title: Tetanus in adults: results of the multicenter ID-IRI study.
abstract: Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Tosun
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Batirel
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
authors.forename: A I
authors.initials: AI
authors.lastname: Oluk
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Aksoy
authors.affiliation: Department of Infectious Diseases, University Hospital Center "Mother Teresa", Tirana, Albania.
authors.forename: E
authors.initials: E
authors.lastname: Puca
authors.affiliation: Infectious Diseases and Intensive Care Unit, University Hospital of Pontchaillou, Rennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Bénézit
authors.affiliation: Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University, Izmir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ural
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Nayman-Alpat
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Yamazhan
authors.affiliation: Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey.
authors.forename: V
authors.initials: V
authors.lastname: Koksaldi-Motor
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Tekin
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ataturk University School of Medicine, Erzurum, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Parlak
authors.affiliation: Infectious Diseases and Intensive Care Unit, University Hospital of Pontchaillou, Rennes, France.
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Kart-Yasar
authors.affiliation: Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Guner
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Bastug
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Meric-Koc
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Oncu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Sagmak-Tartar
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Denk
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Pehlivanoglu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Sengoz
authors.affiliation: Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: S M
authors.initials: SM
authors.lastname: Sørensen
authors.affiliation: School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bulent Ecevit University, Zonguldak, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Celebi
authors.affiliation: Faculty Hospital Brno, Department of Infectious Diseases and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Baštáková
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Gedik
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Dirgen-Caylak
authors.affiliation: Faculty of Medicine, Department of Anesthesiology Intensive Care Unit, Erciyes University, Kayseri, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Esmaoglu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Erol
authors.affiliation: School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Cag
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Karagoz
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Inan
authors.affiliation: Principal Coordinator of ID-IRI, Ankara, Turkey. hakanerdem1969@yahoo.com.
authors.forename: H
authors.initials: H
authors.lastname: Erdem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013742:Tetanus / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D055815:Young Adult