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    The Evaluation of Exposure to Hepatitis A Virus in HBsAg-positive Persons : A Multicentre Study from Turkey
    (Dr M N Khan, 2014) Celen, Mustafa Kemal; Turker, Kamuran; Oztoprak, Nefise; Sener, Alper; Tuna, Nazan; Ince, Nevin; Erdem, Ilknur
    Chronic hepatitis B is a major public health problem in our country. Hepatitis A vaccination in HBV carriers who did not encounter with Hepatitis A virus is also significant. We aimed to evaluate the rate of exposure to HAV in HBsAg-positive persons, and the distribution of seronegative individuals according to age groups. Medical records of 4793 patients from 14 centers who were positive for hepatitis B surface antigen (HBsAg). A total 3514 cases (73.3%) were male and 1279 (26.7) were female. The HBsAg positive patients who were previously tested for HAV IgG at the time of firstly admitted to a center. HBsAg positive patients who were previously not tested for HAV IgG were tested and these patients were confirmed serologically for HAV. The distribution of cases according to age were determined. In this study, 4793 HBsAg-positive patients were evaluated. The ratio of testing of anti-HAV IgG was very low during the first visit (54.2%). Seronegativity was highest in the age group under 19 years of age (26.2%) followed by 20-25 age group (15.5%) and 26-29 age group (12.5%). Testing of HAV serology should not be ignored in especially HBsAg-positive young adults and seronegative young adults should be vaccinated.
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    An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study
    (Aves, 2016) Kaya, Selcuk; Aktas, Seyhan; Senbayrak, Seniha; Tekin, Recep; Oztoprak, Nefise; Aksoy, Firdevs; Firat, Pinar
    Objective: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. Materials and Methods: A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013 guideline. Results: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. Conclusion: Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.
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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.