Person: ERTÜRK ŞENGEL, BUKET
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ERTÜRK ŞENGEL
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Publication Open Access A rare Case of otitis media-associated polymicrobial anaerobic meningitis and brain abscess(2021-12-01) ERTÜRK ŞENGEL, BUKET; TİGEN, ELİF; OLUÇ, YUSUF; ÜLGER, NURVER; KORTEN, VOLKAN; ERTÜRK ŞENGEL B., TİGEN E., YILDIZ F., OLUÇ Y., ÜLGER N., KORTEN V.Otitis media-associated complications are widespread when it is not treated with appropriate antimicrobial treatment. Meningitis and brain abscess are the most reported intracranial complications of otitis media, usually caused by the direct spread of organisms from the contagious site. While anaerobic microorganisms are well-known in brain abscesses, they are not common in meningitis. When the clinical history and pathogenesis of otitis mediaassociated meningitis are combined, special methods to identify and cover anaerobic pathogens should be consideredPublication Open Access Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey(ELSEVIER SCI LTD, 2015-07) ERTÜRK ŞENGEL, BUKET; Saltoglu, N.; Yemisen, M.; Ergonul, O.; Kadanali, A.; Karagoz, G.; Batirel, A.; Ak, O.; Eraksoy, H.; Cagatay, A.; Vatan, A.; Sengoz, G.; Pehlivanoglu, F.; Aslan, T.; Akkoyunlu, Y.; Engin, D.; Ceran, N.; Erturk, B.; Mulazimoglu, L.; Oncul, O.; Ay, H.; Sargin, F.; Ozgunes, N.; Simsek, F.; Yildirmak, T.; Tuna, N.; Karabay, O.; Yasar, K.; Uzun, N.; Kucukardali, Y.; Sonmezoglu, M.; Yilmaz, F.; Tozalgan, U.; Ozer, S.; Ozyazar, M.We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121(27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum beta-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% Cl 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% Cl 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% Cl 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% Cl 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% Cl 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% Cl 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% Cl 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Publication Open Access Diagnostic performance between RT-PCR and chest CT in outpatients with clinically suspected COVID-19(2023-08-01) TİGEN, ELİF; ERTÜRK ŞENGEL, BUKET; ÇİMŞİT, CANAN; APAYDIN KAYA, MEMNUNE ÇİĞDEM; KORTEN, VOLKAN; TİGEN E., ERTÜRK ŞENGEL B., ÇİMŞİT C., PERK GURUN H., APAYDIN KAYA M. Ç., KORTEN V.Objective: To investigate the diagnostic performance between chest computed tomography (CT) and reverse transcription-polymerase chain reaction (RT-PCR) in outpatients with suspected coronavirus disease 2019 (COVID-19). Patients and Methods: Between March and June 2020, a total of 812 patients with clinically suspected COVID-19 who underwent both chest CT and initial-single RT-PCR on admission to outpatient units were retrospectively enrolled. CT severity-score (CT-SS) was calculated and data were matched with PCR results. Results: Of 812 patients, 54% (439/812) had positive RT-PCR results, and 47% (425/812) had a positive chest CT scan. With RT-PCR results as reference, the sensitivity, specificity, accuracy of chest CT in defining COVID-19 infection were 60%, (95% CI 56-65%, 265/439 patients), 57% (95% CI 52-62%, 213/373), 59% (95% CI 55-62%, 478/812), respectively. Three hundred eighty-seven (47%) patients had no CT findings, 380/812 (46.8%) had mild, 45/812 (5.5%) had moderate, and no patients in the severe group Conclusion: Chest CT did not show high sensitivity for the diagnosis of COVID-19 for outpatients. We suggest RT-PCR should be the primary diagnostic tool. Chest CT