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Papers by Huseyin Turgut

Journal of infection in developing countries, 2007

Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears t... more Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears to have a propensity for developing multiple antimicrobial resistance rapidly. We report two cases with post-surgical meningitis due to multidrug resistant A. baumannii which were successfully treated with high-dose intravenous meropenem therapy. Multidrug resistant Acinetobacter spp. in intensive care units are a growing concern. High-dose meropenem is used in the treatment of these infections.

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2014

To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize ... more To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities. By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey. Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatiti...

American Journal of Infection Control, 2015

Background: Surgical site infections (SSIs) are a threat to patient safety; however, there were n... more Background: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. Methods: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. Results: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). Conclusions: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.

Infection, 1994

Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-B (NANB) hepatitis. Wa... more Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-B (NANB) hepatitis. Water-borne epidemics have been reported in many developing countries primarily affecting young and middle-aged adults. To determine the role of HEV in acute sporadic NANB hepatitis, we have studied the profiles of anti-HEV IgG in the sera of patients previously diagnosed for NANB hepatitis. We tested the sera of 53 patients with acute NANB hepatitis and 100 healthy people as a control group for anti-HEV IgG. Thirty-nine of the 53 patients (73.3%) and none of the control group were positive for HEV infection, according to results shown by ELISA. This result suggests that HEV is a common cause of acute sporadic NANB hepatitis in Turkey. Further studies are needed in the other regions to determine the true prevalence of HEV infection in Turkey.

Infection Control and Hospital Epidemiology, 2013

To assess the feasibility and effectiveness of the International Nosocomial Infection Control Con... more To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance. An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period. Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey. Healthcare workers at 99 ICU members of the INICC. A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods. A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% ([Formula: see text]). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; [Formula: see text]), physicians versus nurses (62% vs 72%; [Formula: see text]), and adult versus neonatal ICUs (67% vs 81%; [Formula: see text]), among others. Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented.

BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tube... more BACKGROUND:
The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM.
METHOD:
BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups.
RESULTS:
The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently.
CONCLUSIONS:
When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.

Travel Medicine and Infectious Disease, 2015

Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis dif... more Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis differential diagnosis, Travel Medicine and Infectious Disease (2015), http://dx.

Infection, 2008

Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of... more Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of the study was to investigate device associated infection rates in a small Turkish hospital. Device utilization ratios and device associated infection rates were calculated according to definitions of the Centers for Disease Control (CDC). During a period of 24 months 1,387 patients were surveyed in our ICUs. A total of 287 device associated infections were detected. In our study ventilator associated pneumonia was the most frequent nosocomial infection with a rate of 59.7 per 1,000 ventilator days. The most frequent pathogen of device associated infection was Candida spp. High rates of device associated infections in a small Turkish hospital clearly indicate the urgent need of the implementation of infection control guidelines.

Travel Medicine and Infectious Disease, 2015

Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis dif... more Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis differential diagnosis, Travel Medicine and Infectious Disease (2015), http://dx.

The Journal of Dermatology, 2005

Henoch-Schölein purpura is usually a disease of children presenting with arthralgia, abdominal pa... more Henoch-Schölein purpura is usually a disease of children presenting with arthralgia, abdominal pain, renal involvement, and palpable purpura. Viral and bacterial infections may have a role in its etiology. We present a 32-year-old male patient with recurrent Henoch-Schölein purpura in association with a chronic hepatitis B infection of ten years duration. The patient had received lamuvidine and interferon-alpha for the treatment of hepatitis B infection for a year. The skin lesions disappeared with the treatment of the hepatitis B infection. Four months after discontinuation of the therapy, the purpuric papules reappeared with reactivation of the hepatitis B infection. Although rarely reported, hepatitis B virus infection should be considered in patients with Henoch-Schölein purpura.

