Uğur Kostakoğlu

Background: Despite continuous advancements in diagnostic imaging and targeted antimicrobial protocols for infective endocarditis (IE), global epidemiological data show that both disease burden and incidence continue to rise. This study aimed to evaluate real-world diagnostic and treatment approaches in accordance with the 2023 European Society of Cardiology (ESC) IE Guidelines and to identify independent predictors of mortality in a contemporary patient cohort. Methods: This multicenter, retrospective cohort study analyzed data from 470 consecutive adult patients diagnosed with IE across 27 academic reference centers between 1 September 2023 and 1 June 2025. Patients were managed and adjudicated according to the 2023 ESC diagnostic criteria. Demographic data, clinical characteristics, microbiological profiles, imaging findings, empirical antibiotic therapy patterns, and clinical outcomes were analyzed. Independent predictors of mortality were determined using multivariable Cox proportional hazards regression models. Results: The mean age of the overall study population was 58.08 ± 16.81 years, with a male predominance (60.6%, n = 285). Staphylococcus aureus was the most frequently isolated pathogen (27.9%), with a high proportion of methicillin resistance (38.9%). Hospital-acquired IE was identified in 41.1% of cases. Surgical treatment was performed in 40.6% (n = 191) of the cohort. The 28-day mortality rate was 11.9%, and the overall mortality during follow-up reached 26.4%. Multivariable Cox regression analysis identified hospital-acquired IE (HR = 2.247; 95% CI: 1.216–4.167; p = 0.010) and the presence of major clinical complications (HR = 4.207; 95% CI: 1.556–11.378; p = 0.005) as the strongest independent predictors of mortality. Conclusions: Contemporary infective endocarditis is a highly complex and fatal disease characterized by a prominent healthcare-associated burden and a predominant staphylococcal etiology. The occurrence of major clinical complications and hospital-acquired infections were the primary independent predictors of mortality.

Objective: Toxoplasmosis is a parasitosis that is mostly asymptomatic. It can lead to severe clinical conditions in immunosuppressed patients and fetal infections. Since it is possible to prevent congenital toxoplasmosis with appropriate follow-up and treatment, our study aimed to determine the susceptible population and seroprevalence of our region and to evaluate the course of infections in this group. Material and Method: Patients who applied to our tertiary hospital in the last five years and to whose Anti Toxoplasma IgM and IgG tests were performed were included in our study. Toxoplasmosis seroprevalence, the course of primary infection in pregnant women, the treatments applied, and also acute toxoplasmosis infections in non-pregnant patients were examined. Results: The seropositivity rate was found to be 30.7% (n=1703) in 5545 women included in the study, and the seropositivity rate was 31% (n=1399) in 4503 pregnant women. Sixteen pregnant women with primary infection were followed up in our hospital; one underwent medical abortion at the request of the family, and only four used the recommended treatment. Congenital toxoplasmosis was not detected in any newborn. Of the patients included, 26 (0.4%) were examined to investigate the etiology of fever, 37 (0.6%) for lymphadenopathy (LAP), and 29 (0.5%) for elevated liver enzymes. Among the patients with LAP, four (10.8%) were diagnosed with acute toxoplasmosis. Conclusion: As a result, it is important to determine the seroprevalence of toxoplasmosis, to detect possible primary infections, especially in pregnant women, and ensure close monitoring of these patients.

Introduction: Vaccination is one of the preventive measures that should be taken against COVID-19. In this study, we aimed to evaluate the COVID-19 vaccination status and factors affecting vaccination of healthcare workers (HCWs) working in our hospital. Methods: This cross-sectional study was conducted by filling out a questionnaire form with face-to-face or snowball methods to HCWs in our hospital. The questionnaire is composed of 10 questions, including demographic information, occupation of the person, working in the pandemic unit, COVID-19 and Influenza vaccination information, contracting COVID-19, and hospitalization status. Full-dose vaccination was defined as four doses in total. Pp=0.051, p=0.00, p=0.004). The rate of full-dose vaccination was found to be statistically significantly higher in those who worked in the pandemic unit (39.4%) than in those who did not (27.9%), in those who had influenza vaccination (44.5%) than those who did not (32.2%), and also higher in doctors (61.8%) compared to nurses (31.7%) and other HCWs (27.2%) (p=0.002, p=0.04, p=0.000). The rate of having COVID-19 disease was higher in HCWs who were unvaccinated or vaccinated with a missing dose (63.2%) compared to HCWs who were vaccinated with a full dose (41%) (p=0.000). Conclusion: Full-dose vaccination reduces the rate of COVID-19 disease, and doctors are more inclined to have full-dose vaccination than nurses and other HCWs.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) is a minimally invasive diagnostic tool used for the evaluation of mediastinal lymphadenopathy. It is a safe procedure, but complications such as bleeding and infection may occur. We report a case of a patient who developed a subcutaneous abscess abscess and mediastinitis after EBUSTBNA. A 75-year-old male with a history of right nephrectomy due to renal cell carcinoma and lung adenocarcinoma history underwent EBUS-TBNA for the evaluation of a right upper paratracheal lymph node. Two weeks after the procedure, the patient presented to the emergency department with skin induration and erythema on the right clavicular area. A non-contrast neck and thorax CT scan was performed, which revealed an extensive subcutaneous abscess on the right clavicular area, extending to the supraclavicular region. The patient was hospitalized, and empirical intravenous antibiotics were initiated due to deep neck infection. Repeated drainage of the subcutaneous abscess was performed. Bacteriologic examination revealed Streptococcus mitis. The patient showed improvement with antibiotic treatment, and a follow-up ultrasound showed a decrease in the size of the abscess and was discharged approximately four weeks after hospitalization. Although very rare, serious infectious complications may develop after EBUSTBNA, and our case report is an important example regarding its management process.

