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    Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study
    (Taylor & Francis Ltd, 2017) Guclu, Ertugrul; Ogutlu, Aziz; Karabay, Oguz; Demirdal, Tuna; Erayman, Ibrahim; Hosoglu, Salih; Turhan, Vedat
    This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.
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    Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: A Multicenter retrospective analysis
    (Wolters Kluwer Medknow Publications, 2015) Balkan, Ilker Inanc; Batirel, Ayse; Karabay, Oguz; Agalar, Canan; Akalin, Serife; Alici, Ozlem; Alp, Emine
    Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A) . Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.
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    EFFICACY OF COLISTIN AND NON-COLISTIN MONOTHERAPIES IN MULTI-DRUG RESISTANT ACINETOBACTER BAUMANNII BACTEREMIA/SEPSIS
    (Carbone Editore, 2014) Karabay, Oguz; Batirel, Ayse; Balkan, Ilker Inanc; Agalar, Canan; Akalin, Serife; Alici, Ozlem; Alp, Emine
    Objective: This retrospective study aimed to investigate the efficacies of colistin and non-colistin monotherapies in multi-drug resistant Acinetobacter baumannii bacteremia (MDR-AB). Materials and methods: Cases with MDR-AB from 27 tertiary-referral hospitals between January 2009 and December 2012 were included. Patients' data that were on either colistin monotherapy (CM) or non-colistin monotherapy (NCM) were compared. Mortality on Day 14 was the primary endpoint, whereas microbiological eradication and clinical outcome were the secondary ones. Results: Eighty-four cases were included in the study with 36 being in the CM group and 48 in the NCM group. Thirty-eight (452%) cases were male and the mean age was 602 years. The mean durations of pre-MDR-AB hospital stay and intensive care unit stay were 25.8 days and 20.9 days, respectively. All of the cases had fever (>38 degrees C). The mean Pitt bacteremia score (PBS) of the patients was calculated as 6.8, APACHE 2 score as 18.9 and the Charlson co-morbidity index (CCI) as 3.7 (CM: 3.6 vs. NCM: 3.9). Twenty (55.6%) cases in the CM group and 26 cases in the NCM group (542%) (p=0.81) died; 9 cases in the CM group (25%) and 16 cases in the NCM group (33 3%) had treatment failure (P=0.55). Bacteriological eradication was achieved in 20 (55.6%) cases in the CM group and in 36 cases (75%) in the NCM group (P=0.061). Conclusions: No significant difference could be identified between the colistin monotherapy and non-colistin monotherapy options in MDR-AB cases with respect to the results of efficacy and 14-day mortality.
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    Healthcare expenditures and increasing antimicrobial consumption in Turkey
    (Taylor & Francis Ltd, 2012) Hosoglu, Salih; Karabay, Oguz
    Objectives: The aim of this study was to assess the trend in antimicrobial consumption in Turkey between 2007 and 2010. Methods: Antimicrobial consumption data were obtained from Intercontinental Medical Statistics Turkey office. The total antimicrobial consumption data were calculated as Defined Daily Dose (DDD)/1000 inhabitant-days. The correlation between the previous five-year period and association with the main indicators of economy and healthcare services of the country were assessed. Results: Total utilization of antibiotics increased from 33.7 to 38.8 DDD/1000 inhabitant-days between 2007 and 2010. A steady increase took place during the study period. When this period was compared with the previous period (between 2001 and 2006), a similar trend was found. Turkey's total healthcare expenditure 2001 to 2010 increased from 4.5 billion Turkish Liras to 32 billion Turkish Liras. Conclusion: In Turkey, antibiotic consumption increased steadily in recent years, with a close relation to government healthcare support policy, rising health expenditures and other economical indicators.
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    Impact of antimicrobial drug restrictions on doctors' behaviors
    (Tubitak Scientific & Technological Research Council Turkey, 2016) Karabay, Oguz; Hosoglu, Salih; Guclu, Ertugrul; Akalin, Serife; Altay, Fatma Aybala; Aydin, Emsal; Ceylan, Bahadir
    Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had <= 5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.
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    Increased antimicrobial consumption following reimbursement reform in Turkey
    (Oxford Univ Press, 2008) Karabay, Oguz; Hosoglu, Salih
    Objectives: This study examined antibiotic utilization patterns in Turkey between 2001 and 2006. Methods: A comprehensive collection and analysis of Turkish antibiotic data from 2001 to 2006 was conducted. The anatomical therapeutic chemical (ATC) classification and the defined daily dose (DDD) methodology were used to calculate antibiotic consumption. Data were presented as DDD/1000 inhabitant-days, and the relation between antimicrobial consumption and governmental reimbursement policy was evaluated. Results: Total utilization of antibiotics increased from 14.62 to 31.36 DDD/1000 inhabitant-days between 2001 and 2006. The largest increase took place after the implementation of social insurance reform (SIR) in 2005, as evidenced by the DDD ratio increasing 1.87-fold after SIR went into effect. The largest increase occurred in the prescription of penicillins, from 7.13 in 2001 to 14.09 in 2006. Conclusions: In Turkey, antibiotic consumption increased markedly in recent years, in a close relationship, to a new reimbursement policy following the implementation of the SIR, which facilitated the prescription and consumption of drugs compared with the earlier SIR conditions.
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    Sofosbuvir/Velpatasvir/Voxilaprevir Experience in Treatment-Naive Chronic Hepatitis C Patients: Preliminary Findings of Real World Data
    (Galenos Publ House, 2023) Cakirca, Tuba Damar; Yamazhan, Tansu; Yuksekkaya, Esra; Akgul, Fethiye; Kurtaran, Behice; Karasahin, Omer; Karabay, Oguz
    Objectives: The aim of this study was to present the preliminary findings of real-world data of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) in treatment-naive chronic hepatitis C (CHC) patients, which was approved for the first time in treatment-naive patients in Turkey. Materials and Methods: This retrospective, cross-sectional, multicenter and national study comprised treatment-naive CHC patients receiving SOF/VEL/VOX between June-December 2022 in ten centers from Turkey. The sustained virological response (SVR) was defined as undetectable hepatitis C virus (HCV)-RNA after at least 12 weeks or more from the end of antiviral therapy. Results: Forty one patients initiating SOF/VEL/VOX were included in the study; median age 55 [interquartile range (IQR): 34.5-61 years], 63.4% males, and median HCV-RNA 521,644 IU/mL. Genotype distribution ranged from 1 to 4 in 28 patients who underwent genotype analysis, and genotype-1 was detected in 24 (85.7%) patients. The most common risk factor was substance abuse (n=10, 24.4%) and the most common comorbidity was hypertension (n=111, 26.8%). 3 (7.3%) patients had compensated cirrhosis and one (2.4%) had hepatocellular carcinoma. While in the 1st month of treatment, HCV-RNA was negative in all patients except one patient, at the end of treatment all patients' viral load was negative. SVR12 results were available in 23 patients and SVR24 in 10 patients. SVR12 and SVR24 were achieved in all patients who could be evaluated (100%) (SVR12, 23/23; SVR24, 10/10). Adverse events were reported by two patients: Diarrhea (2.4%) and nausea (2.4%), but did not lead to a discontinuation of treatment. Conclusion: The preliminary results of our study corroborated the efficacy and well tolerateability of SOF/VEL/VOX in treatment- naive CHC patients. High SVR rates were also observed across genotypes 1, 2, 3, 4 with the pangenotypic SOF/VEL/VOX.