Acta Neurologica Scandinavica, 2009

In 14 normal male adults and 97 male patients having impotence alone or together with systematic ... more In 14 normal male adults and 97 male patients having impotence alone or together with systematic and/or neuro-psychiatric symptoms and signs, the somatosensory cerebral-evoked potentials were obtained by glans penis stimulation (penile SEP); by peroneal nerve stimulation (peroneal SEP) and by electrically-induced bulbocavernous (BC) reflex. In normal subjects, the configurations of both SEPs were basically similar, except that the onset of latency was 1&15 msec longer and the amplitude in the PI-NI component was higher in penile SEP. BC-reflex latency was abnormally prolonged, especially in diabetic impotence and in patients with cauda/ conus lesions, while the abnormalities on the penile and peroneal SEP were more frequent in patients with spinal cord injuries, MS and parkinsonism. In impotent patients with epilepsy, chronic prostatitis and psychogenic problems, all the tests were generally normal.

Psychosomatics, 2005

The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of the... more The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of their psychological state. Participants (43 asymptomatic hepatitis B virus carriers and 43 healthy comparison subjects) completed self-report questionnaires. Psychiatric disorders and psychosocial functioning were evaluated with structured clinical interviews and the Global Assessment of Functioning scale. Hepatitis B virus carriers were more likely to have psychiatric disorders than comparison subjects (30.2% vs. 11.6%). Also, carriers had significantly higher depression and anxiety scores and lower Global Assessment of Functioning scores than did comparison subjects. Worries about contamination and illnesses related to hepatitis B infection were associated with the presence of psychiatric disorder. The results suggest that asymptomatic hepatitis B virus carriers need emotional support.

Journal of Surgical Research, 2005

Materials and methods. Graft infections were established in the back subcutaneous tissue of 120 a... more Materials and methods. Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation of 1-cm 2 Dacron/ ePTFE prosthesis followed by topical inoculation with 2 ؋ 10 7 CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1 ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture.

SUMMARY Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various c... more SUMMARY Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various clinical findings. It can lead to complications affecting many systems. Endocarditis is an infrequent, but serious complication of brucellosis. The aim of this case presentation is to remind that endocarditis can be a complication of brucellosis and if is undiagnosed or misdiagnosed, progresses fatal in a

The Journal of Infection in Developing Countries, 2008

Background: Infectious complications in febrile neutropenic patients are still major causes of mo... more Background: Infectious complications in febrile neutropenic patients are still major causes of morbidity and mortality despite significant advances in diagnostic techniques and antimicrobial therapy. In this study, we describe the characteristics of patients with hematological malignancies who were evaluated for suspected infection. This study was also conducted to assess the isolation rate of bacterial and fungal causative agents in febrile neutropenic attacks. Method: The study was conducted at Pamukkale University Hospital, Turkey. In order to identify the characteristics of patients with hematological malignancies in the presence/suspicion of any accompanying infectious disease, patients' charts with hematological malignancies were reviewed for signs/symptoms of any infection between October 1, 2001, and May 31, 2005, retrospectively. Results: Overall, 90 infectious episodes occurred in 59 patients. The most common underlying diseases were acute myelogenous leukemia (61.0%) and acute lymphocytic leukemia (15.3%). The absolute neutrophil count was lower than 100/mm³ in 33 (36.7%) episodes. Microbiologically and clinically documented infections and fever of unknown origin were observed in 35.6%, 28.9%, and 35.6% of the participants, respectively. Bloodstream infections and pneumonia were detected in 21.1% and 18.9% of episodes, respectively. Gram negative organisms were most common (58.4%), followed by gram positive cocci. A combination of third generation cephalosporin and an aminoglycoside were used in 44.4% of episodes initially. Fever resolved in 24.4% of episodes using the initial therapy. The mortality rate was 15.6%. Conclusion: These results showed that infections with gram-negative bacteria continue to predominate in febrile neutopenic episodes in our center.

Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2004

A prospective study was designed in order to determine to what extent antibiotics are used in tre... more A prospective study was designed in order to determine to what extent antibiotics are used in treating community-acquired infections and their costs. Between February and July 2001 a total of 43,011 prescriptions from a representative sample of pharmacies in the city of Denizli (Turkey) were evaluated during the study period. Antibiotics accounted for 16.4 % of total prescriptions and 30.8% of the market value of drugs. Penicillins (49.7%), followed by cephalosporins (17.3%), macrolides (9.5%), and aminoglycosides (7.6%) were the most frequently prescribed antibiotics during the study period. The economic burden of antibiotic usage in the community is found higher than in developed countries. In order to reduce this cost the proper use of antibiotics is a matter of urgency

Objective: To determine epidemiology and risk factors for nosocomial infections in intensive care... more Objective: To determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU). Design: Prospective incidence survey. Setting: An adult general ICU in a university hospital in western Turkey. Patients: All patients who stayed more than 48 h in ICU during a 2-year period (2000-2001). Measurements and results: The study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillinresistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26-32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41-66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34-45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47-5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10-30.20; P=0.04) and APACHE II scores 10-19 (OR: 10.80; 95% CI: 1.10-106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001). Conclusion:

Summary Introduction: The treatment of postoperative mediastinitis is very important because of i... more Summary Introduction: The treatment of postoperative mediastinitis is very important because of its high morbidity, mortality, and increased hospital stay and hospital costs. The aims of our research were to investigate whether linezolid alone can be an effective treatment agent for methicillinresistant Staphylococcus aureus (MRSA) mediastinitis, and to determine whether linezolid can provide synergistic activity when given in combination with rifampin. Methods: A partial upper median sternotomy was performed on 70 rats. The animals were divided into seven groups: an uncontaminated control group; an untreated contaminated group; three contaminated groups that received antibiotic therapy with either 25 or 50 mg/kg linezolid twice a day, or rifampin 5 mg/kg twice a day; and two contaminated groups that received a combination therapy consisting of 25 or 50 mg/kg linezolid and rifampin 5 mg/kg twice a day. The antibiotic treatment lasted 7 days. Tissue samples from the upper ends of the sternum and swab specimens of the upper mediastinum were obtained and evaluated microbiologically. Results: The 25-mg/kg dose of linezolid, either alone or combined with rifampin, was not effective in reducing the bacterial counts in mediastinum and sternum. Quantitative bacterial cultures of mediastinum and sternum were significantly lower in the groups receiving 50 mg/kg linezolid alone or in combination with rifampin compared with the control. Adding of rifampin to linezolid therapy did not result in a significant change in bacterial counts versus linezolid alone. Conclusion: A high dose of linezolid should be considered as a possible therapeutic agent for the treatment of post-sternotomy infection caused by MRSA. #

International Journal of Infectious Diseases, 2008

Streptococcus mitis, an important member of the viridans streptococci and a normal part of the or... more Streptococcus mitis, an important member of the viridans streptococci and a normal part of the oropharynx, skin, gastrointestinal system, and female genital system flora, is a bacterium with low pathogenicity and virulence. 1-5 How-ever viridans streptococci are the most common cause of subacute bacterial endocarditis. 3 S. mitis causes severe clinical conditions including sepsis and septic shock especially in neutropenic patients. 4,6 Meningitis with S. mitis is rare, but has been described in individuals with previous spinal anesthesia, neurosurgical procedure, malignancy, or neurological complications of endocarditis, and in newborns. 2,3,7-12 We report herein an unusual case of S. mitis meningitis in a man with a history of alcoholism, poor oral hygiene, and maxillary sinusitis.

Klimik Dergisi/Klimik Journal, 2010

Intravesical bacillus Calmette-Guerin (BCG) administration is used as a treatment method in super... more Intravesical bacillus Calmette-Guerin (BCG) administration is used as a treatment method in superficial bladder cancer and is generally well tolerated. Side effects following BCG are usually mild and self-limiting and serious systemic side effects are rarely seen. BCG-related ...

