Care Hospital In Turkey Research Articles

Evaluation of clinical and laboratory predictors of fatality in patients with Crimean-Congo haemorrhagic fever in a tertiary care hospital in Turkey

The fatality rate of Crimean-Congo haemorrhagic fever (CCHF) disease has been reported as 5.4-80%. In this prospective study our aim was to evaluate the clinical and laboratory predictors of fatality in patients with CCHF. Among probable CCHF patients admitted to our clinic between 2005 and 2008, patients with positive IgM antibodies and/or polymerase chain reaction for CCHF virus were included in the study. To determine the predictors of fatality, we compared epidemiological, clinical and laboratory findings of the fatal cases with survivors. Ninety-three confirmed CCHF patients were included in the study; 56 (60.2%) of them were female. Mean patient age was 48.4+/-17.7 y and mean hospital stay was 7.9+/-3.0 days. Five patients died (5.4%). The rates of haemorrhage, diarrhoea and confusion were higher in fatal cases compared with non-fatal cases (p<0.05). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, lactate dehydrogenase (LDH), and C-reactive protein levels were higher in fatal cases; the international normalized ratio (INR) and activated partial thromboplastin time (aPTT) were longer and mean platelet counts were lower (p<0.05). By multivariate analysis, diarrhoea, melena, haematemesis, haematuria, elevated ALT and LDH, and prolongation of aPTT were independent clinical and laboratory predictors associated with fatality. We suggest that for patients who have diarrhoea, melena, haematemesis, haematuria, elevated AST and LDH, and a prolonged aPTT, physicians should be aware of the high fatality risk.

Factors influencing survival in patients with multi-drug-resistant Acinetobacter bacteraemia

Objectives The incidence of multi-drug-resistant (MDR) Acinetobacter strains is increasing and therapeutic options are limited. However, controversy exists regarding the mortality attributable to antimicrobial resistance. The aim of this study was to analyse the clinical features and outcomes of patients with MDR Acinetobacter calcoaceticus–Acinetobacter baumannii complex (Acb complex) bacteraemia and determine the factors influencing survival by using 14-day mortality as the main outcome measure. Methods An observational study was conducted at a tertiary care hospital in Turkey from February 2007 to March 2008. Only one bacteraemic episode from one patient was included in the study. Results A total of 100 clinically significant Acb complex bacteraemic episodes were detected. The overall mortality was 63% in 14 days. According to univariate analysis, diabetes mellitus, haematological malignancy, unknown source of bacteraemia, septic shock, resistance to carbapenems, and inappropriate empirical therapy were associated with mortality amongst patients with Acb complex bacteraemia. Multivariate analysis showed that diabetes mellitus (RR, 1.68; 95% CI, 1.22–1.76), carbapenem resistance (RR, 1.63; 95% CI, 1.19–1.89), and septic shock (RR, 1.65; 95% CI, 1.23–1.85) were independent risk factors for 14-day mortality. Conclusion Although severe underlying diseases play an important role in the clinical outcome of patients with Acb complex bacteraemia, carbapenem resistance and inappropriate therapy are of great concern. Special attention should be paid to infection control practices in the hospitals where MDR Acinetobacter infections are endemic, and well-controlled prospective clinical trials are needed to determine the optimal antimicrobial therapy in critically ill patients suspected of having MDR Acinetobacter bacteraemia.

Emergence and spread of carbapenem-resistant Acinetobacter baumannii in a tertiary care hospital in Turkey

An intensive care unit (ICU)-based OXA-23-producing multiple-drug resistant Acinetobacter baumannii (MDRAB) outbreak was detected between October 2005 and October 2006. A total of 47 patients were infected/colonized with the outbreak strain. Clinical data were available from 37 patients. The all-cause mortality rate among the patients exposed to the epidemic strain was 35% (13/37). The outbreak strain and the resistance determinants were characterized both by microbiological methods and by molecular techniques. Cloning and sequencing experiments identified ISAbaI-associated bla(oxa-23) on the chromosome. Screening of imipenem-resistant Acinetobacter isolated from the ICU during the outbreak period with PCR identified 97 isolates as positive for the ISAbaI-bla(oxa-23) structure. Pulsed-field gel electrophoresis and plasmid analyses with selected nonrepetitive isolates revealed the clonality. Disk diffusion on cloxacillin-supplemented agar media and the real-time PCR experiments showed that outbreak isolates are overexpressing the ampC enzyme. This study highlights the occurrence of OXA-23-producing and ampC-overexpressing MDRAB in ICUs.

Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures

A Crimean-Congo haemorrhagic fever (CCHF) outbreak emerged from 2001 to 2003 in the Middle Anatolia region of Turkey. This study describes the clinical characteristics and outcome features of CCHF patients admitted to four tertiary care hospitals in Turkey. Definitive diagnosis was based on the detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by RT-PCR. Related data were collected by a retrospective chart review. Hospital costs were extracted from the final discharge bills. Univariate and multivariate analyses were conducted to determine the independent predictors of mortality. CCHF virus-specific antibodies or genomic segments were detected in the sera of 99 cases. Seven cases that were treated with ribavirin were excluded from the study. Cases were mostly farmers (83 cases, 90 %), and 60 % had a tick-bite history before the onset of fever. Impaired consciousness and splenomegaly were independent predictors of a fatal outcome.

Evaluation of antibiotic use in intensive care units of a tertiary care hospital in Turkey

The object of this study was to evaluate the appropriateness of antibiotic use in relation to diagnosis and bacteriological findings in the intensive care units (ICUs) of a 1100-bed referral and tertiary care hospital with an antibiotic restriction policy in Turkey. Between June and December 2002, patients who received antibiotics in the medical and surgical ICUs were evaluated prospectively. Two infectious diseases (ID) specialists assessed the antibiotics ordered daily. Of the 368 patients admitted to the ICUs, 223 (60.6%) received 440 antibiotics. The most frequently prescribed antibiotics were first-generation cephalosporins (16.1%), third-generation cephalosporins (15.2%), aminoglycosides (12.1%), carbapenems (10.7%) and ampicillin-sulbactam (8.7%). Antibiotic use was inappropriate in 47.3% of antibiotics. ID specialists recommended the use of 47% of all antibiotics. An antibiotic order without an ID consultation was more likely to be inappropriate [odds ratio (OR)=13.2, P<0.001, confidence intervals (CI)=4.4-39.5]. Antibiotics ordered empirically were found to be less appropriate than those ordered with evidence of culture and susceptibility results (OR=3.8, P=0.038, CI=1.1-13.1). Inappropriate antibiotic use was significantly higher in patients who had surgical interventions (OR=3.6, P=0.025, CI=1.2-10.8). Irrational antibiotic use was high for unrestricted antibiotics. In particular, antibiotic use was inappropriate in surgical ICUs. Additional interventions such as postgraduate training programmes and elaboration of local guidelines could be beneficial.