Person: KORTEN, VOLKAN
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KORTEN
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VOLKAN
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Publication Open Access An outbreak investigation of Burkholderia cepacia infections related with contaminated chlorhexidine mouthwash solution in a tertiary care center in Turkey(BMC, 2021-12) GÜL, FETHİ; Bilgin, Huseyin; Gelmez, Gulsen Altinkanat; Bayrakdar, Fatma; Sayin, Elvan; Gul, Fethi; Pazar, Nazli; Culha, Gulcan; Yildiz, Serap Suzuk; Cinel, Ismail; Korten, VolkanBackground: We report a nosocomial outbreak caused by Burkholderia cepacia that occurred among six patients admitted in the medical and surgical intensive care unit between 04 March 2019 and 02 April 2019 in Istanbul, Turkey. Methods: The outbreak investigation was launched on 11 March 2019 five days after the detection of B. cepacia in four different patients. We defined potential reservoirs and started environmental screening. We sampled the liquid solutions used in patient care activities. Pulse-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness of environmental and patient samples. Results: Burkholderia cepacia was isolated in tracheal aspiration cultures of six patients. Three out of six patients developed healthcare-associated pneumoniae due to B. cepacia. Environmental cultures in the ICUs revealed B. cepacia growth in 2% chlorhexidine-gluconate mouthwash solution that been used in the colonized patients as well as in samples obtained from the unused products. PFGE revealed the patient and a specific batch of chlorhexidine mouthwash solution samples had a 96% similarity. Conclusion: Contamination of medical solutions used in critical patient care could cause outbreaks and should be detected early by infection control teams.Publication Open Access Miliary Tuberculosis Induced Acute Liver Failure(HINDAWI LTD, 2015) BİLGİN, HÜSEYİN; Toptas, Tayfur; Ilhan, Birkan; Bilgin, Huseyin; Dincses, Elif; Ozdogan, Osman; Kaygusuz-Atagunduz, Isik; Odabasi, Zekaver; Korten, Volkan; Firatli-Tuglular, TulinHepatobiliary tuberculosis is uncommon even in endemic countries. It is associated with a high mortality and is even diagnosed early in the disease course. Acute liver failure (ALF) caused by tuberculosis bacilli has been reported in only a few reports. All previous cases have been diagnosed by postmortem examination. Time to antituberculosis treatment is very critical. In case of suggestive findings on clinical and radiologic examination, antituberculosis treatment should be initiated immediately. Drug use can be a challenge in patients with ALF. However, as long as the other possible causes of ALF can be excluded and hepatotoxic drugs were avoided during the early course of treatment, such a highly fatal presentation of tuberculosis can be treated safely. Here, we report a case of acute liver failure as a presentation of miliary tuberculosis. He was treated successfully with antituberculosis treatment.Publication Open Access Successful treatment of an invasive fungal infection caused by Talaromyces sp. with voriconazole(ELSEVIER SCIENCE BV, 2015-06) BİLGİN, HÜSEYİN; Sili, Uluhan; Bilgin, Huseyin; Masania, Rikesh; Eryuksel, Emel; Cimsit, Nun I. Cagatay; Ayranci, Gulcicek; Richardson, Malcolm; Korten, VolkanInvasive fungal infections (lFl) are on the rise due to increasing numbers of immunosuppressed and critically ill patients. A malignant-looking pulmonary nodule in an immunosuppressed patient may indeed be caused by a fungal organism. We report a patient, who was eventually diagnosed with an IFI caused by an agent of hyalohyphomycosis, Talaromyces sp determined via molecular methods and succesfully treated with voriconazole. (C) 2015 The Authors, International Society for Human and Animal Mycology Published by Elsevier B.V.Publication Open Access Transmission of SARS-CoV-2 in Different Districts of a County in Istanbul, March to September 2020(SAGE PUBLICATIONS INC, 2021-07) TOPUZOĞLU, AHMET; Bilgin, Huseyin; Topuzoglu, Ahmet; Korten, VolkanEpidemics caused by airborne viruses in cities with large populations create a big problem as in the current COVID-19 pandemic. Cramped lifestyle, busy workplaces, crowded public transportation, and higher household member counts are responsible for the transmission of the disease. In Turkey, Istanbul has taken the lead in the number of cases since the beginning of the epidemic. The excess population density is the major cause for disease transmission. It is essential to monitor the contaminated regions with geographical information systems on city maps. Outbreak maps visualize and help analyze the patterns of transmission and serve as a communication and education tool. A dynamic heat map video of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction positive cases in a county of Istanbul was generated. The