Journal of infection in developing countries, 2007

Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears t... more Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears to have a propensity for developing multiple antimicrobial resistance rapidly. We report two cases with post-surgical meningitis due to multidrug resistant A. baumannii which were successfully treated with high-dose intravenous meropenem therapy. Multidrug resistant Acinetobacter spp. in intensive care units are a growing concern. High-dose meropenem is used in the treatment of these infections.

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2014

To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize ... more To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities. By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey. Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatiti...

American Journal of Infection Control, 2015

Background: Surgical site infections (SSIs) are a threat to patient safety; however, there were n... more Background: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. Methods: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. Results: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). Conclusions: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.

Infection, 1994

Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-B (NANB) hepatitis. Wa... more Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-B (NANB) hepatitis. Water-borne epidemics have been reported in many developing countries primarily affecting young and middle-aged adults. To determine the role of HEV in acute sporadic NANB hepatitis, we have studied the profiles of anti-HEV IgG in the sera of patients previously diagnosed for NANB hepatitis. We tested the sera of 53 patients with acute NANB hepatitis and 100 healthy people as a control group for anti-HEV IgG. Thirty-nine of the 53 patients (73.3%) and none of the control group were positive for HEV infection, according to results shown by ELISA. This result suggests that HEV is a common cause of acute sporadic NANB hepatitis in Turkey. Further studies are needed in the other regions to determine the true prevalence of HEV infection in Turkey.

Infection Control and Hospital Epidemiology, 2013

To assess the feasibility and effectiveness of the International Nosocomial Infection Control Con... more To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance. An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period. Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey. Healthcare workers at 99 ICU members of the INICC. A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods. A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% ([Formula: see text]). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; [Formula: see text]), physicians versus nurses (62% vs 72%; [Formula: see text]), and adult versus neonatal ICUs (67% vs 81%; [Formula: see text]), among others. Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented.

BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tube... more BACKGROUND:
The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM.
METHOD:
BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups.
RESULTS:
The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently.
CONCLUSIONS:
When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.

Travel Medicine and Infectious Disease, 2015

Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis dif... more Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis differential diagnosis, Travel Medicine and Infectious Disease (2015), http://dx.

Infection, 2008

Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of... more Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of the study was to investigate device associated infection rates in a small Turkish hospital. Device utilization ratios and device associated infection rates were calculated according to definitions of the Centers for Disease Control (CDC). During a period of 24 months 1,387 patients were surveyed in our ICUs. A total of 287 device associated infections were detected. In our study ventilator associated pneumonia was the most frequent nosocomial infection with a rate of 59.7 per 1,000 ventilator days. The most frequent pathogen of device associated infection was Candida spp. High rates of device associated infections in a small Turkish hospital clearly indicate the urgent need of the implementation of infection control guidelines.

Travel Medicine and Infectious Disease, 2015

Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis dif... more Please cite this article in press as: Erdem H, et al., Tuberculous and brucellosis meningitis differential diagnosis, Travel Medicine and Infectious Disease (2015), http://dx.

The Journal of Dermatology, 2005

Henoch-Schölein purpura is usually a disease of children presenting with arthralgia, abdominal pa... more Henoch-Schölein purpura is usually a disease of children presenting with arthralgia, abdominal pain, renal involvement, and palpable purpura. Viral and bacterial infections may have a role in its etiology. We present a 32-year-old male patient with recurrent Henoch-Schölein purpura in association with a chronic hepatitis B infection of ten years duration. The patient had received lamuvidine and interferon-alpha for the treatment of hepatitis B infection for a year. The skin lesions disappeared with the treatment of the hepatitis B infection. Four months after discontinuation of the therapy, the purpuric papules reappeared with reactivation of the hepatitis B infection. Although rarely reported, hepatitis B virus infection should be considered in patients with Henoch-Schölein purpura.

