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Öğe Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis: Clinical Characteristics, Etiological Agents and Their Antibiotic Susceptibilities(Aves, 2016) Sagmak-Tartar, Ayse; Ozden, Mehmet; Akbulut, Ayhan; Demirdag, Kudbettin; Ozer-Balin, SafakObjective: The objective of this study was to determine clinical characteristics, etiological agents, and their antibiotic susceptibilities in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis encountered in our hospital. Methods: Thirty patients with peritonitis attack among 55 adult patients aged >= 18 years, who applied to Nephrology Clinic of Firat University Hospital between January 2012 and February 2013 and who were monitored in the CAPD unit were included in this prospective study. Cultures were performed on both solid media and blood culture bottles according to the recommendations of International Society for Peritoneal Dialysis. Antibiotic susceptibilities were investigated by disk diffusion method. Results: During clinical evaluation, abdominal guarding (n=28, 93.3%), rebound tenderness (n=4, 13.3%), fever (n=9, 30%), nausea and vomiting (n=13, 43.3%), and diarrhea (n=5, 16.7%) were detected. Turbid dialysis fluid and abdominal pain were noted in all patients. Direct Gram staining yielded positive result in 1 (3.3%) patient. In 28 (93.3%) patients bacterial growth was detected in the cultures. Bacterial growth was detected on solid culture media in 14 (46.7%), and blood culture bottles in 28 (93.3%) patients. In 2 (6.7%) patients, bacterial growth was not detected in both media. The same microorganisms were identified in both methods, and their antibiograms yielded similar results. Gram-positives included coagulase-negative staphylococci (n=16, 57.1%), Staphylococcus aureus (n=4, 14.3%), streptococci (n=4, 14.3%), and enterococci (n=1, 3.6%). Gram-negatives consisted of Escherichia coli (n=2), and Yersinia enterocolitica (n=1). In 46.2% of Gram-positive microorganisms penicillin resistance was detected, while 9.5% of staphylococci were methicillin-resistant. Conclusions: Each health center should have knowledge of its prevalent microbial agents, and their susceptibility profile, which is essential for the determination of suitable alternative empirical treatment. This strategy will obviate unnecessary use of antibiotics, and contribute to the decrease in the potential development of antibiotic resistance.Öğe Detection of Clonal Relationship Between Carbapenem-resistant Acinetobacter baumannii Isolates in an University Hospital(Galenos Yayincilik, 2021) Kirik, Yasemin; Demirdag, Kutbeddin; Otlu, Baris; Sagmak Tartar, Ayse; Akbulut, AyhanIntroduction: Nosocomial infections continue to be an important health problem since they seriously increase the rate of mortality and morbidity as well as hospitalization period and treatment costs. Acinetobacter spp. have an important place among the factors that cause hospital infections. Fast and accurate detection of Acinetobacter baumannii outbreaks is important in the treatment and control of epidemic infections. In our study, it was aimed to investigate the molecular similarities of carbapenem resistant A. baumannii isolates isolated as hospital infectious agents with Pulsed-Field Gel Electrophoresis (PFGE) method. Materials and Methods: This study was conducted in a medical center to examine the genetic relationship of a specific agent group detected in the non-pandemic period and is a cross-sectional study. In our study, the molecular similarities of 93 carbapenem resistant A. baumannii isolates isolated as hospital infectious agents from various clinical materials sent to Firat University Hospital Central Laboratory and Infectious Diseases Department Laboratory between December 1, 2013 and June 30, 2014 were investigated with PFGE method. Results: A. baumannii strains showed 30 different PFGE profiles. Clonally related strains were included in seven different clusters. Eighty of 93 A. baumannii strains in total were included in any cluster. The clustering rate of the strains was found to be 86 %. When the isolate dates of 55 strains in 1 cluster with the highest number of isolates were examined in our study, it was seen that this clone survived in our hospital for about five months. Conclusion: This study showed that A. baumannii strains isolated as nosocomial infection agents can survive for a long time. It was thought that carbapenem resistance spread horizontally among Acinetobacterspp. It was concluded that the necessity of training activities for infection control measures and compliance should be examined, and antibiotic use policies should he revised in terms of carbapenem resistance.