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Amaç: Kanıta dayalı tıp uygulamaları gerçek bilgiye en güvenilir şekilde ulaşmak, bilimsel aynı zamanda eleştirel düşünceyi geliştirmek açısından önemlidir. Tıpta yeni bilgilere gereksinim, kanıta dayalı tıp uygulamalarının yaygınlaşmasına neden olmaktadır. Sürekli tıp eğitimi de kanıta dayalı tıbbın önemli bir parçası olarak kabul edilmektedir. Fakültemizdeki kanıta dayalı tıp uygulamalarının amacı, tıp fakültesi öğrencilerine kanıta dayalı tıbbın önemini kavratmak, bilimsel bir çalışmanın içinde yer almalarını sağlamak ve bu çalışma basamaklarını öğretmektir Gereç ve Yöntemler: Kanıta dayalı tıp kapsamında yapılan çalışmalar, Tıp Fakültesi Dönem 3 öğrencileri tarafından yürütülmektedir. Dersin sorumlu öğretim üyesi tarafından gruplara ayrılırlar. Her bir grup için de sorumlu araştırmacı öğretim üyesi belirlenir. Ders programında belirlenen tarihlerde öğrenciler bir araya gelip araştırma konusunun başlığını kesinleştirir. Etik kurul formu hazırlanıp etik kurula başvuru yapılır. Çalışma sonlandıktan sonra da özet/makale hâline getirilir ve özet hâline getirilen çalışmalar sunulur ve tartışılır. Bulgular: 2020-2021 Eğitim ve Öğretim döneminde gerçekleştirilen kanıta dayalı tıp kapsamında 194 sayıda Dönem 3 öğrencisi çalıştı. COVID-19 pandemisinin etkileri ve aşı üzerine olan çalışmalar başta olmak üzere; kanser, uyku, güneşin zararları, yeni sosyal hayat ve cinsel mitler gibi güncel konularda sorumlu öğretim üyesi gözetiminde toplam 15 farklı çalışma yapıldı. Bu çalışmaların başlıkları ve sorumlu öğretim üyeleri Tablo-1 de yer almaktadır. Hazırlanan özetler dijital platform üzerinden sunuldu ve tartışıldı. Sonuç: Tüm Dönem 3 öğrencileri, COVID-19 pandemisinden dolayı uzaktan eğitim aldıkları 2020-2021 Eğitim ve Öğretim döneminde çevrimiçi öğrenme ortamlarında bilimsel bir çalışmanın tüm aşamalarını yürüttüler ve çalışmalarını başarıyla sonlandırdılar.

Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesinde COVID-19 pandemi sürecinde eğitim deneyimlerimizi paylaşmayı amaçladık. Fakültemizde YÖK’ün 13 Mart 2020’de eğitim ilgili kararı sonrası tüm dönemlerde eğitim online dijital platformlar üzerinden senkron ve asenkron olarak başladı. Tüm sınavlar dijital platform üzerinden yapıldı. Bu süreçte hem öğretim üyeleri, hem de öğrencilerle düzenli aralıklarla dijital platformlar üzerinden toplantılar yapıldı ve geri bildirimleri alındı. Her ne kadar bu süreç içinde bazı yetersizlikler yaşandıysa da öğrenci ve öğretim üyelerinin adaptasyonu hızlı oldu. Eğitime ara verilmemesiyle öğrenci mağduriyeti yaşanmadı. Bundan sonraki süreçte uzaktan eğitimin tıp eğitiminin ayrılmaz bir parçası olacağını düşünmekteyiz.