might be considered if there is a strong clinical suspicion with repeatedly negative RT-PCR test results, ensuring infection prevention and control measures can be preserved.Publication Metadata only COVID-19 tanısı ile antikoagulasyon altında gelişeninfekte retroperitoneal hematom(2021-05-26) ERTÜRK ŞENGEL, BUKET; KORTEN, VOLKAN; Marku M., ERTÜRK ŞENGEL B., Çolak G. M. , KORTEN V.Amaç C.auris sağlık bakımı ilişkili infeksiyonlara neden olan, birçok antifungale dirençli son derece virülan bir mantardır. Sağlık merkezlerinde salgınlara neden olduğundan erken tanı konulması gerekli önlemlerin alınması bakımından çok önemlidir. Ancak standart laboratuvar teknikleri ile tanımlanması zordur ve spesifik yöntemler kullanılmazsa yanlış tanımlanabilir. Bu yazı COVID-19 tanısı ile yoğun bakımında yatmakta olan hastalarda nadir ve infeksiyon kontrol açısından büyük risk oluşturan C.auris üremelerini anlatmaktadır. Olgular Hastaların demografik ve klinik özellikleri Tablo 1’de özetlenmiştir. Tüm hastaların 60 yaşın üzerinde olması, öncesinde geniş spektrumlu antibiyotik ve steroid kullanım öyküleri olması dikkat çekmektedir. İntrakranial kanama nedeniyle opere edilen Olgu 1’in yara yeri ve Olgu 2’nin ise genital bölge sürüntüsünde C.auris üremesi olmuştur ve etken olarak kabul edilmemişlerdir. Olgu 5’in ise inguinal bölge sürüntü kültürlerinin yanı sıra periferik kan ve idrar kateter kültürlerinde de üreme olduğundan etken olarak kabul edilmiştir. Hastalara ait klinik örneklerden üretilmiş maya kolonileri MALDI-TOF MS (VITEK MS, V3.0, BioMérieux) kullanılarak % 99.9 identifikasyon skoru oranlarıyla C.auris olarak tanımlanmıştır. Olgu 4 halen yatmakta olup diğer tüm hastalar kaybedilmiştir. Sonuç Ülkemizde şimdiye kadar C.auris ile infekte olgu raporlanmamıştır. C. auris üremeleri, COVID-19 nedeniyle yoğun bakım yatışlarının uzaması, COVID-19 seyrinde kullanılan immunsupresif tedaviler ve geniş spektrumlu antibiyotik kullanımları gibi faktörlere bağlı olabilir. Etkenin doğru tanınması ve tedavinin erken başlanması mortalite açısından çok önemlidir. Olgularımız hem COVID-19 hastalarında hem de Türkiye’de bildirilen ilk C.auris vakaları olması nedeniyle dikkat çekici özellik taşımaktadır.Publication Metadata only Outcomes of Fecal Carriage of Extended-spectrum beta-Lactamase After Transrectal Ultrasound-guided Biopsy of the Prostate(ELSEVIER SCIENCE INC, 2014) ERTÜRK ŞENGEL, BUKET; Tigen, Elif Tukenmez; Tandogdu, Zafer; Ergonul, Onder; Altinkanat, Gulsen; Gunaydin, Bilal; Ozgen, Mahir; Sariguzel, Nevin; Sengel, Buket Erturk; Odabasi, Zekaver; Cek, Mete; Tokuc, Resit; Turkeri, Levent; Mulazimoglu, Lutfiye; Korten, VolkanOBJECTIVE To determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (PE) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy (TRUSbx) and its relationship with post-biopsy infections. METHODS A prospective clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted. Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy. Rectal swab culture specimens were acquired immediately before the procedure. Demographic data, prophylaxis choice, quinolone or any other antibiotic consumption within the past 2 months, history of prostatitis, repeat biopsy, intensive care unit admission, hospitalization, urethral catheterization, diabetes mellitus (DM), and steroid usage were recorded. RESULTS ESBL carriage was detected in 19% of patients and quinolone use within the last 2 months; other antibiotic use within the last 2 months and DM were found to be significantly associated (P < .05). Symptomatic urinary tract infection (UTI) on the third day after biopsy was seen in 9% of patients and was associated with fluoroquinolone (FQ) consumption before biopsy. Although ESBL-PE carriage was associated with post-biopsy UTI symptoms, it was not found to be associated with post-biopsy symptomatic UTI. Urosepsis was seen in 2 patients (0.5%) after biopsy, and both the patients were ESBL-PE carriers. CONCLUSION The presence of ESBL-PE was associated with DM and FQ consumption before biopsy. ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation; however, it was not associated with microbiologically proven infections. FQ consumption before TRUSbx was also associated with post-biopsy infections. (C) 2014 Elsevier Inc.Publication Open Access Marmara Üniversitesi Pendik Eğitim ve ID_x000D_ Araştırma Hastanesi’nde 2014-2018 Yılları_x000D_ Arasındaki Kronik Hepatit C Prevalansı,_x000D_ Genotip Dağılımı ve Tedavi Yanıtları(2020) ERTÜRK ŞENGEL, BUKET; Betül ERTÜRK ŞENGEL;Tuğçe BAŞARI;Elif TÜKENMEZ TİGEN;Rabia CAN SARINOĞLU;Barış CAN;ULUHAN SİLİ;Volkan KORTENHepatit C dünyada yaygın olarak görülen ve mortaliteye neden olabilen ciddi bir hastalıktır.Bu çalışmada Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi’nebaşvuran hastalarda anti-HCV seropozitiflik sıklığının ve kronik viral hepatit C (HCV)tanısı konarak tedavi verilen hastaların genotip dağılımları ile tedavi başarılarınındeğerlendirilmesi amaçlanmıştır. Çalışmada retrospektif olarak Ocak 2014-Aralık 2018tarihleri arasında anti-HCV istemi yapılan serum örnekleri taranmıştır. Reaktif bulunanörneklerin HCV RNA pozitiflikleri ile genotip dağılımları ve kronik HCV tanısı ile tedaviverilen hastaların kalıcı viral yanıt başarı oranları değerlendirilmiştir. Total 76,413 hastadan100,100 serum örneğinde anti-HCV istemi yapılmış ve 1,808 (% 2,36) hastadapozitif bulunmuştur. Bu hastaların 1,286’sında (% 71) HCV RNA bakılmış ve 291 (% 23)hastada pozitif saptanmıştır. HCV RNA tespit edilen hastalarda 129’una (% 44) hastanemizdekronik HCV tanısı ile tedavi verilmiştir. En sık genotip 1b saptanmış olup, tedavisonrası 24’üncü haftada kalıcı viral yanıt hastaların % 87’sinde elde edilmiştir. Sonuçolarak antiviral tedavi ile virolojik başarı oranları yüz güldürücü olsa da halen tanı vetedavi alması gereken ancak tespit edilemeyen hasta sayısı da oldukça yüksektir.Publication Metadata only Yara polikliniğine başvuran venöz bacak ülseri(2022-10-16) ERTÜRK ŞENGEL, BUKET; Tak P., Gelgeç İ., DEMİRBAŞ E., ERTÜRK ŞENGEL B., TÜZÜN S.Amaç: Bu vaka sunumunda Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi Yara Polikliniğine sağ ayak ve ayak bileğinde yara ve ağrı şikayetiyle başvuran bir hastanın sunulması amaçlanmıştır. Olgu: Anamnezinde 42 yaşında, erkek hastanın yaklaşık 3 aydır sağ ayak ve ayak bileğinde yara ve ağrı şikâyeti olduğu tespit edilmiştir. Özgeçmişinde 11 yıl önce derin ven trombozu (DVT) olan hastanın bilinen ek bir hastalığı bulunmamaktaydı. Kullandığı herhangi bir ilaç öyküsü bulunmayan hastanın 20 paket/yıl sigara kullanımı öyküsü bulunmaktaydı. Hastanın vitalleri değerlendirildiğinde, ateş: 36,5°C, nabız:86/ritmik, kan basıncı: 128/75 mmHg olarak saptanmıştır. Hastanın fizik muayenesinde sistem sorgusunda herhangi bir patoloji saptanmamış olup, periferik nabzılar bilateral pozitif ve Homans bulgusu şüpheli pozitif olarak tespit edilmiştir. Hastanın yapılan tetkiklerinde HbA1c: %5.4, açlık kan glukozu:86 mg/dl, Hgb:16.3 g/dl olarak saptanmıştır. Ayrıca yara yerinden alınan kültürde helcococcus kunzii (gram pozitif anaerop), dermabacter hominis ve difteroidler üremesi bulunmuştur. Ardından sağ ayak ve ayak bileği kontrastlı MR ile değerlendirilen hastada osteomiyelit gözlenmemiştir. Bilateral alt