Acta Neurologica Scandinavica, 2009

In 14 normal male adults and 97 male patients having impotence alone or together with systematic ... more In 14 normal male adults and 97 male patients having impotence alone or together with systematic and/or neuro-psychiatric symptoms and signs, the somatosensory cerebral-evoked potentials were obtained by glans penis stimulation (penile SEP); by peroneal nerve stimulation (peroneal SEP) and by electrically-induced bulbocavernous (BC) reflex. In normal subjects, the configurations of both SEPs were basically similar, except that the onset of latency was 1&15 msec longer and the amplitude in the PI-NI component was higher in penile SEP. BC-reflex latency was abnormally prolonged, especially in diabetic impotence and in patients with cauda/ conus lesions, while the abnormalities on the penile and peroneal SEP were more frequent in patients with spinal cord injuries, MS and parkinsonism. In impotent patients with epilepsy, chronic prostatitis and psychogenic problems, all the tests were generally normal.

Psychosomatics, 2005

The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of the... more The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of their psychological state. Participants (43 asymptomatic hepatitis B virus carriers and 43 healthy comparison subjects) completed self-report questionnaires. Psychiatric disorders and psychosocial functioning were evaluated with structured clinical interviews and the Global Assessment of Functioning scale. Hepatitis B virus carriers were more likely to have psychiatric disorders than comparison subjects (30.2% vs. 11.6%). Also, carriers had significantly higher depression and anxiety scores and lower Global Assessment of Functioning scores than did comparison subjects. Worries about contamination and illnesses related to hepatitis B infection were associated with the presence of psychiatric disorder. The results suggest that asymptomatic hepatitis B virus carriers need emotional support.

Journal of Surgical Research, 2005

Materials and methods. Graft infections were established in the back subcutaneous tissue of 120 a... more Materials and methods. Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation of 1-cm 2 Dacron/ ePTFE prosthesis followed by topical inoculation with 2 ؋ 10 7 CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1 ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture.

SUMMARY Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various c... more SUMMARY Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various clinical findings. It can lead to complications affecting many systems. Endocarditis is an infrequent, but serious complication of brucellosis. The aim of this case presentation is to remind that endocarditis can be a complication of brucellosis and if is undiagnosed or misdiagnosed, progresses fatal in a

The Journal of Infection in Developing Countries, 2008

Background: Infectious complications in febrile neutropenic patients are still major causes of mo... more Background: Infectious complications in febrile neutropenic patients are still major causes of morbidity and mortality despite significant advances in diagnostic techniques and antimicrobial therapy. In this study, we describe the characteristics of patients with hematological malignancies who were evaluated for suspected infection. This study was also conducted to assess the isolation rate of bacterial and fungal causative agents in febrile neutropenic attacks. Method: The study was conducted at Pamukkale University Hospital, Turkey. In order to identify the characteristics of patients with hematological malignancies in the presence/suspicion of any accompanying infectious disease, patients' charts with hematological malignancies were reviewed for signs/symptoms of any infection between October 1, 2001, and May 31, 2005, retrospectively. Results: Overall, 90 infectious episodes occurred in 59 patients. The most common underlying diseases were acute myelogenous leukemia (61.0%) and acute lymphocytic leukemia (15.3%). The absolute neutrophil count was lower than 100/mm³ in 33 (36.7%) episodes. Microbiologically and clinically documented infections and fever of unknown origin were observed in 35.6%, 28.9%, and 35.6% of the participants, respectively. Bloodstream infections and pneumonia were detected in 21.1% and 18.9% of episodes, respectively. Gram negative organisms were most common (58.4%), followed by gram positive cocci. A combination of third generation cephalosporin and an aminoglycoside were used in 44.4% of episodes initially. Fever resolved in 24.4% of episodes using the initial therapy. The mortality rate was 15.6%. Conclusion: These results showed that infections with gram-negative bacteria continue to predominate in febrile neutopenic episodes in our center.

Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2004

A prospective study was designed in order to determine to what extent antibiotics are used in tre... more A prospective study was designed in order to determine to what extent antibiotics are used in treating community-acquired infections and their costs. Between February and July 2001 a total of 43,011 prescriptions from a representative sample of pharmacies in the city of Denizli (Turkey) were evaluated during the study period. Antibiotics accounted for 16.4 % of total prescriptions and 30.8% of the market value of drugs. Penicillins (49.7%), followed by cephalosporins (17.3%), macrolides (9.5%), and aminoglycosides (7.6%) were the most frequently prescribed antibiotics during the study period. The economic burden of antibiotic usage in the community is found higher than in developed countries. In order to reduce this cost the proper use of antibiotics is a matter of urgency

Objective: To determine epidemiology and risk factors for nosocomial infections in intensive care... more Objective: To determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU). Design: Prospective incidence survey. Setting: An adult general ICU in a university hospital in western Turkey. Patients: All patients who stayed more than 48 h in ICU during a 2-year period (2000-2001). Measurements and results: The study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillinresistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26-32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41-66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34-45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47-5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10-30.20; P=0.04) and APACHE II scores 10-19 (OR: 10.80; 95% CI: 1.10-106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001). Conclusion:

Summary Introduction: The treatment of postoperative mediastinitis is very important because of i... more Summary Introduction: The treatment of postoperative mediastinitis is very important because of its high morbidity, mortality, and increased hospital stay and hospital costs. The aims of our research were to investigate whether linezolid alone can be an effective treatment agent for methicillinresistant Staphylococcus aureus (MRSA) mediastinitis, and to determine whether linezolid can provide synergistic activity when given in combination with rifampin. Methods: A partial upper median sternotomy was performed on 70 rats. The animals were divided into seven groups: an uncontaminated control group; an untreated contaminated group; three contaminated groups that received antibiotic therapy with either 25 or 50 mg/kg linezolid twice a day, or rifampin 5 mg/kg twice a day; and two contaminated groups that received a combination therapy consisting of 25 or 50 mg/kg linezolid and rifampin 5 mg/kg twice a day. The antibiotic treatment lasted 7 days. Tissue samples from the upper ends of the sternum and swab specimens of the upper mediastinum were obtained and evaluated microbiologically. Results: The 25-mg/kg dose of linezolid, either alone or combined with rifampin, was not effective in reducing the bacterial counts in mediastinum and sternum. Quantitative bacterial cultures of mediastinum and sternum were significantly lower in the groups receiving 50 mg/kg linezolid alone or in combination with rifampin compared with the control. Adding of rifampin to linezolid therapy did not result in a significant change in bacterial counts versus linezolid alone. Conclusion: A high dose of linezolid should be considered as a possible therapeutic agent for the treatment of post-sternotomy infection caused by MRSA. #

International Journal of Infectious Diseases, 2008

Streptococcus mitis, an important member of the viridans streptococci and a normal part of the or... more Streptococcus mitis, an important member of the viridans streptococci and a normal part of the oropharynx, skin, gastrointestinal system, and female genital system flora, is a bacterium with low pathogenicity and virulence. 1-5 How-ever viridans streptococci are the most common cause of subacute bacterial endocarditis. 3 S. mitis causes severe clinical conditions including sepsis and septic shock especially in neutropenic patients. 4,6 Meningitis with S. mitis is rare, but has been described in individuals with previous spinal anesthesia, neurosurgical procedure, malignancy, or neurological complications of endocarditis, and in newborns. 2,3,7-12 We report herein an unusual case of S. mitis meningitis in a man with a history of alcoholism, poor oral hygiene, and maxillary sinusitis.

Klimik Dergisi/Klimik Journal, 2010

Intravesical bacillus Calmette-Guerin (BCG) administration is used as a treatment method in super... more Intravesical bacillus Calmette-Guerin (BCG) administration is used as a treatment method in superficial bladder cancer and is generally well tolerated. Side effects following BCG are usually mild and self-limiting and serious systemic side effects are rarely seen. BCG-related ...