Introduction The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. Materials and Methods Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. Results Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1 ± 7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2–11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. Conclusion This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

WOS: 000481718600013, Objective: Leptospirosis is one of the most common zoonotic diseases worldwide. Transmission to humans usually occurs by mucosal inoculation of the bacteria or exposure of non-intact skin via contact with water or soil contaminated with urine or feces of rodents. Occupational groups such as farmers, rice plant workers, sewer workers, miners, hunters, military personnel, mariners, shepherds, milkers, slaughterhouse workers, veterinarians and laboratory personnel are under risk for leptospirosis. In this study, we aimed to determine the seroprevalence of leptospirosis in coal miners in Zonguldak region. Methods: Blood samples were obtained from total 185 volunteer coal miners, who worked in 5 coal mines of Turkish Hard Coal Authority in Zonguldak and Bartin provinces, during June and July 2013. Serum samples were stored at -80 degrees C. Additionally, we conducted an interview with each miner about demographical and epidemiological data such as age, location, duration of mining, other occupations, observing rodent or rodent excreta in the mine, noticing rodent contact with personal belongings or drinks or food in mine and hand hygiene compliance. Microscopic agglutination test (MAT), the reference diagnostic test for seroepidemiological studies of leptospirosis, was conducted in Spirochetal Diseases Diagnostic Laboratory, Veterinary Control Central Research Institute, Etlik, Ankara in June 2014. Anti-Leptospira antibody levels for 8 serotypes (Leptospira grippotyphosa Moskva V, L. australis Bratislava Jez Bratislava, L. canicola Hund Utrech IV, L. hardjo Hardjoprajitno, L. pomona Pomona, L. icterohaemorrhagiae Ictero 1, L. hebdomadis Hebdomadis ve L. patoc Patoc 1) was investigated with MAT. Results: All the miners were male and the mean age was 36 +/- 6. The mean duration of working in underground part of the mine was 11 +/- 6 years, the mean working hours was 44 +/- 6 hours a week on average. Distribution of the miners according to inhabiting location was 18.5% village, 50.3% county and 30.8% city. In addition to mining, some of the miners were also occupied with farming (7%), hunting (2.7%), seafaring (0.5%) and livestock raising (0.5%). 82.7% of the miners confirmed seeing rodents in the mine every day and 35.7% of the miners confirmed seeing rodent excreta in the mine. 68.1% reported observing sign of rodent bite on their clothes or food saving box. 91.9% of the miners reported that they saved their food in plastic or paper bags up to meal time. Hand washing rate in the mine was 76.2% among the miners and 94.3% of those were washing their hands without soap. Although, a risky environment for leptospirosis was defined, no seropositivity was detected in any of the serum samples of the miners. Conclusions: Miners reported risky environmental conditions and risky behavioral models for transmission of leptospirosis. However, no seropositivity was detected in any of the serum samples obtained from 185 miners in Zonguldak region.

BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex (ABC) strains are great problem for intensive care units. ABC strains can develop resistance to all the antibiotics available. Carbapenem resistance is common and colistin resistance is rare in our country. Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country. AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and -resistant Acinetobacter sp. Strains. METHODS During the study period, 108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively. Continuous variables were compared with the Mann-Whitney U test, and categorical variables were compared using Pearson's chi-square test or Fisher's Exact chi-square test for two groups. A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains. RESULTS High Acute Physiology and Chronic Health Evaluation II scores (OR = 1.9, 95%CI: 1.4-2.7; P < 0.001) and prior receipt of teicoplanin (OR = 8.1, 95%CI: 1.0- 63.3; P = 0.045) were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp. Different combinations of antibiotics including colistin, meropenem, ampicillin/sulbactam, amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains. Although the median duration of microbiological cure (P < 0.001) was longer in the colistin-resistant group, clinical (P = 0.703), laboratory (P = 0.277), radiological (P = 0.551), microbiological response (P = 1.000) and infection related mortality rates (P = 0.603) did not differ between the two groups. Among the patients with infections due to colistin-resistant strains, seven were treated with antibiotic combinations that included sulbactam. Clinical (6/7) and microbiological (5/7) response rates were quite high in these patients. CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp. infections. Although combinations with sulbactam seems to be more effective in our study patients, data supporting the usefulness of combinations with sulbactam is very limited. © The Author(s) 2019.