Öğe Hastane kökenli Acinetobacter suşlarına karşı çeşitli dezenfektanların etkinliği(2004) Cihangiroğlu, Mustafa; Bayındır, Yaşar; Çelik, İlhami; Denk, Affan; Sevim, Erol; Akbulut, AyhanÖz: Hastane kaynaklı infeksiyonların önlenmesinde uygun dezenfektan seçimi ve kullanımı önemli basamaklardan biridir. Bu nedenle, her hastane bünyesinde en fazla sorun oluşturan mikroorganizmaların, kullanılan dezenfektanlara duyarlılığını bilmelidir. Çalışmamızda, yoğun bakım hastalarından izole edilen ve çoklu antibiyotik direnci gösteren 10 Acinetobacter spp. susuna karşı 10 farklı dezenfektanın etkinliğini mikrodilüsyon yöntemiyle araştırdık. Acinetobacter spp. suşlarına en etkili dezenfektanlar; Chlorispray^® (etanol + klorhekzidin diglukonat + gluteraldehid + formaldehid + didesil dimetil amonyum klorür), Endex^® (kokospropilen diamin diguanidyum diasetat/didesiloksimetil amonyum propionat) ve Savlex^® (setrimid/klorhekzidin) olarak saptanırken, en sık kullanılan dezenfektanlar olan alkol (%70), benzalkonyum klorür ve povidon iyodin çözeltilerinin etkinliğinin en az olduğu gözlendi. Hastanelerde sürveyans sonuçlarına göre sık görülen çoğul ilaç dirençli mikroorganizmalarda dezenfektanlara karşı direncin saptanması ve dezenfektan kullanım politikalarının buna göre belirlenmesi gerektiği kanısındayız.Öğe IS TIGECYCLINE EFFECTIVE IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS RELATED PERITONITIS(Carbone Editore, 2017) Tartar, Ayse Sagmak; Ozden, Mehmet; Dogukan, Ayhan; Akbulut, Ayhan; Demirdag, Kutbeddin; Tartar, TugayIntroduction: To compare conventional intraperitoneal vancomycin-amikacin and intravenous tigecycline treatments for continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Materials and methods: Patients diagnosed with CAPD-related peritonitis were randomized into two groups as intravenous tigecycline group (n = 10) and intraperitoneal vancomycin-amikacin group (n = 20). Patients accompanied by peritonitis exit site infection, peritonitis based on Pseudomonas or fungi were excluded from the study. Results: As for 24th and 48th hours peritoneal fluid leukocyte count of patients, significant difference was not observed in tigecycline group at 24th hours, while significant reduction was observed in vancomycin-amikacin group (p < 0.05). A significant reduction was observed at 48th hours in both groups. As for the treatment response, abdominal pain decreased in 18 (90%) patients in vancomycin-amikacin group, decreased in 8 (80%) patients in tigecycline group at 48th hours. It was detected that dialysate leukocyte count decreased significantly (p > 0.05). Relapse was observed in 4 (40%) patients in tigecycline group, while not observed in vancomycin-amikacin group (p < 0.05). Conclusion: Tigecycline proved its effectiveness in the clinical use for complicated intra-abdominal infections. However, it was considered that tigecycline cannot be alternative to vancomycin-amikacin treatment for continuous ambulatory peritoneal dialysis related peritonitis.Öğe Sürekli Ayaktan Periton Diyaliziyle İlişkili Peritonit: Klinik Özellikler, Etken Mikroorganizmalar ve Antibiyotik Duyarlılıkları(2016) Sağmak Tartar, Ayşe; Özden, Mehmet; Akbulut, Ayhan; Demirdağ, Kudbettin; Balin Özer, ŞafakÖz: Amaç: Bu çalışmanın amacı, hastanemizde gelişen sürekli ayaktan periton diyalizi (SAPD) ile ilişkili peritonitlerde klinik özelliklerin, etken mikroorganizmaların ve antibiyotik duyarlılıklarının belirlenmesidir. Yöntemler: Bu prospektif çalışmaya Ocak 2012-Şubat 2013 tarihleri arasında Fırat Üniversitesi Hastanesi Nefroloji Kliniği, sürekli ayaktan periton diyalizi ünitesinde takip edilen 55 olgudan peritonit atağıyla başvuran 18 yaş ve üstü erişkin 30 hasta alındı. Kültürler Uluslararası Periton Diyalizi Derneği'nin önerdiği şekilde hem katı besiyerine hem de kan kültürü şişelerine ekilerek yapıldı. Antibiyotik duyarlılığı disk difüzyon yöntemiyle araştırıldı.Bulgular: Hastaların 28 (%93.3)'inde batında hassasiyet, 4 (%13.3)'ünde batında defans /"rebound", 9 (%30)'unda ateş, 13 (%43.3)'ünde bulantı ve kusma, 5 (%16.7)'inde ishal saptandı. Bulanık diyaliz sıvısı ve karın ağrısı bütün hastalarda saptandı. Periton sıvısının direkt Gram boyamasında bir (%3.3) hastada pozitiflik mevcuttu. Periton sıvısı kültüründe 28 (%93.3) hastada üreme oldu. Katı besiyerinde 14 (%46.7), kan kültürü şişesinde 28 (%93.3) hastada üreme saptandı. İki (%6.7) hastada ise periton sıvısı kültürlerinde her iki yöntemle de üreme olmadı. Her iki yöntemle idantifiye edilen mikroorganizmalar ve antibiyogramları birbirinin aynısıydı. Gram-pozitif mikroorganizmalardan 16 (%57.1)'sı koagülaz-negatif stafilokok, 4 (%14.3)'ü Staphylococcus aureus, 4 (%14.3)'ü streptokok, 1 (%3.6)'i enterokok olarak tespit edildi. Gram-negatif mikroorganizmalardan 2'si Escherichia coli, 1'i Yersinia enterocolitica idi. Gram-pozitif mikroorganizmalarda penisilin direnci %46.2 olarak saptandı. Stafilokok türlerinde metisiline direnç oranı ise %9.5 olarak bulundu.Sonuçlar: Her merkezin kendi etken ve duyarlılık profilini bilmesi, uygun ampirik tedavi seçeneğini belirlemesi açısından gereklidir. Bu strateji sayesinde gereksiz antibiyotik kullanımının önlenmesi sağlanmış ve antibiyotiklere karşı direnç gelişmesi ihtimali de azaltılmış olacaktır.
