Researcher:
Karaaslan, Doruk Can

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Doruk Can

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Karaaslan

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Karaaslan, Doruk Can

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2018 - 2019112020 - 20212

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    Data on smoking in Turkey: systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors
    (Elsevier, 2019) Ozer, N.; Kilickap, M.; Tokgozoglu, L.; Goksuluk, H.; Kayikcioglu, M.; Yilmaz, M. B.; Barcin, C.; Abaci, A.; Sahin, M.; N/A; Karaaslan, Doruk Can; Undergraduate Student; School of Medicine; N/A
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    Data on prevalence of obesity and waist circumference in Turkey: systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors
    (AVES, 2018) Kılıçkap, Mustafa; Göksülük, Hüseyin; Kayıkçıoğlu, Meral; Özer, Necla; Barçın, Cem; Yılmaz, Mehmet Birhan; Abacı, Adnan; Şengül, Şule; Arınsoy, Turgay; Erdem, Yunus; Sanisoğlu, Yavuz; Şahin, Mahmut; Tokgözoğlu, Lale; Ural, Dilek; Karaaslan, Doruk Can; Faculty Member; Undergraduate Student; School of Medicine; School of Medicine; 1057; N/A
    Objective: Obesity is the most important epidemic of the 21st century and its incidence is increasing steadily in Turkey. The aim of this study was to assess the current status and temporal change in the prevalence of obesity in Turkey with a systematic review and meta-analysis of epidemiological studies conducted in the last 15 years. Methods: Ovid Medline, the Web of Science Core Collection and the Turkish Academic Network and Information Center (ULAKBIM) databases, as well as the web pages of the Turkish Ministry of Health, the Turkish Statistical Institute, and cardiology, nephrology and endocrinology associations were searched for epidemiological studies conducted within Turkey the last 15 years. Research focusing on local data was excluded. Studies included in the analysis were assessed with a special bias score and categorized as having low or high risk of bias. Body mass index (BMI), waist circumference, obesity and prevalence of abdominal obesity were calculated as crude values. Meta-regression analysis was performed to assess heterogeneity and change over time. Results: The agreement between the two investigators on the selection and bias scoring of the studies was excellent (kappa=0.95), but the heterogeneity between the studies was high. BMI (10 studies, n=93.554) was calculated as 28.2 kg/m(2) for women and 26.5 kg/m(2) for men. The prevalence of obesity (12 trials, n=106.553) was 33.2% in females and 18.2% in males. In 6 studies (n=66.591) that included a measurement of waist circumference, the values were 89.72 cm in women and 93.57 cm in men. Especially in women, the prevalence of abdominal obesity (5 studies, n=62331) was greater than that of general obesity (50.8% in women vs 20.8% in men). Meta-regression analysis revealed that the variance of the obesity prevalence between the studies could partly be explained by the age differences, but there was no temporal change in the prevalence of obesity during the years the studies were conducted. Conclusion: The prevalence of obesity, especially abdominal obesity, is considerably high in Turkish women and increases with advancing age. This finding points out that nationwide action plans against obesity, especially for women, should be designed and implemented by health policy makers.