WOS: 000464106600010, Objective: Health care workers are exposed to many infectious agents when compared with general population. Immunization to vaccine-preventable diseases is an important part of infection control among health care workers, both for their own health and to prevent the spread of infections. The aim of this study is to detect the immune status of health care workers of our hospital to measles, mumps, rubella (MMR) and varicella and to define an appropriate vaccination program and also to analyze the cost efficiency of pre-vaccination screening. Methods: This study was conducted at Bulent Ecevit University Hospital between March 2014 and January 2015. The following data were recorded for each participant: age, gender, profession, department, duration of employment, childhood residence location, history of MMR and varicella, and status of vaccinations. The specific IgG antibodies were screened by immunosorbent enzyme-linked assay. Results: 184 health care workers participated in the study. 61.2% were female, and 38.8% were male. The mean age was 32.43 +/- 6.4. The serologic test results revealed that 92.2% of the health care workers were immune to measles, 98.2% were immune to rubella, 94% were immune to mumps and 94.3% were immune to varicella. The validity of the medical history of participants were high for mumps and measles (81.6% and 80.5%, respectively) and low for rubella (43.4%). The positive predictive values for the history of rubella, mumps, varicella and measles were 98.9%, 97.5% and 96.9%, 95.6%, respectively. Cost efficiency analysis showed that the cost of vaccination without screening was more expensive for varicella and MMR (cost difference 18 253 Turkish Lira and 1432 Turkish Lira, respectively) Our findings support that a negative medical history or serological screening before vaccination is cost effective especially for varicella. Conclusions: In conclusion, immune status of health care workers who worked in high-risk departments should be determined by serologic tests and susceptible health care workers must be vaccinated.

Background: Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. Methods: We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. Results: In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. Conclusions: Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn't differ however, they were more efficacious than MPV. © 2018 The Author(s).

WOS: 000436365200003, PubMed: 29924770, Background: Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug-drug interactions associated with antimicrobials among hospitalized patients. Material/Methods: This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged (3) 18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex (R) online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. Results: Potential drug-drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237-3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943-1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035-3.1564) were independent risk factors for developing drug interactions. Conclusions: Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides.

WOS: 000437936900017, Introduction: This study investigated differences in clinical features, types, etiology, and risk factors for complications between young and older patients with skin and soft tissue infections. Futhermore, age-related differences in healthcare-associated and complicated infections were identified. Materials and Method: This retrospective study included 206 skin and soft tissue infection patients hospitalized during an 8-year period. Data were collected using a form: patients' characteristics, clinical features, laboratory values, prior antibiotic use, causative microorganisms, and antibiotic treatment. For cases with clinically diagnosed, samples were taken from the suspected infection sites. Gram staining, deep swab, deep tissue and blood culture results were evaluated. Results: The incidence of diabetes mellitus was significantly higher among patients aged >= 65 years. Among these old patients, Escherichia coli (11/31, 35.5%) and Pseudomonas aeruginosa (8/31, 25.8%) were the most frequently isolated pathogens. Approximately half of the Staphylococcus aureus and Staphylococcus epidermidis strains isolated from patients with health care-associated infection were resistant to methicillin (8/15, 53.3%), and these patients produced higher levels of extended-spectrum beta-lactamase. Venous insufficiency (p=0.008) and prior hospitalization (p=0.001) were identified as risk factors for complication in patients aged >= 65. The median time-to-clinical response was 7 days in older patients with non-complicated infection (p=0.007). Conclusion: Diabetes mellitus was the most common co-morbid factor in older patients. Risk factors for complication may differ by age. Gram-negative pathogens were more commonly isolated in older patients. The time-to-clinical response was significantly longer in older patients with non-complicated infection than young patients.

