Person: ERTÜRK ŞENGEL, BUKET
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ERTÜRK ŞENGEL
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BUKET
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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 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 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 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.Publication Open Access Cryptococcus meningitis presented with multiple cerebral infarcts in an immunocompetent patient(ELSEVIER SCI LTD, 2021) ERTÜRK ŞENGEL, BUKET; Sengel, Buket Erturk; Tigen, Elif Tukenmez; Sarinoglu, Rabia Can; Midi, Ipek; Cerikcioglu, Nilgun; Odabasi, ZekaverCryptococcus neoformans is generally observed with immunosuppressive conditions. Rarely, it may be seen in immunocompetent individuals and presented with non-specific conditions. We described an immunocompetent case of cryptococcal meningitis presented with multiple cerebral infarcts. Despite the late diagnosis and emergence of hydrocephalus during treatment, the patient was recovered without any sequelae. In immunocompetent patients, the conventional diagnostics tests may be negative because of the low fungal load. If it is available, the Biofire FilmArray meningitis panel has high sensitivity and specificity for diagnosis. (C) 2021 The Authors. Published by Elsevier Ltd.Publication 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 Determination of fosfomycin susceptibility in carbapenemase-producing K. pneumoniae strains isolated prior to clinical use of the intravenous formulation in Turkey(MARMARA UNIV, FAC MEDICINE, 2021-05-25) ERTÜRK ŞENGEL, BUKET; Altinkanat Gelmez, Gulsen; Can, Baris; Erturk Sengel, Buket; Korten, Volkan; Soyletir, GunerObjectives: The incidence of infections caused by carbapenem-resistant Enterobacteriaceae has increased worldwide. Limitations in the development of new antimicrobial agents have led clinicians to reconsider the clinical efficiency of old antibiotics, such as intravenous formulation of fosfomycin, in the treatment of multidrug-resistant Gram-negative bacterial infections. We investigated the fosfomycin susceptibility of carbapenemase-producing Klebsiella pneurnoniae strains isolated prior to the clinical use of the intraveno US formulation of fosfomycin in Turkey. Materials and Methods: A total of the 155 K. pneurnoniae isolates which previously characterized at the molecular level for their carbapenemase were included in this study. The minimum inhibitory concentration of fosfomycin was determined by the agar dilution method. Results: Overall, 65.1% of the isolates were susceptible to fosfom ycin. The MIC50 and MIC90 values were 32 and 256 mg/L, respectively. According to our results, at least two-third of carbapenemase-positive K. pneumoniae are susceptible to fosfomycin. Conclusions: Although, the susceptibility of fosfomycin, which has just been put into the clinical use of intravenous formulation in Turkey, is not very high, it can be considered as an alternative adjunct antimicrobial for the treatment of systemic infections caused by carbapenentase-positive K. pneumoniae isolates.Publication Open Access Medication reconciliation service in hospitalized patients with infectious diseases during coronavirus disease-2019 pandemic: An observational study(2023-08-01) ENVER, CÜNEYD; ERTÜRK ŞENGEL, BUKET; SANCAR, MESUT; KORTEN, VOLKAN; OKUYAN, BETÜL; ENVER C., ERTÜRK ŞENGEL B., SANCAR M., KORTEN V., OKUYAN B.Objectives: To determine the prevalence and type of medication discrepancies and factors associated with unintentional discrepancies and identify the rate of hospital readmission and emergency service visit within 30 days after discharge among hospitalized patients with infectious diseases and receiving clinical pharmacist-led medication reconciliation during the coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods: This observational study was conducted in the internal medicine and infectious diseases wards of a tertiary university hospital between July 2020 and February 2021 among hospitalized adult patients with infectious diseases. Medication reconciliation service (including patient counseling) was provided in person or by telephone. The number and type of medication discrepancies detected during the medication reconciliation services, the acceptance rate of pharmacists’ recommendation, and factors associated with having at least one unintentional medication discrepancy at admission were evaluated. At follow-up, hospital readmission and emergency service visit within 30 days after discharge were assessed by telephone. Results: Among 146 patients, 84 (57.5%) had at least one unintentional discrepancy at admission. Only three unintentional discrepancies were determined in three patients at hospital discharge. All the pharmacists’ recommendations for medication discrepancies were accepted by the physicians. Having COVID-19 [odds ratio (OR): 2.25, 95% confidence interval (CI): 1.15-4.40; p<0.05], being at a high risk for medication error (OR: 2.01, 95% CI: 1.03-3.92; p<0.05), and higher number of medications used at home (OR: 1.41, 95% CI: 1.23-1.61; p<0.001) were associated with having at least one unintentional discrepancy at admission. The rates of 30 day hospital readmission and admission to the emergency medical service were 12.3% and 15.8%, respectively. Conclusion: Medication reconciliation service provided by in-person or by telephone was useful for detecting and solving unintentional medication discrepancies during the COVID-19 pandemic.