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    Data on prevalence of hypertension and blood pressure in Turkey: systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors
    (Kare Yayıncılık, 2018) Kilickap, Mustafa; Barcin, Cem; Goksuluk, Huseyin; Ozer, Necla; Kayikcioglu, Meral; Yilmaz, Mehmet Birhan; Abaci, Adnan; Arici, Mustafa; Altun, Bulent; Tokgozoglu, Lale; Sahin, Mahmut; N/A; Karaaslan, Doruk Can; Ural, Dilek; Undergraduate Student; Faculty Member; School of Medicine; School of Medicine; N/A; 1057
    Objective: Cardiovascular risc factors may show significant changes over the years. A systematic review and meta-analysis of epidemiological studies conducted in Turkey was performed to assess the latest profile and temporal changes in cardiovascular risk factors. Presented here are the data on hypertension (HT) and blood pressure (BP). Methods: Ovid Medline, the Web of Science Core Collection, and the Turkish Academic Network and Information Center (ULAKBIM) were searched for epidemiological studies conducted in Turkey during the last 15 years. In addition, the web pages of the Ministry of Health, the Turkish Statistical Institute, and associations of cardiology, nephrology, and endocrinology were searched for appropriate studies. Regional studies were excluded. The studies included were assessed with a bias score developed by our team, then categorized as having a low risk or a high risk of bias. The crude values of HT prevalence and BP were pooled using a random effects model. Meta-regression was performed to explain heterogeneity and to assess temporal changes. Results: The agreement between the 2 authors on the selection and bias scoring of the studies was perfect (Kappa >= 0.95). There were 7 (n=73218) studies providing HT prevalence data, and 8 (n=75879) studies with BP data. The heterogeneity between the studies was high. Meta-analysis of the studies with a low risk of bias indicated that the crude prevalence of HT is higher in women, but that BP levels were similar in both sexes. The HT prevalence and BP value decreased between 2003 and 2012; however, the number of hypertensives stabilized at approximately 15 million, and the number of uncontrolled hypertensives, despite some decrease, was around 11 million. Conclusion: Despite some improvement, HT is still an important public health problem in Turkey. / Amaç: Kardiyovasküler (KV) risk faktörlerinin profili yıllar içinde değişim gösterebilmektedir. Türkiye’de KV risk faktörlerinin son durumu ve yıllar içindeki değişimini değerlendirmek amacıyla epidemiyolojik çalışmaların sistematik derleme ve meta-analizi planlandı. Bu makalede hipertansiyon (HT) ve kan basıncına ait sonuçlar açıklanmaktadır. Yöntemler: Son 15 yılda Türkiye’de yapılan epidemiyolojik çalışmalar Ovid Medline, Web of Science Core Collection ve ULAKBİM veritabanlarında tarandı. Ayrıca Sağlık Bakanlığı, Türkiye İstatistik Kurumu, Kardiyoloji, Nefroloji ve Endokrinoloji Derneklerinin web sayfaları uygun araştırmalar açısından tarandı. Bölgesel çalışmalar çalışma dışı bırakıldı. Analize alınan araştırmalar kendi geliştirdiğimiz bir yanlılık (bias) skoru ile değerlendirilerek yanlılık riski yüksek ve düşük olarak iki gruba ayrıldı. HT prevalansı ve kan basıncı verileri kaba (crude) değerler olarak hesaplandı. Meta-analizde rastgele etkiler modeli (random effects model) kullanıldı. Prevalans ve kan basıncı değerlerindeki heterojeniteyi ve zamansal değişimi değerlendirmek üzere meta-regresyon yapıldı. Bulgular: Makale seçiminde ve yanlılık skorlamasında iki araştırıcı arasındaki uyum mükemmel düzeydeydi (Kappa ≥0.95). HT prevalansı ile ilgili bilgi veren 7 (n=73218), kan basıncı bilgisini veren 8 (n=75879) çalışma bulundu. Çalışmalar arasındaki heterojenite yüksekti. 2003-2012 yılları arasında yapılmış olan bu çalışmaların yanlılık riski düşük olanlarının meta-analizinde HT kaba prevalansının kadınlarda erkeklere göre daha fazla olduğu, kan basıncı düzeylerinin her iki grupta benzer olduğu, hem HT prevalansında hem de kan basıncı değerlerinde azalma olduğu, buna rağmen hipertansif kişi sayısının 15 milyon civarında sabit kaldığı, kontrolsüz hipertansiyonu olanların sayısının azalmakla birlikte 11 milyon kişi düzeyinde olduğu saptandı. Sonuç: HT sıklığı ve kan basıncı değerlerinde olumlu değişmeler olmasına rağmen HT halen önemli bir halk sağlığı problemi olmaya devam etmektedir.