ekstremize venöz Doppler USG’sinde “sol yüzeyel femoral vende kronik DVT, sağ ve sol popliteal vende DVT sekeli ve kısmi rekanalize DVT” tespit edilmiştir. Hastaya, sigara bırakma polikliniğine yönlendirilerek, sigara bırakma tedavisi başlanmıştır. Ayrıca yara bakım eğitimi verilmiştir. Hastanın yara dokusuna otolitik debridman uygulanmıştır. Yara kültüründeki üremesi nedeniyle hastaya amoksisilin/klavulanik asit 1000 mg 2x1 ve metronidazol 3x500 mg tedavisi başlanmıştır. Saptanan kronik DVT için hastaya 10 gün DMAH 6000 ü 1x1 ve ardından ASA 100 mg 1x1, varis çorabı, mikronize saflaştırılmış flebotonik flavonoid fraksiyonu 2x1 tedavisi başlanmıştır. Bu tedaviler ile hastaya haftalık yara polikliniği kontrolü önerilmiştir. Hastanın takipleri esnasında debridman sonrası yarada iyileşme amacıyla epidermal büyüme faktörü içeren krem tedavisi başlanmış ve haftalık poliklinik kontrolü önerilmiştir. Hastanın 2 aylık tedavi süreci sonunda yaralarında belirgin iyileşme gözlenmiştir. Sonuç: Yara bakımında sağlık hizmetinin multidisipliner yaklaşım ile sunulması iyileşme sürecine önemli katkı sağlamaktadır.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 Metadata only Switch to oral antibiotics in Gram-negative bacteraemia: a randomized, open-label, clinical trial(2023-01-01) ERTÜRK ŞENGEL, BUKET; Omrani A. S., Abujarir S. H., Ben Abid F., Shaar S. H., Yilmaz M., Shaukat A., Alsamawi M. S., Elgara M. S., Alghazzawi M. I., Shunnar K. M., et al.Objectives: To evaluate the safety and efficacy of switching from intravenous (IV) to oral antimicrobial therapy in patients with Enterobacterales bacteraemia, after completion of 3–5 days of microbiologically active IV therapy. Methods: A multicentre, open-label, randomized trial of adults with monomicrobial Enterobacterales bacteraemia caused by a strain susceptible to ≥1 oral beta-lactam, quinolone, or trimethoprim/sulfamethoxazole. Inclusion criteria included completion of 3–5 days of microbiologically active IV therapy, being afebrile and haemodynamically stable for ≥48 hours, and absence of an uncontrolled source of infection. Pregnancy, endocarditis, and neurological infections were exclusion criteria. Randomization, stratified by urinary source of bacteraemia, was to continue IV (IV Group) or to switch to oral therapy (Oral Group). Agents and duration of therapy were determined by the treating physicians. The primary endpoint was treatment failure, defined as death, need for additional antimicrobial therapy, microbiological relapse, or infection-related re-admission within 90 days. Non-inferiority threshold was set at 10% in the 95% CI for the difference in the proportion with treatment failure between the Oral and IV Groups in the modified intention-to-treat population. The protocol was registered at ClinicalTrials.gov (NCT04146922). Results: In the modified intention-to-treat population, treatment failure occurred in 21 of 82 (25.6%) in the IV Group, and 18 of 83 (21.7%) in the Oral Group (risk difference –3.7%, 95% CI –16.6% to 9.2%). The proportions of subjects with any adverse events (AE), serious AE, or AE leading to treatment discontinuation were comparable. Discussion: In patients with Enterobacterales bacteraemia, oral switch, after initial IV antimicrobial therapy, clinical stability, and source control, is non-inferior to continuing IV therapy.Publication Open Access Clinical pharmacist-led medication reconciliation service in patients with infectious disease during COVID-19 pandemic(2021-10-29) ERTÜRK ŞENGEL, BUKET; SANCAR, MESUT; OKUYAN, BETÜL; KORTEN, VOLKAN; ENVER C., ERTÜRK ŞENGEL B., SANCAR M., KORTEN V., OKUYAN B.