heat map visualizes how the epidemic spread to all the districts and the cumulative cases increased in one county of Istanbul with real attack rates.Publication Open Access The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system(ELSEVIER SCI LTD, 2019-05) ERTÜRK ŞENGEL, BUKET; Sengel, Buket Erturk; Bilgin, Huseyin; Bilgin, Beyza Oren; Gidener, Tolga; Saydam, Simge; Pekmezci, Aslihan; Ergonul, Onder; Korten, VolkanObjectives: Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP. Methods: A prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use >= 72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use >= 72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods. Results: A total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095). Conclusions: This study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.Publication Open Access Hand hygiene knowledge, perception and practice of healthcare workers in a Turkish university hospital intensive care unit(J INFECTION DEVELOPING COUNTRIES, 2019-08-31) BİLGİN, HÜSEYİN; Sili, Uluhan; Ay, Pinar; Bilgin, Huseyin; Hidiroglu, Seyhan; Korten, VolkanIntroduction: While improvement of hand hygiene (HH) compliance is considered as the best approach to reduce healthcare-associated infections, the instructional interventions in HH among healthcare workers of intensive care unit (ICU) of our hospital was not successful enough. The following study was conducted to evaluate HH knowledge, perception, practice and effectiveness of the trainings among healthcare workers of ICU in our hospital. Methodology: A cross-sectional study was conducted in the ICU containing 8 medical and 16 surgical beds with 284 filled questionnaires about HH knowledge and 1187 observed opportunities for HH compliance. Results: Overall observed HH compliance rate was 40.6%; lowest compliance was 21.7% for before clean/aseptic procedure indication and highest compliance was 68.6% for after touching a patient indication. Although > 90% healthcare workers correctly identified the World Health Organization's five indications for HH, 82 -85% failed to recognize non-indications, i.e. when it was not necessary to perform HH. Our study showed that 15.1% of healthcare workers neither received nor felt the need for HH training. Conclusions: Despite regular HH trainings, healthcare workers could not differentiate when HH was not required which suggested failure to understand HH rationale. This may explain poor HH compliance rates. A systematic study is needed in order to find out the reasons behind of this noncompliance and improve HH training methods for educating healthcare workers.Publication Open Access Frequency and associated factors for carbapenem-non-susceptible Bacteroides fragilis group bacteria colonization in hospitalized patients: Case control study in a university hospital in Turkey(ELSEVIER, 2021-10) ÖZAYDIN, AYŞE NİLÜFER; Toprak, Nurver Ulger; Akgul, Oncu; Bilgin, Huseyin; Ozaydin, Ayse Nilufer; Gelmez, Gulsen Altinkanat; Sayin, Elvan; Sili, Uluhan; Korten, Volkan; Soyletir, GunerPurpuse: The carbapenem-resistant Bacteroides fragilis group (CR-BFG) bacteria have been reported in several countries recently with increasing global attention. The high incidence of CR-BFG isolated from our hospitalized patients has become an important problem. Therefore, we aimed to determine the frequency and associated factors for intestinal colonization by carbapenem-non-susceptible BFG (CNS-BFG) among adult patients hospitalized at intensive care units, neurosurgery and internal medicine wards in our hospital. Methods: Rectal swabs (n = 1200), collected from 766 patients between February 2014 and March 2015, were inoculated onto kanamycin-vancomycin-leaked blood agar containing 0.125 mg/L meropenem. The isolates were identified by MALDI-TOF MS. Susceptibility testing was performed by agar dilution method. The carbapenemase gene (cfiA) was detected by PCR. Logistic regression analysis was used to evaluate the associated factors for intestinal colonization by CNS-BFG. Results: A total 180 non-duplicate BFG isolates were obtained from 164 patients. Ten different species, including Parabacteroides distasonis (n = 46, 25.6%), and Bacteroides fragilis (n = 30; 16.6%), were identified. Twenty- five percent of the isolates were non-susceptible to meropenem (MIC >2 mg/L). The highest prevalence of meropenem resistant strains (MIC >8 mg/L) was detected among B. fragilis (n = 12), followed by Parabacteroides spp. (n = 4). All but one B. fragilis strains were cfiA gene positive. Hospital admission, increasing Charlson score, use of antibiotics; including carbapenems in past three months, colonization with other accompanying carbapenem-resistant Gram negative bacteria (Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa), and having undergone surgical operations were significantly associated with