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    Data on prevalence of dyslipidemia and lipid values in Turkey: systematic review and meta-analysis of epidemiological studies on cardiovascular risk factors
    (AVES, 2018) Kayıkcıoğlu, Meral; Tokgözoğlu, Lale; Kılıçkap, Mustafa; Göksuluk, Hüseyin; Özer, Necla; Abacı, Adnan; Yılmaz, Mehmet Birhan; Barçın, Cem; Ateş, Kenan; Bayram, Fahri; Şahin, Mahmut; N/A; Karaaslan, Doruk Can; Ural, Dilek; Undergraduate Student; Faculty Member; School of Medicine; School of Medicine; N/A; 1057
    Objective: Dyslipidemias, primarily hypercholesterolemia, are independent and strong predictors of cardiovascular (CV) events. The frequency of dyslipidemia is very important in terms of determining CV prevention policies. In order to determine the up-to-date frequency of CV risk factors in Turkey, a meta-analysis of the epidemiologic studies carried out in the last 15 years was performed. This article presents the results on the dyslipidemia data including hypercholesterolemia principally. Methods: Epidemiological studies conducted during the last 15 years and having the potential to represent the general population in Turkey were searched in databases (Ovid Medline, Web of Science Core Collection, and Turkish Academic Network and Information Center [ULAKBIM]) and web pages (Ministry of Health, Turkey Statistical Institute, Turkish Society of Cardiology, Nephrology and Endocrinology Associations). A total of 7 studies including lipid data were found. Systematic review and meta-analysis of the studies with low bias score were performed. Crude values of the prevalence of hypercholeterolemia, hypertriglyceridemia and low HDL and mean lipid levels were calculated. Random effects model was used in meta-analysis. Results: The prevalence of hypercholesterolemia defined as a LDLcholesterol >130 and/or ≥130 mg/dL, was 29.1% (95% CI 23.6–35.0) in the general population, 30.2% in females (%95 CI 24.7–36.1), and 27.8% in males (95% CI 22.3–33.6). The prevalence of low HDLcholesterol (≤50 mg/dL for females and ≤40 mg/dL for males) was calculated as 46.1% (95% CI 42.4–49.9) in the whole group, 50.7% (95% CI 47.7–53.6) in females and 41.1% (95% CI 36.1–46.3) in males. The prevalence of hypertriglyceridemia (>150 mg/dL) was 36.5% (95% CI 30.6–42.5) in general, 32.0% (95% GA 26.6–37.8) in females and 41.3% (95% CI 34.9–47.8) in males. Conclusion: Dyslipidemia constitutes a major public health problem in Turkey. In the adult population, almost 3 of 10 have hypercholesterolemia, one of 2 has a low HDL-cholesterol, and 1 of 3 has high triglycerides levels. / Amaç: Başta hiperkolesterolemi olmak üzere, dislipidemiler kardiyovasküler (KV) olayların bağımsız ve kuvvetli bir öngördürücüsüdür. Toplumsal dislipidemi sıklığı, KV korunma politikalarının belirlenmesi açısından çok önemlidir. Türkiye’de KV risk faktörlerinin güncel sıklığını belirlemek amacı ile son 15 yıllık dönemde gerçekleştirilen epidemiyolojik çalışmalar bir meta-analizle değerlendirilmiş, bu makalede başta hiperkolesterolemi olmak üzere ülkemizin lipit verilerine ait sonuçlar sunulmuştur. Yöntemler: Son 15 yılda Türkiye’yi örnekleyen veya örnekleme potansiyeli olan epidemiyolojik çalışmalar veri tabanlarında (Ovid Medline, Web of Science Core Collection ve ULAKBİM) ve web sayfalarında (Sağlık Bakanlığı, Türkiye İstatistik Kurumu, Türk Kardiyoloji Derneği, Nefroloji ve Endokrinoloji Dernekleri) tarandı. Lipit verisi içeren toplam 7 çalışmaya ulaşıldı. Yanlılık skoru düşük çalışmaların sistematik derleme ve meta-analizi yapıldı. Hiperkolesterolemi, hipertrigliseridemi ve düşük HDL prevalansı ve ortalama lipit düzeyleri kaba (crude) değerler olarak hesaplandı. Meta-analizde rastgele etkiler modeli (random effects model) kullanıldı. Bulgular: LDL-kolesterol düzeyi >130 ve/veya ≥130 mg/dL olarak tanımlandığında hiperkolesterolemi prevalansı genel popülasyonda %29.1 (%95 GA 23.6–35.0), kadınlarda %30.2 (%95 GA 24.7– 36.1) ve erkeklerde %27.8 (%95 GA 22.3–33.6) saptandı. Düşük HDL-kolesterol (sınır değeri kadınlarda ≤50 mg/dL, erkeklerde ≤40 mg/dL) prevalansı tüm grupta %46.1 (%95 GA 42.4–49.9), kadınlarda %50.7 (%95 GA 47.7–53.6) ve erkeklerde %41.1 (%95 GA 36.1–46.3) hesaplandı. Trigliserit yüksekliği prevalansı (sınır >150 mg/dL kabul edildiğinde) tüm grupta %36.5 (%95 GA 30.6–42.5), kadınlarda %32.0 (%95 GA 26.6–37.8) ve erkeklerde %41.3 (%95 GA 34.9–47.8) saptandı. Sonuç: Türkiye’de dislipidemi önemli bir sağlık problemidir. Erişkin nüfusta yaklaşık her 10 kişiden üçünde hiperkolesterolemi, her 2 kişiden birinde HDL düşüklüğü ve her 3 kişiden birinde trigliserit yüksekliği vardır.
