the severity of infection in patients with chronic gastritis.Öğe The role of trace elements in wagner classified diabetic patients(Academic Journals, 2011) Bozkurt, Fatma; Gulsun, Serda; Ustun, Cemal; Geyik, M. Faruk; Tegin, Ibrahim; Satici, OmerWagner's classification is the most widely used grading system in diabetic foot infections. The aim of this study was to evaluate the role of the trace elements in diabetic foot infected patients graded with Wagner's classification. This prospective study was carried out on 50 diabetic patients with variable severity of foot infections and 50 age and sex matched healthy subjects in Dicle University, Turkey, between October 2006 and November 2008. Diabetic foot infections were graded according to Wagner classification and deep tissue cultures were performed from all diabetic foot infected patients. The atomic absorption spectrophotometer was used in the measurement of trace elements in the serum. serum zinc and copper levels were significantly elevated in patients with Wagner 3 and 4 compared to Wagner 2 and 1 graded patients and healthy controls. Also Wagner 1 and 2 graded patients had higher serum zinc levels compared to healthy controls (p < 0.001). This study confirms that trace elements may be used as a leading sign to determine the severity of infections in diabetic foot wounds and may be used to predict outcome of diabetic foot infections.Öğe Treatment of Chronic Delta Hepatitis: A Nine-Year Retrospective Analysis(Kowsar Publ, 2011) Gulsun, Serda; Tekin, Recep; Bozkurt, FatmaBackground: Chronic delta hepatitis is the most severe form of viral hepatitis, for which interferon administration is the only available treatment. However, the efficacy of interferon treatment is affected by the dose and duration of treatment, and relapse rates are high. Objectives: In this study, we sought to evaluate the efficacy of treatment with pegylated interferon and observe the relapse rates of delta hepatitis after treatment. Patients and Methods: Forty-six patients with chronic delta hepatitis were retrospectively studied between January 2002 and December 2010. Patients were evaluated for biochemical, virological, and histological responses. They were then followed-up for at least 1 year after discontinuation of the treatment. Results: All the 46 patients in the study received PEG-IFN therapy. Of the 46 patients, 25 were treated with PEG-IFN for 1 year and 21 were treated for 2 years. Sixteen patients (34.7%) showed a biochemical response, 27 (58.6%) showed a virological response, and 39 (84.7%) showed a histological response. Sustained virological and biochemical responses were achieved in 41% and 47.8% of the patients, respectively. Sixteen (84.2%) patients of the 19 with high levels of hepatitis delta virus RNA (HDV RNA) (HDV RNA level >1 x 105) and 10 (71.4%) of the 14 patients with high titers of hepatitis B surface antigen (HbsAg) (HbsAg > 102 IU/mL) at the beginning of the treatment showed relapse after treatment. Conclusions: We found no significant differences between 1-year and 2-year treatments. However, the relapse rate was lower in the 2-year treatment group. Higher HDV RNA and HbsAg levels before treatment were associated with higher relapse rates. Younger age was a significant factor in predicting response. (C) 2011 Kowsar M.P.Co. All rights reserved.Öğe Two Consecutive Outbreaks of Foodborne Gastroenteritis Caused by Salmonella Enteritidis in Turkey(Ortadogu Ad Pres & Publ Co, 2011) Dorman, Vedat; Aslan, Selda; Gulsun, Serda; Kubat, Namik Kemal; Cevrim, Ugur; Yasar, Ekrem; Ozbek, ErdalObjective: We report two foodborne outbreaks caused by Salmonella enterica serovar Enteritidis occurred in four youth hostels and two private schools in Diyarbakir, Turkey to identify the involving pathogen(s) in the possible source of infection, to control and to prevent further of the outbreaks. Material and Methods: An outbreak survey was conducted and food items, water supply, work surface samples and stool cultures were analyzed. Results: Out of 346 persons, a questionnaire was administered to 208 persons, 117 affected ill and 91 control healthy persons, to describe the illness and to identify its likely source. Salmonella enterica serovar Enteritidis was isolated from 51 stool cultures and also samples of chicken and potatoes meals in the first outbreak and samples of green salad in the second outbreak. Conclusion: In this study, we described how we identified the sources of both outbreaks and how we managed it with a case control study.
