Oguz Resat Sipahi

Ege University, Ismir, İzmir, Turkey

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Publications (78)172.15 Total impact

  • Journal of chemotherapy (Florence, Italy) 03/2015; DOI:10.1179/1973947815Y.0000000020 · 1.07 Impact Factor
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    ABSTRACT: Data regarding factors predicting unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases is scarce in the literature. We conducted a multicenter study to provide insights into the predictors of outcome with special emphasis to use and timing of antivirals. Overall, 501 patients with molecular confirmation from the cerebrospinal fluid were included from 35 referral centers in 10 countries. Overall, 438 patients were found to be eligible for the analysis. Finally, 232 (52.9%) patients experienced unfavorable outcomes; 44 died and 188 survived with sequlae. Age (OR 1.04, 95% CIs 1.02-1.05), Glasgow coma scale (OR 0.84, 95% CIs 0.77-0.93), symptomatic period of 2-7 days (OR 1.80, 95% CIs 1.16-2.79) and over seven days (OR 3.75, 95% CIs 1.72-8.15) until treatment commenced, predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to favorable outcome. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 03/2015; DOI:10.1128/AAC.05016-14 · 4.45 Impact Factor
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    ABSTRACT: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Travel Medicine and Infectious Disease 03/2015; DOI:10.1016/j.tmaid.2015.02.008 · 1.54 Impact Factor
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    ABSTRACT: The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of Turkey, France, and Italy from 1990 to 2014. The mean age of the patients was 57 years (range, 19-92 years), and 64% were males. The all-cause immunosuppression rate was 54 % (54/100). Forty-nine (49 %) patients were referred to a hospital because of the classical triad of symptoms (fever, nuchal rigidity, and altered level of consciousness). Rhombencephalitis was detected radiologically in 9 (9 %) cases. Twenty-seven (64 %) of the patients who had cranial magnetic resonance imaging (MRI) performed had findings of meningeal and parenchymal involvement. The mean delay in the initiation of specific treatment was 6.8 ± 7 days. Empiric treatment was appropriate in 52 (52 %) patients. The mortality rate was 25 %, while neurologic sequelae occurred in 13 % of the patients. In the multivariate analysis, delay in treatment [odds ratio (OR), 1.07 [95 % confidence interval (CI), 1.01-1.16]] and seizures (OR, 3.41 [95 % CI, 1.05-11.09]) were significantly associated with mortality. Independent risk factors for neurologic sequelae were delay in treatment (OR, 1.07 [95 % CI, 1.006-1.367]) and presence of bacteremia (OR, 45.2 [95 % CI, 2.73-748.1]). Delay in the initiation of treatment of neuroinvasive listeriosis was a poor risk factor for unfavorable outcomes. Bacteremia was one of the independent risk factors for morbidity, while the presence of seizures predicted worse prognosis. Moreover, the addition of aminoglycosides to ampicillin monotherapy did not improve patients' prognosis.
    European Journal of Clinical Microbiology 02/2015; 34(6). DOI:10.1007/s10096-015-2346-5 · 2.54 Impact Factor
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    ABSTRACT: Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.
    Journal of Neurology 01/2015; DOI:10.1007/s00415-014-7651-5 · 3.84 Impact Factor
  • Surgical Infections 10/2014; 15(5):659. DOI:10.1089/sur.2013.220 · 1.72 Impact Factor
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    ABSTRACT: Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years-old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white matter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.