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    The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs
    (Springer, 2018) Keşke, Siran; Palaoğlu, Erhan; N/A; Ergönül, Önder; Tutucu, Faik; Karaaslan, Doruk Can; Can, Füsun; Faculty Member; Undergraduate Student; Undergraduate Student; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 110398; N/A; N/A; 103165
    We aimed to describe the potential benefit of new rapid molecular respiratory tests (MRT) in decreasing inappropriate antibiotic use among the inpatients presenting with influenza-like illness (ILI). We included patients from inpatient and outpatient departments who had ILI and performed MRT between 1 January 2015 and 31 December 2016 in a 265-bed private hospital in İstanbul. At the end of 2015, we implemented antimicrobial stewardship including systematic use of MRT. Then, we compared our observations between the year 2015 and the year 2016. We designed the study according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) tool. A U.S. Food and Drug Administration (FDA)-cleared multiplexed polymerase chain reaction (PCR) system (BioFire FilmArray, Idaho Technology, Salt Lake City, UT) which detects 17 viruses and three bacteria was used for diagnosis. In total, 1317 patients were included; 630 (48%) were inpatients and 569 (43%) were older than 16 years of age. At least one virus was detected in 747 (57%) patients. Rhinovirus/enterovirus, influenza virus, and adenovirus were the most commonly detected. Among hospitalized patients, in children, a significant decrease in antibiotic use (44.5% in 2015 and 28.8% in 2016, p = 0.009) was observed, but in adults, the decrease was not statistically significant (72% in 2015 and 63% in 2016, p = 0.36). The duration of antibiotic use after the detection of virus was significantly decreased in both children and adults (p < 0.001 and p = 0.007, respectively). By using MRT, inappropriate antibiotic use and, also, duration of inappropriate antibiotic use after the detection of virus was significantly decreased. It is time to increase the awareness about the viral etiology in respiratory tract infections (RTIs) and implement MRT in clinical practice.
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    Is relative overhydration measurement by bioimpedance spectroscopy useful in reducing morbidity and mortality in chronic kidney disease?
    (Oxford Univ Press, 2018) Afsar, Baris; N/A; Karaaslan, Doruk Can; Kanbay, Mehmet; Undergraduate Student; Faculty Member; School of Medicine; School of Medicine; N/A; 110580
    It is well known that one of the main determinants of mortality and morbidity in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients is fluid overload acting on the cardiovascular system causing hypertension, increased arterial stiffness, left ventricular hypertrophy and eventually heart failure. Therefore, assessment and management of volume status is crucial. Bioimpedance spectroscopy is one of the most popular and practical methods for volume evaluation. Volume evaluation should be a routine part of following CKD and ESRD patients, in order to decrease associated mortality and morbidity.
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    Temporal trends in obesity and status of dyslipidemia in Turkey: a meta-analysis of epidemiological studies
    (Elsevier Ireland Ltd, 2018) Tokgozoglu, L.; Ural, D.; Kayikcioglu, M.; Kilickap, U.; Goksuluk, H.; Karaaslan, D.; Ural, Dilek; Karaaslan, Doruk Can; Faculty Member, Undergraduate Student; School of Medicine; School of Medicine; 1057; N/A
    Aim: Global burden of cardiovascular risk factors shows a decrease in the latest 10 years in European countries and Northern America. Atherogenic dyslipidemia and obesity are the two main risk factors contributing to cardiovascular diseases in Turkey, but their latest status temporal trends are unknown. The aim of this study is to assess temporal changes in dyslipidemia and obesity in the last two decades. Methods: Epidemiological studies on lipid levels and body composition of adult Turkish population conducted between years 2002-2017 were searched in the Ovid Medline, and Web of Science Core Collection. Web documents of Ministry of Health and Turkish Statistical Institute were also searched. Random-effects model and meta-regression were performed to assess the changes in the prevalence of dyslipidemia and obesity during this time period. Results: Crude prevalence of obesity (BMI ?30 kg/m2) in the low risk of bias studies (8 studies, n=73,906) was 28.5% (95% CI 24.2-33.2) in the whole group, 33.2% (95% CI 28.8-37.7) in women and 18.2% (95% CI 16.2-20.2) in men; and did not change during a 11-year time (p ?0.75). Crude prevalence of abdominal obesity (5 studies, n= 62,331) was 39.6% (95% CI 30.3-49.3) in the whole group, 50.8% (95% CI 46.5-55.0) in women, and 20.8% (95% CI 16.9-24.9) in men. Although overall prevalence did not change, crude prevalence seemed to increase in men (p=0.004), but not in women (p=0.84) (Figure). Crude prevalence of hyperlipidemia (LDL-C ?130 mg/dl in 3 studies, n=28216) was 29.1 % (95% of CI 23.6-35.0%) in the whole group, 30.2% (95% CI 24.7-36.1) in women, and 27.8 (95% CI 22.3-27.8) in men. As there were only 3 studies, time-dependent change could not be assessed. Conclusion: The crude prevalence of abdominal obesity is high and stable in women; however, it seems to increase in men over time. Intervention at both public and individual level should be undertaken to decrease their rate effectively.
