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Tetanus in adults: results of the multicenter ID-IRI study

  • S. Tosun
  • A. Batirel
  • A. I. Oluk
  • F. Aksoy
  • E. Puca
  • F. Bénézit
  • S. Ural
  • S. Nayman-Alpat
  • T. Yamazhan
  • V. Koksaldi-Motor
  • R. Tekin
  • E. Parlak
  • P. Tattevin
  • K. Kart-Yasar
  • R. Guner
  • A. Bastug
  • M. Meric-Koc
  • S. Oncu
  • A. Sagmak-Tartar
  • A. Denk
  • F. Pehlivanoglu
  • G. Sengoz
  • S. M. Sørensen
  • G. Celebi
  • L. Baštáková
  • H. Gedik
  • S. Dirgen-Caylak
  • A. Esmaoglu
  • S. Erol
  • Y. Cag
  • E. Karagoz
  • A. Inan
  • H. ErdemEmail author
Original Article

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.

Keywords

Tetanus Vaccination History Tetanus Vaccination Protective Antibody Titer Tetanus Case 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Funding

We did not receive any kind of funding.

Conflict of interest

None to declare.

Ethical approval

Yes, it is obtained from Izmir Bozyaka Education and Research Hospital’s Review Board.

Informed consent

Not applicable. The study has a retrospective design.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • S. Tosun
    • 1
  • A. Batirel
    • 2
  • A. I. Oluk
    • 1
  • F. Aksoy
    • 3
  • E. Puca
    • 4
  • F. Bénézit
    • 5
  • S. Ural
    • 6
  • S. Nayman-Alpat
    • 7
  • T. Yamazhan
    • 8
  • V. Koksaldi-Motor
    • 9
  • R. Tekin
    • 10
  • E. Parlak
    • 11
  • P. Tattevin
    • 5
  • K. Kart-Yasar
    • 12
  • R. Guner
    • 13
  • A. Bastug
    • 14
  • M. Meric-Koc
    • 15
  • S. Oncu
    • 16
  • A. Sagmak-Tartar
    • 17
  • A. Denk
    • 17
  • F. Pehlivanoglu
    • 18
  • G. Sengoz
    • 18
  • S. M. Sørensen
    • 19
  • G. Celebi
    • 20
  • L. Baštáková
    • 21
  • H. Gedik
    • 12
  • S. Dirgen-Caylak
    • 22
  • A. Esmaoglu
    • 23
  • S. Erol
    • 24
  • Y. Cag
    • 25
  • E. Karagoz
    • 26
  • A. Inan
    • 24
  • H. Erdem
    • 27
    Email author
  1. 1.Department of Infectious Diseases and Clinical MicrobiologyIzmir Bozyaka Training and Research HospitalIzmirTurkey
  2. 2.Department of Infectious Diseases and Clinical MicrobiologyDr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  3. 3.Department of Infectious Diseases and Clinical MicrobiologyKaradeniz Technical University School of MedicineTrabzonTurkey
  4. 4.Department of Infectious DiseasesUniversity Hospital Center “Mother Teresa”TiranaAlbania
  5. 5.Infectious Diseases and Intensive Care UnitUniversity Hospital of PontchaillouRennesFrance
  6. 6.Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical MicrobiologyKatip Celebi UniversityIzmirTurkey
  7. 7.Department of Infectious Diseases and Clinical MicrobiologyOsmangazi University School of MedicineEskisehirTurkey
  8. 8.Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
  9. 9.Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical MicrobiologyMustafa Kemal UniversityHatayTurkey
  10. 10.Department of Infectious Diseases and Clinical MicrobiologyDicle University School of MedicineDiyarbakirTurkey
  11. 11.Department of Infectious Diseases and Clinical MicrobiologyAtaturk University School of MedicineErzurumTurkey
  12. 12.Department of Infectious Diseases and Clinical MicrobiologyBakırköy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
  13. 13.Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical MicrobiologyYildirim Beyazit UniversityAnkaraTurkey
  14. 14.Department of Infectious Diseases and Clinical MicrobiologyNumune Training and Research HospitalAnkaraTurkey
  15. 15.Department of Infectious Diseases and Clinical MicrobiologyKocaeli University School of MedicineIzmitTurkey
  16. 16.Department of Infectious Diseases and Clinical MicrobiologyAdnan Menderes University School of MedicineAydinTurkey
  17. 17.Department of Infectious Diseases and Clinical MicrobiologyFirat University School of MedicineElazigTurkey
  18. 18.Department of Infectious Diseases and Clinical MicrobiologyHaseki Training and Research HospitalIstanbulTurkey
  19. 19.Department of Infectious DiseasesAalborg University HospitalAalborgDenmark
  20. 20.School of Medicine, Department of Infectious Diseases and Clinical MicrobiologyBulent Ecevit UniversityZonguldakTurkey
  21. 21.Faculty Hospital Brno, Department of Infectious Diseases and Faculty of MedicineMasaryk UniversityBrnoCzech Republic
  22. 22.Department of Infectious Diseases and Clinical MicrobiologyMugla Sitki Kocman University School of MedicineMuglaTurkey
  23. 23.Faculty of Medicine, Department of Anesthesiology Intensive Care UnitErciyes UniversityKayseriTurkey
  24. 24.Department of Infectious Diseases and Clinical MicrobiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  25. 25.School of Medicine, Department of Infectious Diseases and Clinical MicrobiologyMedeniyet UniversityIstanbulTurkey
  26. 26.Department of Infectious Diseases and Clinical MicrobiologyFatih Sultan Mehmet Training and Research HospitalIstanbulTurkey
  27. 27.Principal Coordinator of ID-IRIAnkaraTurkey

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