9 research outputs found
Treatment efficacy and superinfection rates in complicated urinary tract infections treated with ertapenem or piperacillin tazobactam
Background/aim: In this retrospective study, the efficacy of ertapenem
and piperacillin tazobactam was compared in the treatment of complicated
urinary tract infections (cUTIs). Treatment responses were also
evaluated for both antibiotics.
Materials and methods: A total of 230 patients were enrolled in the
study. Of these, 170 received ertapenem and 60 received
piperacillin-tazobactam.
Results: In both groups, urine cultures after 48 h were negative for the
initial uropathogen. The frequency of superinfection was 29.4\% in the
ertapenem group and 8.3\% in the piperacillin-tazobactam group over the
duration of treatment (P < 0.05). Urinary catheterization increased the
superinfection risk 2.88-fold in the ertapenem group and diabetes
mellitus increased the risk 8.50-fold in the piperacillin-tazobactam
group (CI: 1.44-5.76 and 1.16-62.09, respectively, P < 0.05). The main
pathogen isolated from superinfection in the ertapenem group after 48 h
was Enterococcus spp. (71.4\%).
Conclusion: Both ertapenem and piperacillin-tazobactam were effective in
the treatment of cUTIs caused by ESBL-producing microorganisms. A high
frequency of superinfection in the ertapenem group was the result of
Enterococcus and Pseudomonas spp., against which ertapenem is not
active. In the presence of urinary catheterization, diabetes mellitus,
and urological intervention, patients should be closely monitored for
the development of a superinfection, especially patients receiving
ertapenem
Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study
Background Gram-positive spectrum antibiotics such as vancomycin,
teicoplanin, daptomycin, and linezolid are frequently used in empirical
treatment combinations in critically ill patients. Such inappropriate
and unnecessary widespread use, leads to sub-optimal utilisation.
However they are covered by the antibiotics restriction programme. This
prospective observational study, evaluates gram-positive anti-bacterial
utilisations in intensive care units (ICUs) with various evaluation
criteria, to determine the frequency of inappropriate usage and the
intervention targets required to ensure optimum use. Methods This
clinical study was conducted prospectively between 01.10.2018 and
01.10.2019 in the medical and surgical ICUs of Gazi University Faculty
of Medicine Hospital, Turkey. The total bed capacity was 55. Patients
older than 18 years and who were prescribed gram-positive spectrum
antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were
included. Patients under this age or immunosuppressed patients
(neutropenic,- HIV-infected patients with hematologic or solid organ
malignancies) were not included in the study. During the study period,
200 treatments were evaluated in 169 patients. The demographic and
clinical features of the patients were recorded. Besides observations by
the clinical staff, the treatments were recorded and evaluated by two
infectious diseases specialists and two clinical pharmacists at 24-h
intervals from the first day to the last day of treatment. SPSS software
for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data.
Categorical variables were presented as number and percentage, and
non-categorical variables were presented as mean +/- standard deviation.
Results It was found that inappropriate gram-positive antibiotic use in
ICUs was as high as 83\% in terms of non-compliance with the selected
quality parameters. Multivariate analysis was performed to evaluate the
factors associated with inappropriate antibiotic use, increased
creatinine levels were found to increase the risk of such use.
Conclusions In spite of the restricted antibiotics programme,
inappropriate antibiotic use in ICUs is quite common. Thus, it is
necessary to establish local guidelines in collaboration with different
disciplines for the determination and follow-up of de-escalation of such
use and optimal treatment doses
Ceftazidime - Avibactam susceptibility among carbapenem-resistant Enterobacterales in a pilot study in Turkey
This study aimed to detect carbapenemase genes and to determine the in vitro susceptibility of Ceftazidime-Avibactam (CZA) in Enterobacterales isolates. Carbapenemase genes were detected by polymerase chain reaction. CZA sensitivity of isolates was evaluated with broth microdilution (BMD) and disk diffusion methods. A total of 318 carbapenem-resistant Enterobacterales isolates were included. Most of the isolates (n = 290, 91.2%) were identified as Klebsiella pneumoniae. The most common carbapenemase type was OXA-48 (n = 82, 27.6%). CZA susceptibility was evaluated in 84 isolates with OXA-48 and KPC carbapenemase activity. Both BMD and disk diffusion methods revealed that 95.2% of the isolates were sensitive to CZA; whereas, 4 (4.76%) isolates were resistant to CZA. Among colistin resistant isolates, 96.5% (n = 80) of them were susceptible to CZA. Our study demonstrated high in vitro efficacy of CZA in Enterobacterales isolates producing OXA-48 carbapenemase. High susceptibility rates against colistin resistant isolates which generally are also pan drug resistant, makes CZA a promising therapeutic choice for difficult-to-treat infections. Due to its high correlation with the BMD, disk diffusion method is a suitable and more practical method in detecting CZA in vitro activity