Antibiyotik direnci, sağlık hizmetiyle ilişkili enfeksiyonlarda (SHIE) önemli bir sorun olarak karşımıza çıkabilmektedir. Çalışmada aynı il içinde bulunan ikinci basamak hastane (2.BH) ile üçüncü basamak hastane (3.BH) yoğun bakım ünitelerindeki (YBÜ) SHİE hızlarının ve antimikrobiyal direnç oranlarının karşılaştırılması amaçlanmıştır. 2.BH ve 3.BH’deki YBÜ’lerde, 1 Ocak 2017 – 31 Aralık 2019 tarihleri arasında, Centers for Disease Control and Prevention (CDC) kriterlerine göre SHİE tanısı almış 18 yaş ve üzerindeki hastalar çalışmamıza dahil edilmiştir. SHİE insidans hızı, insidans dansitesi ve Klebsiella spp., Pseudomonas spp. ve Acinetobacter spp.’de karbapenem direnç oranları karşılaştırılmıştır. YBÜ’lerde 2.BH’de 158, 3.BH’de 519 SHİE gelişmiştir. SHİE insidans hızı 3.BH’deki YBÜ’lerde 2.BH’dekilerden daha yüksek bulunmuştur. 2.BH YBÜ’lerinde 2017-2019 yılları arasındaki karbapenem dirençli Klebsiella spp. oranları 3.BH’ye kıyasla istatistiksel açıdan anlamlı olarak daha yüksek saptanmıştır (p=0.001). Hastaneler arasında Pseudomonas spp. ve Acinetobacter spp.türlerinde karbapenem direnç oranları açısından istatistiksel açıdan anlamlı bir fark bulunamamıştır (sırasıyla p=0.723, p=0.267). Her iki hastanede de yıllar arasında karbapenem direnci oranlarında anlamlı bir değişiklik saptanmamıştır (p>0.05). 3.BH YBÜ’lerde SHİE hızı daha yüksek saptanmasına rağmen direnç oranları 2.BH’ye kıyasla daha düşük veya benzer bulunmuştur. Bu farkı inceleyen ileri çalışmalar antimikrobiyal direncin azalmasında yardımcı olabilir.

Background: Computed tomography (CT) evaluation systematics has become necessary to eliminate the difference of opinion among radiologists in evaluating COVID-19 CT findings. Introduction: The objectives of this study were to evaluate the efficiency of CO-RADS scoring system in our patients with COVID-19 as well as to examine its correlation with clinical and laboratory findings. Method: The CO-RADS category of all patients included in the study was determined by a radiologist who did not know the rtRT-PCR test result of the patients, according to the Covid-19 reporting and data system of Mathias Prokop et al. Results: A total of 1338 patients were included. CT findings were positive in 66.3%, with a mean CO-RADS score of 3,4 ± 1,7. 444 (33.1%) of the patients were in the CO-RADS 1-2, 894 (66.9%) were in the CO-RADS 3-5 group. There were positive correlations between CO-RADS score and age, CMI, hypertension, diabetes mellitus, chronic pulmonary diseases presence of symptoms, symptom duration, presence of cough, shortness of breath, malaise, CRP, and LDH, while CORADS score was negatively correlated with lymphocyte count. The results of the ROC analysis suggested that those with age ≥40 years, symptom duration >2 days, CMI score >1 and/or comorbid conditions were more likely to have a CO-RADS score of 3-5. Conclusion: The CO-RADS classification system is a CT findings assessment system that can be used to diagnose COVID-19 in patients with symptoms of cough, shortness of breath, myalgia and fatigue for more than two days.

OBJECTIVE: We aimed to compare the clinical, epidemiological, and prognostic features of the H1N1 pandemic in 2009 and the severe acute respiratory syndrome coronavirus 2 pandemic in 2020. METHODS: This retrospective study involved subjects from seven centers that were admitted and found to be positive for H1N1 or COVID-19 real-time polymerase chain reaction test. RESULTS: A total of 143 patients with H1N1 and 309 patients with COVID-19 were involved in the study. H1N1 patients were younger than COVID-19 ones. While 58.7% of H1N1 patients were female, 57.9% of COVID-19 patients were male. Complaints of fever, cough, sputum, sore throat, myalgia, weakness, headache, and shortness of breath in H1N1 patients were statistically higher than in COVID-19 ones. The duration of symptoms until H1N1 patients were admitted to the hospital was shorter than that for COVID-19 patients. Leukopenia was more common in COVID-19 patients. C-reactive protein levels were higher in COVID-19 patients, while lactate dehydrogenase levels were higher in H1N1 ones. The mortality rate was also higher in H1N1 cases. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 pandemic is a major public health problem that continues to affect the world with its high rate of contagion. In addition, no vaccines or a specific drug for the benefit of millions of people have been found yet. The H1N1 pandemic is an epidemic that affected the whole world about ten years ago and was prevented by the development of vaccines at a short period. Experience in the H1N1 pandemic may be the guide to prevent the COVID-19 pandemic from a worse end.