Yaman, Ferda/0000-0001-6847-1720; Kuscu, Ferit/0000-0001-5662-8305 WOS: 000373245600004 PubMed: 26166495 The aim of this study was to investigate the incidence of acute kidney injury (AKI) and risk factors due to colistin use in patients infected with multidrug-resistant pathogens. This multicenter, retrospective, observational study was conducted in Turkey, at 5 different research and university hospitals. Cox regression analyses were performed, to determine independent predictors of AKI. From April 2012 to July 2014, a total of 216 patients aged between 18-94 years, treated with colistimethate sodium (CMS) were included in the study. The mean age of the patients was 60.3 +/- 20.1 years. The overall incidence of AKI was 34.3% (74/216) at any time during treatment. Concomitant use of loop diuretics, baseline creatinine level, and CMS dosage were independently associated with AKI. According to our results, patients with higher baseline creatinine levels, or patients who had to use concomitant loop diuretics may need to be monitored more closely, and dose adjustment should be done promptly. More comprehensive studies are, however, still needed to evaluate the efficacy of low-dose colistin since higher doses tend to increase the risk of AKI.

Objective: The evaluation of risk factors in patients with Nosocomial pneumonia (NP) may provide useful guidance for patients who need intensive care. The aim of this study was to identify risk factors of NP in ICU. Methods: During the six months period of time, patients who stayed in ICUs for at least 48 hours were included in a tertiary medical center. A total of 304 patients were prospectively followed and 78 of them who developed NP made up the NP group. Patients who did not develop any infection were defined as control group. Variables which was thought or detected as a risk factor of NP in univariate analysis were analyzed with multivariate logistic regression analysis. Results: Among 304 patients, 78 (25.6%) had NP. Multivariate analysis revealed that advanced age (odds ratio [OR] 1, 95% confidence interval [CI] 1.00-1.06), length of stay (LOS) in the ICU (OR 1.3, 95% CI 1.17-1.39), prior infection on admission to ICU (OR 6.7, 95% CI 1.52-29.94), transfusion of blood and blood products (OR 4.0, 95% CI 1.43-11.46) and prior antibiotic usage within the last two weeks before admission (OR 3.3, 95% CI 1.28-8.48) were independent risk factors for NP. Additionally, the mean APACHE II score of cases with NP (16.7±6.7) was significantly higher than that of controls (11.5±8.1; p, Amaç: Nozokomiyal pnömoni (NP) yoğun bakım ünitesi (YBÜ)’nde en sık karşılaşılan nozokomiyal enfeksiyondur. NP gelişen hastalardaki risk faktörlerinin değerlendirilmesi YBÜ ihtiyacı olan hastalar için yol gösterici olabilir. Bu çalışmanın amacı YBÜ’de gelişen NP risk faktörlerinin belirlenmesidir. Yöntemler: Altı aylık süre içerisinde, bir üniversite hastanesinin YBÜ’lerinde 48 saatten uzun kalan hastalar çalışmaya alındı. Toplam olarak 304 hasta prospektif izlenirken, bu hastaların NP gelişen 78’i NP grubunu oluşturdu. Herhangi bir enfeksiyon gelişmeyen hastalar ise kontrol grubu olarak tanımlandı. Tek değişkenli analiz ile NP risk faktörü olabileceği düşünülen veya saptanan değişkenler çok değişkenli lojistik regresyon analizi ile incelendi. Bulgular: 304 hastanın 78’inde (% 25,6) NP gelişti. Çok değişkenli analiz ile ileri yaş (odds ratio [OR] 1, %95 güven aralığı [CI] 1,00-1,06), YBÜ’de yatış süresi (OR 1,3, % 95 CI 1,17-1,39), YBÜ öncesi enfeksiyon varlığı (OR 6,7, %95 CI 1,52-29,94), kan ürünü transfüzyonu (OR 4, %95 CI 1,43-11,46) ve YBÜ yatışından önceki 2 hafta içerisinde antibiyotik kullanım öyküsü (OR 3,3, %95 CI 1,28-8,48) NP için bağımsız risk faktörleri olarak tanımlandı. Ayrıca, NP gelişen hastaların ortalama APACHE II skoru (16,7±6,7) kontrol grubundan anlamlı olarak yüksek bulundu (11,5±8,1; p