The prognostic role of neopterin in COVID-19 patients
In Coronavirus disease-2019 (COVID-19) cases, hyper inflammation is
associated with the severity of the disease. High levels of circulating
cytokines were reported in severe COVID-19 patients. Neopterin produced
by macrophages on stimulation with interferon-gamma, which is an
important cytokine in the antiviral immune response, hence it can be
used to predict the severity of disease in COVID-19 cases. In this
study, it was aimed to determine the prognostic value of the neopterin
for the prediction of severe disease in patients with COVID-19. This
single-center, prospective study was conducted in hospitalized COVID-19
patients and healthy volunteers. Severe and mild COVID-19 cases were
compared in terms of clinical and laboratory findings as well as serum
neopterin levels on hospital admission. To assess the prognostic utility
of neopterin between the severe and mild COVID-19 groups, a
receiver-operating characteristic (ROC) curve was generated, and the
area under the curve (AUC) was calculated. The median serum neopterin
level was four times higher in COVID-19 patients than the healthy
controls (46 vs. 12 nmol/L;p < .001). The AUC value of serum neopterin
was 0.914 (95\% confidence interval, 0.85-0.97). The sensitivity and
specificity of serum neopterin for the cut-off value of 90 nmol/L to
identify severe COVID-19 cases were 100\% and 76\%, respectively. Serum
neopterin levels on hospitalization were significantly higher in severe
COVID-19 disease than mild COVID-19 patients. Neopterin levels can be
used as an early prognostic biomarker for COVID-19 on admission
Post-discharge mortality in the first wave of COVID-19 in Turkey
© 2022 Asian Pacific Journal of Tropical Medicine.Objective: To determine post-discharge mortality and associated factors of the first-wave multicenter Turkish Thoracic Society (TTD)-TURCOVID study. Methods: In this retrospective cohort study, we analyzed the data of 18 of 26 centers included in the first TTD-TURCOVID study, and 1 112 cases diagnosed with COVID-19 between 11 March and 31 July 2020 participated in the study. All causes of death after COVID-19 discharge were recorded. Results: The mean age of the patients was (51.07±16.93) years, with 57.6% male patients. In the cohort group, 89.1% of COVID-19 treatment locations were hospital wards, 3.6% were intensive care units (ICUs), and 7.2% were community outpatients. In the longterm follow-up, the in-hospital mortality rate was 3.6% (95% CI 2.64.8), the post-discharge mortality rate was 2.8% (95% CI 1.9-3.9), and the total mortality was 6.3% (95% CI 5.0-7.8). After discharge, 63.3% of mortality overall occurred during the first six months. Mortality rates in post-discharge follow-ups were 12.7% (95% CI 8.0-30.6) in cancer patients, 10.8% (95% CI 6.3-22.9) in chronic obstructive pulmonary disease patients, 11.1% (95% CI 4.4-22.7) in heart failure patients, 7.8 (95% CI 3.8-14.3) in atherosclerotic heart disease patients, and 2.3% (95% CI 0.8-5.6) in diabetes mellitus patients. In smokers/ex-smokers, the all-mortality rates were higher than in non-smokers. Conclusions: This multicenter study showed that patients over 65 years of age, males, former/active smoker, ICU stay, lung, heart disease, and malignancy should be followed up for at least the first six months after discharge due to COVID-19
The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
© 2021 Elsevier LtdThe COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored
The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort
Copyright © 2022 Babayigit, Kokturk, Kul, Cetinkaya, Atis Nayci, Argun Baris, Karcioglu, Aysert, Irmak, Akbas Yuksel, Sekibag, Baydar Toprak, Azak, Mulamahmutoglu, Cuhadaroglu, Demirel, Kerget, Baran Ketencioglu, Ozger, Ozkan, Ture, Ergan, Avkan Oguz, Kilinc, Ercelik, Ulukavak Ciftci, Alici, Nurlu Temel, Ataoglu, Aydin, Cetiner Bahcetepe, Gullu, Fakili, Deveci, Kose, Tor, Gunluoglu, Altin, Turgut, Tuna, Ozturk, Dikensoy, Yildiz Gulhan, Basyigit, Boyaci, Oguzulgen, Borekci, Gemicioglu, Bayraktar, Elbek, Hanta, Kuzu Okur, Sagcan, Uzun, Akgun, Altinisik, Dursun, Cakir Edis, Gulhan, Oner Eyuboglu, Gultekin, Havlucu, Ozkan, Sakar Coskun, Sayiner, Kalyoncu, Itil and Bayram.Background and objectives: Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods: Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results: We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011). Conclusion: Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment
The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
© 2021 Elsevier LtdThe COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored
Image_1_The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort.JPEG
Background and objectivesAlthough several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity.MethodsPatients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation.ResultsWe retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011).ConclusionOur findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.</p