    Mikrobiyoloji bülteni 07/2014; 48(3):507-511. DOI:10.5578/mb.7693 · 0.44 Impact Factor
  • 06/2014; 3(1):1-6. DOI:10.5578/mjima.6691
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    ABSTRACT: Background Tigecycline is a relatively new glycylcycline antimicrobial, active in vitro against a variety of Gram-positive and Gram-negative organisms. In this study we evaluated the outcomes of spondylodiscitis cases treated with tigecycline-including therapies retrospectively. Methods All adult (age >18 years) cases with a diagnosis of spondylodiscitis, who were treated with a tigecycline-including therapy between 2007 and 2011, were included in the study. The primary efficacy outcome was clinical success with tigecycline at the end of induction, while the secondary efficacy outcome was maintenance of success through 3 months following completion of induction. Success through induction was also compared by dosing strategy. Results A total of eight spondylodiscitis cases fulfilled the study inclusion criteria. All cases had back pain, restricted mobility, magnetic resonance findings associated with spondylodiscitis, and microbiology or pathological findings related to spondylodiscitis. All had post-neurosurgical spondylodiscitis. In five cases, tigecycline was started in accordance with the antibacterial susceptibility results from intervertebral tissue biopsy cultures, whereas in three it was started empirically. All cases had received several different antibacterials with failure before receiving tigecycline. The mean duration of tigecycline treatment was 37 ± 21 days. One case was lost to follow-up after 2 days of tigecycline. Primary and secondary success was achieved in the remaining seven cases. Conclusions These limited data suggest that tigecycline may have a role in the treatment of refractory spondylodiscitis cases.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 06/2014; 23. DOI:10.1016/j.ijid.2014.01.027 · 2.33 Impact Factor
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    ABSTRACT: Polymerase chain reaction (PCR) method has improved the diagnosis rates for patients with community-acquired pneumonia (CAP). We aimed to evaluate the bacterial and viral etiology of hospitalized CAP cases and compare clinical and laboratory findings of patients with pure bacterial and bacterial and viral (mixed) infections. A total of 55 patients hospitalized with CAP were enrolled into the prospective study between February 2010 and December 2010. Clinical and laboratory follow-up were performed on days 0, 7 and 14. Deep tracheal aspiration samples were examined for bacterial and viral pathogens by multiplex PCR, and standard bacteriological culture method. The etiological identification rate in 50 patients for bacteria, viruses and mixed virus-bacteria combination by PCR were 62%, 4%, 32%, respectively and 60% in 55 patients by bacterial culture method. Streptococcus pneumoniae concomitant with Haemophilus influenzae (36%) and rhinovirus (16%) was very common, whereas atypical pathogens (only Mycoplasma pneumoniae) were rare (6%). Rhinovirus was the most common viral agent (20%). Recently identified viruses, human coronavirus HKU1 and human bocavirus were not detected except for human metapneumovirus (one case). There was no significant difference in terms of mean age, immune status, leukocyte count, C-reactive protein (CRP) values, hospitalization duration and CURB-65 score between bacterial and mixed viral-bacterial detections. Advanced age (p < 0.01) and higher CURB-65 score (p = 0.01) were found to be associated with increased mortality. Concomitance of bacterial and viral agents is frequent and resemble with bacterial infections alone. Further studies are needed for the clinical significance of mixed detections.
    The Journal of Infection in Developing Countries 04/2014; 8(4):510-518. DOI:10.3855/jidc.3560 · 1.27 Impact Factor
  • International Journal of Infectious Diseases 04/2014; 21:163. DOI:10.1016/j.ijid.2014.03.762 · 2.33 Impact Factor
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    ABSTRACT: Writing a thesis is mandatory for getting a postgraduate medical degree in Turkey. Publication of the results of the thesis in an indexed journal makes the results available to researchers, however publication rate is usually low. The aim of this retrospective observational study was to investigate the publication rate of Turkish Infectious Diseases and Clinical Microbiology, Medical Microbiology specialty theses and Microbiology doctorate theses in international peer-review journals. On August 17th 2007, the thesis database of the Council of Higher Education of the Republic of Turkey (YOK) where all specialization and doctorate theses are recorded obligatorily, was searched for Infectious Diseases and Clinical Microbiology and Medical Microbiology specialty and Microbiology doctorate theses. Assuming that publication of a thesis would last at least six months, theses dated to February 2007 and after were excluded. The publication rate of those theses was found out by searching Science Citation Index-Expanded database for thesis author and supervisor between August 17-September 12, 2007. Chi-square test was used for statistical analysis. Our search yielded a total of 834 theses dated from 1997 to 2007, however 10 of them were excluded, since they were dated to February 2007 or after. It was found that the overall publication rate was 11.4% (94/824). The publication rates for Microbiology doctorate, Medical Microbiology and Infectious Diseases and Clinical Microbiology specialty theses were 13.7% (34/249), 10.7% (33/309) and 10.2% (27/266), respectively, with no statistical significance (p> 0.05). It was determined that nine (9.6%) of the 94 published theses belonged to 1997-2001 period, whereas 85 (80.4%) were in 2002-2007 period (p< 0.05). The probable reason for this increase was thought to be related with the updated criteria of YOK carried out in 2000 for academic promotions, nevertheless the publication rate of the investigated theses in international peer-review journals was still low. Thesis is an important part of specialty and doctorate education and necessitates intense work. The created knowledge usually contains important data about the country and the world. Publication of the theses supplies dissemination of new knowledge and completes the process of a scientific study. Solutions must be generated to promote the publication of specialty and doctorate theses.