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    Data on prevalence of metabolic syndrome in Turkey: systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors
    (Kare Yayıncılık, 2018) Abaci, Adnan; Kilickap, Mustafa; Goksuluk, Huseyin; Barcin, Cem; Kayikcioglu, Meral; Ozer, Necla; Yilmaz, Mehmet Birhan; Sahin, Mahmut; Tokgozoglu, Lale; N/A; Karaaslan, Doruk Can; Undergraduate Student; School of Medicine; N/A
    Objective: The incidence of metabolic syndrome varies greatly in developed and developing countries. In the last 10 to 15 years, important studies have been performed examining the incidence of metabolic syndrome in Turkey. This article is a meta-analysis of the studies that investigated the incidence of metabolic syndrome this country. Methods: Epidemiological studies from the last 15 years that provided information about the incidence of metabolic syndrome in Turkey were screened in the Ovid Medline, the Web of Science Core Collection, and the Turkish Academic Network and Information Center (ULAKBIM) databases. In addition, web pages of the Ministry of Health, the Turkish Statistical Institute, and the associations of the related medical discipilnes were screened for appropriate studies. A bias tool that is developed by our team was used to categorize the included studies as having low- or high risk of bias. A random effects model was used in the meta-analysis. Linear and nonlinear meta-regression analyses were performed to evaluate heterogeneity and temporal variations in prevalence rates. Results: Four studies (n=34893) were identified that provided information about the status of metabolic syndrome in Turkey using the Adult Treatment Panel III definition. There was excellent interobserver agreement regarding the selection of studies and the scoring of the selected research with respect to bias. The meta-analysis revealed a prevalence of 32.9% (95% confidence interval [CI]: 30.2-35) overall, 38.3% (95% CI: 35.8-40.8) in women, and 26.8% (95% CI: 23.4-30.3) in men. Two studies (n=8568) provided data according to the International Diabetes Federation definition of metabolic syndrome. The random effects model used in the meta-analysis of these studies demonstrated a prevalence of metabolic syndrome of 43.3% (95% CI: 41.9-44.7) overall, 50.4% (95% CI: 49.0-51.9) in women, and 35.4% (95% CI: 32.5-38.5) in men. Conclusion: In Turkey, the incidence of metabolic syndrome is 1 in every 4 men, and 1 in every 3 women. The rate is particularly high among women. Studies designed to prevent the development of metabolic syndrome are needed. / Amaç: Gerek gelişmiş gerekse gelişmekte olan ülkelerde metabolik sendrom sıklığı ülkeler arasında büyük değişkenlik göstermektedir. Ülkemizde son 10–15 yılda metabolik sendrom sıklığı ile ilgili önemli çalışmalar yapılmıştır. Bu yayında Türkiye genelini örnekleyen metabolik sendrom sıklığı ile ilgili çalışmaların meta-analizi yapılmıştır. Yöntemler: Son 15 yılda Türkiye’de yapılan ve metabolik sendrom sıklığı hakkında bilgi veren epidemiyolojik çalışmalar Ovid Medline, Web of Science Core Collection ve ULAKBİM veritabanlarında tarandı. Ayrıca Sağlık Bakanlığı, Türkiye İstatistik Kurumu ve ilgili meslek örgütlerinin web siteleri konu ile ilgili araştırmalar açısından incelendi. Analize alınan araştırmalar kendi geliştirdiğimiz bir yanlılık (bias) skoru ile değerlendirilerek yanlılık riski yüksek ve düşük olarak iki gruba ayrıldı. Meta-analizde rastgele etkiler modeli kullanıldı. Prevalans değerlerindeki heterojeniteyi ve zamansal değişimi değerlendirmek üzere lineer ve non-lineer meta-regresyon yapıldı. Bulgular: ATP III tanımına göre metabolik sendrom ile ilgili bilgi veren 4 çalışmaya (n=34893) ulaşıldı. Hem makalelerin seçiminde hem de seçilen makalelerin