RCS- BFG colonization. Conclusions: The high carriage rate of CNS-BFG in hospitalized patients may lead to worse clinical outcomes, such as serious infections and mortality, and deserves attention.Publication Open Access Comparison of SARS-COV-2 antibody assays in PCR negative and PCR positive Turkish patients(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2021) KARAHASAN, AYŞEGÜL; Karahasan, Aysegul; Sarinoglu, Rabia Can; Can, Baris; BIlgIn, Huseyin; Cimsit, Nuri Cagatay; Korten, VolkanPublication Open Access Occupation-Related Injuries Among Healthcare Workers: Incidence, Risk Groups, and the Effect of Training(CUREUS INC, 2021-04-06) ERTÜRK ŞENGEL, BUKET; Sengel, Buket Erturk; Tigen, Elif Tukenmez; Bilgin, Huseyin; Dogru, Arzu; Korten, VolkanBackground and objective Occupation-related injuries (ORIs) are undesirable and harmful situations among healthcare workers (HCWs) and may have serious consequences. In this study, we aimed to identify and analyze ORI incidences, risk groups, and the outcomes of a training program to prevent them. Materials and methods Between January 2011 and December 2019, HCWs who applied for infection prevention and control (IPC) due to ORIs (percutaneous needlestick and sharp-object injury or contact with blood or body fluids) were included in the study. Their characteristic features, vaccine histories, injury types, viral serologies, and administered prophylaxis were recorded. After 2014, a periodic ORI training program was started. We used joinpoint regression analysis to compare the ORI incidences before and after the education program. Results During the nine-year study period, 965 ORIs were registered. The mean age of HCWs was 39.3 +/- 8.4 years, and 67.9% of them were female. The total injury incidence for all professions was 34.1 (95% CI: 33.1-37.5) per 1,000 HCWs. The injury incidences were significantly higher in nurses compared to other HCWs (p<0.01). Most of the injuries occurred in the ward setting (37%). HCWs were injured most commonly while administering treatment (36.7%). The trend analysis for the incidence of injuries showed no significant change throughout the study period. The trend in personal protective equipment (PPE) use showed a significant increase (annual percentage change: 1.7, p<0.01). Conclusions The major finding of this study with respect to its implication on the healthcare system is that nurses are an important risk group for ORIs. Although the ORI incidence did not change during the study period, a significantly increased use of appropriate PPE following a systematic training program implementation was observed.Publication Open Access Relationship of the cycle threshold values of SARS-CoV-2 polymerase chain reaction and total severity score of computerized tomography in patients with COVID 19(ELSEVIER SCI LTD, 2020-12) KARAHASAN, AYŞEGÜL; Yagci, Aysegul Karahasan; Sarinoglu, Rabia Can; Bilgin, Huseyin; Yanilmaz, Ozgur; Sayin, Elvan; Guneser, Deniz; Guncu, Mehmet Mucahit; Doyuk, Zahide; Can, Baris; Kuzan, Beyza Nur; Aslan, Bulent; Korten, Volkan; Cimsit, CagatayAim: Studies analyzing viral load in COVID-19 patients and any data that compare viral load with chest computerized tomography (CT) severity are limited. This study aimed to evaluate the severity of chest CT in reverse transcriptase polymerase chain reaction (RT-PCR)-positive patients and factors associated with it. Methodology: SARS-CoV-2 RNA was extracted from nasopharyngeal swab samples by using Bio-speedy viral nucleic acid buffer. The RT-PCR tests were performed with primers and probes targeting the RdRp gene (Bioexen LTD, Turkey) and results were quantified as cycle threshold (Ct) values. Chest CT of SARS-CoV-2 RNA-positive patients (n = 730) in a period from 22 March to 20 May 2020 were evaluated. The total severity score (TSS) of chest CT ranged 0-20 and was calculated by summing up the degree of acute lung inflammation lesion involvement of each of the five lung lobes. Results: Of the 284 patients who were hospitalized, 27 (9.5%) of them died. Of 236 (32.3%) patients, there were no findings on CT and 216 (91.5%) of them were outpatients (median age 35 years). TSS was significantly higher in hospitalized patients; 5.3% had severe changes. Ct values were lower among outpatients, indicating higher viral load. An inverse relation between viral load and TSS was detected in both groups. CT severity was related to age, and older patients had higher TSS (p < 0.01). Conclusion: Viral load was not a critical factor for hospitalization and mortality. Outpatients had considerable amounts of virus in their nasopharynx, which made them contagious to their contacts. Viral load is important in detecting early stages of COVID-19, to minimize potential spread, whereas chest CT can help identify cases requiring extensive medical care. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.