    Mikrobiyoloji bülteni 04/2014; 48(2):341-5. DOI:10.5578/mb.7003 · 0.44 Impact Factor
  • International Journal of Infectious Diseases 04/2014; 21:245. DOI:10.1016/j.ijid.2014.03.930 · 2.33 Impact Factor
  • International Journal of Infectious Diseases 04/2014; 21:283-284. DOI:10.1016/j.ijid.2014.03.1009 · 2.33 Impact Factor
  • Selin Bardak-Ozcem, Oguz Resat Sipahi
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    ABSTRACT: Among hospital-associated infections, healthcare-associated central nervous system infections are quite important because of high morbidity and mortality rates. The causative agents of healthcare-associated meningitis differ according to the status of immune systems and underlying diseases. The most frequent agents are Gram-negative bacilli (Pseudomonas spp., Acinetobacter spp., Escherichia coli and Klebsiella pneumoniae) and Gram-positive cocci (Staphylococcus aureus and coagulase-negative staphylococci). There are currently several problems in the treatment strategies of healthcare-associated meningitis due to a globally increasing resistance problem. Strategies targeting multidrug-resistant pathogens are especially limited. This review focuses on healthcare-associated meningitis and the current treatment strategies with a particular focus on methicillin-resistant Staphylococcus aureus (MRSA) meningitis.
    Expert Review of Anticancer Therapy 03/2014; 12(3):333-42. DOI:10.1586/14787210.2014.890049 · 3.06 Impact Factor
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    ABSTRACT: Dear Editor,Sarcoidosis is a systemic inflammatory disorder of unknown etiology characterized by the formation of non-caseating granulomas in the involved tissues and lymph nodes. It usually involves multiple organs, including the lungs, skin, bones, muscles, eyes, heart, liver, spleen and lymph nodes [1]. Although liver is an important site of sarcoidosis, isolated hepatic involvement is quite rare [2]. In this paper it is aimed to present a case of sarcoidosis with isolated liver microabscesses.A 51-year-old woman with no known prior disease admitted to our outpatient clinic with the complaints of fever persisting for 20 days and abdominal pain. In the physical examination her length was 150 cm and her weight was 65 kg. She had fever (38 °C) and abdominal tenderness on palpation in the upper right quadrant. She had malaise and 8 kg weight loss within the previous month. Her main laboratory findings were: hemoglobin 9.7 g/dl, leukocyte 15.57 × 103/mm3, neutrophil 80.9 %, C reactive pr
    Irish Journal of Medical Science 02/2014; 183(3). DOI:10.1007/s11845-014-1074-7 · 0.57 Impact Factor
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    ABSTRACT: The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever. Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was - fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period. A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts. In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.
    International Journal of Clinical Practice 12/2013; 68(2). DOI:10.1111/ijcp.12279 · 2.54 Impact Factor
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    ABSTRACT: Objectives We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. Methods Haydarpasa-1 study involved microbiologically confirmed patients for TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, and Turkey between 2000-2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. Results 506 TBM cases were included. The sensitivities of the tests were as follows: Interferon gamma (IFN-γ) release assay (IGRA, Quantiferon TB gold in tube) 90.2%, automated culture systems (ACSs) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9%, and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR test (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (κ,-0.189); ACS and L-J culture (κ -0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ,-0.299, p<0.05). Conclusions Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of nonculture tests appears to contribute early diagnosis. Hence, diagnostic approach to TBM should be individualized according to technical capacities of medical institutions with poor resources in particular.
    Clinical Microbiology and Infection 11/2013; DOI:10.1111/1469-0691.12478 · 5.20 Impact Factor
  • Journal of Antimicrobial Chemotherapy 11/2013; DOI:10.1093/jac/dkt465 · 5.44 Impact Factor
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    ABSTRACT: The aim of this study was to determine the point prevalence of nosocomial urinary tract infections (UTIs) and to investigate risk factors for pathogen type (E. coli vs. others) and extended-spectrum beta-lactamase (ESBL) positivity among nosocomial UTI patients. A questionnaire consisting of 44 questions on demographic data and risk factors of UTI cases was sent to 51 tertiary care hospitals. Univariate and multivariate analyses were conducted. The overall prevalence of UTI was 1.82% (483/26534). The prevalence of UTI was higher in intensive care units (ICUs) with 6.77% versus 1.45% outside ICUs. Hospitals of the Ministry of Health (compared to university hospitals), hospitals in less developed provinces and hospitals with bed capacity <500 had higher UTI prevalence. Patients without a urinary catheter were more likely to have received immunosuppressive therapy, current corticosteroid use, renal transplantation and uterine prolapsus and less likely to have another infection outside the urinary tract, as compared to catheterized patients. Among the 422 culture-positive patients, the most common pathogen was E.coli (45.5%). The risk factors increasing the likelihood of E.coli in urine culture were being female, history of urinary tract operation, no use of antibiotics in the preceding three months and infection outside the urinary tract. Among patients having E.coli/Klebsiella positive in culture, antibiotic use in the preceding three months and history of urinary tract operation were the independent risk factors significantly increasing the risk of ESBL. The reasons underlying the high prevalence of nosocomial UTIs, and a better understanding of the risk factors might lead to improved control of these infections.
    Annals of Clinical Microbiology and Antimicrobials 11/2013; 12(1):31. DOI:10.1186/1476-0711-12-31 · 1.51 Impact Factor