yanlılık açısından skorlanmasında gözlemciler arasındaki uyum mükemmel düzeyde bulundu. Rastgele etkiler modeli ile yapılan meta-analizde metabolik sendrom prevalansı tüm grupta %32.9 (%95 CI 30.2–35.6), kadınlarda %38.3 (%95 GA 35.8–40.8), erkeklerde %26.8 (%95 GA 23.4–30.3) olarak hesaplandı. Uluslararası Diyabet Federasyonu’nun tanımına göre metabolik sendrom prevalansı ile ilgili bilgi veren 2 çalışma vardı (n=8568). Bu çalışmaların meta-analizinde rastgele etkiler modelinde metabolik sendrom prevalansı tüm grupta %43.3 (%95 GA 41.9–44.7), kadınlarda %50.4 (%95 GA 49.0–51.9), erkeklerde ise %35.4 (%95 GA 32.5–38.5) bulundu. Sonuç: Ülkemizde metabolik sendrom sıklığı, özellikle kadınlarda çok yüksektir ve her dört erkekten birinde ve her üç kadından birinde metabolik sendrom vardır. Metabolik sendromu önlemeye yönelik çalışmalar yapılması gerekmektedir.
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    Mitraclip implantation in younger patients and pediatric populations: 19 year-old patient with multiple comorbidities and a prior mitral valve annuloplasty
    (Elsevier, 2019) Ates, Ismail; Kaya, Zeynettin; Mutlu, Deniz; Cilingiroglu, Mehmet; N/A; Karaaslan, Doruk Can; Undergraduate Student; School of Medicine; Koç University Hospital; N/A
    MitraClip is an effective treatment method for severe mitral regurgitation in high-risk populations in terms of reducing morbidity and frequency of hospitalizations. Efficacy and safety of MitraClip device in elderly population have been established, yet there are only 2 case reports of MitraClip implantation in the younger patients, who generally tend to have less surgical risk (Gorenflo et al.; Joffe et al., 2016). Wedescribe a 19-year-old patient with severe mitral regurgitation with prior mitral valve annuloplasty and received MitraClip implantation due to high-surgical risk.
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    Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection
    (Oxford University Press (OUP), 2018) Menekse, Şirin; Karahan, Salih Nafiz; Azap, Oztem Kurt; Timurkaynak, Funda; Yavuz, Serap Şimşek; Basaran, Seniha; Yörük, Fugen; Azap, Alpay; Koculu, Safiye; Benzonana, Nur; N/A; N/A; N/A; N/A; N/A; N/A; Department of Industrial Engineering; N/A; N/A; N/A; Can, Füsun; İspir, Pelin; Ataç, Nazlı; Albayrak, Özgür; Demir, Tuana; Karaaslan, Doruk Can; Gönen, Mehmet; Lack, Nathan Alan; Ergönül, Önder; Kapmaz, Mahir; Faculty Member; Master Student; Researcher; Researcher; Undergraduate Student; Undergraduate Student; Faculty Member; Faculty Member; Faculty Member; Doctor; Department of Industrial Engineering; Koç Üniversitesi İş Bankası Enfeksiyon Hastalıkları Uygulama ve Araştırma Merkezi (EHAM) / Koç University İşbank Center for Infectious Diseases (KU-IS CID); School of Medicine; Graduate School of Health Sciences; N/A; N/A; School of Medicine; School of Medicine; College of Engineering; School of Medicine; School of Medicine; N/A; Koç University Hospital; 103165; N/A; N/A; N/A; N/A; N/A; 237468; 120842; 110398; N/A
    Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods: A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results: A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55%) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61%. ST101 was the most common ST and accounted for 68 (59%) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72%. In ST101, 94% (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40% (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81%) and 22 (19%) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P = 0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P = 0.002) were found to be significantly associated covariates. Conclusions: Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.