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Öğe Antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infections in a tertiary care hospital(2021) Dogan, Ahmet; Kose, Adem; Gezer, Yakup; Bayindir, Yasar; Ersoy, Yasemin; Ozden, Mehmet; Memisoglu, Funda; Altunisik Toplu, SibelAim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital. Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017. Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli. Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.Öğe Antimicrobial susceptibility pattern of Escherichia coli andKlebsiella pneumoniae isolated from patients with urinarytract infections in a tertiary care hospital(2021) Doğan, Ahmet; Köse, Adem; Gezer, Yakup; Ersoy, Yasemin; Bayindir, Yasar; Özden, Mehmet; Memisoglu, Funda; Altunisik Toplu, SibelAim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital.Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017.Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli.Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.Öğe A Case of Infective Endocarditis Due to Abiotrophia defectiva, and Treatment with Ertapenem(Galenos Publ House, 2021) Duman, Yucel; Altunisik Toplu, Sibel; Tanriverdi, Elif Seren; Bayindir, YasarThe most frequently reported infections due to Abiotrophia defectiva worldwide are bacteraemia and endocarditis. It is estimated that A. defectiva causes approximately 5-6% of microbiologically proven endocarditis and plays a role in the etiology of culture negative endocarditis. In this article we reported a patient with infective endocarditis (IE) due to penicillin resistant A defectiva, which caused vegetation in the mitral valve, embolism in the spleen and successfully treated with ertapenem. A 70-year-old female patient was admitted to the emergency service with fever and abdominal pain. The patient had a pronounced widespread abdominal tenderness in the left quadrant. The body temperature was 38.9 degrees C, C-reactive protein (CRP) level was 12.7 mg/dl and white blood cell count was 13.3x10(3) mm(3). The patient was hospitalized to investigate fever's reason. It was learned in the anamnesis that she used warfarin. Considering the pre-diagnosis of urinary tract infection, empirical treatment with ceftriaxone 2x1 g/day was started. However, due to the increase in International Normalized Ratio value on the second day of ceftriaxone treatment, ertapenem 1x1 g/day was started by considering drug interaction between warfarin and ceftriaxone. Transesophageal echocardiography of the patient revealed a 1.2x1.2 cm vegetation on the posterior leaflet surface of the mitral valve, and ischemia due to embolism in the spleen was detected on abdominal computer tomography. Penicillin resistant A defectiva grew in the blood culture. The patient was diagnosed as having IE on the seventh day of her admission. Ertapenem treatment was completed in six weeks due to the patient's absence of fever, decreased CRP level, and the absence of A. defectiva in the seventh day control blood culture. After treatment, vegetation was not observed in the transthoracic echocardiography of the patient and no signs of ischemia was detected in the spleen. Detection of A. defectiva shaped the follow-up process of our patient by bringing the diagnosis of IE to mind. In treatment of A defectiva-related IE, guidelines suggest long-term combination of aminoglycosides with beta-lactams or vancomycin. However, in our patient, treatment was provided by using ertapenem alone for six weeks. In addition, we believed that early diagnosis and treatment in our patient prevented serious complications.Öğe Commentary on Potential risk factors for Varicella-zoster virus reactivation after COVID-19 vaccination(Wiley, 2022) Turkmen, Dursun; Altunisik, Nihal; Altunisik Toplu, Sibel[Abstract Not Available]Öğe Evaluation of clinical characteristics and outcomes of postoperative infections in living liver donors(Wiley, 2021) Kose, Adem; Altunisik Toplu, Sibel; Akbulut, Sami; Yasar, Seyma; Sarici, Kemal Baris; Duman, Yucel; Kutlu, RamazanAim To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). Methods Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. Results The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum beta-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 +/- 2 (min 1-max 30, IQR:1) and hospitalization days was 14 +/- 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. Conclusion Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.Öğe Evaluation of HLA-B*57:01 and its effect on antiretroviral therapy in patients with human immunodeficiency virus infection: Experience of a University Hospital(2020) Altunisik Toplu, Sibel; Ersoy, Yasemin; Bayindir, Yasar; Memisoglu, Funda; Kose, Adem; Otlu, GoncaAim: Before the decision to start abacavir (ABC), which is a member of the antiretroviral therapy (ART) combinations, the presence of the HLA-B*57:01 allele gene should be investigated in case of hypersensitivity to the drug. In recent years, many clinics tend to conduct “treat now” policy for HIV therapy. We aimed to evaluate HLA-B*57:01 test results and its effect on the initiation time of ART, combination and changing of ART.Materials and Methods: HLA-B*57:01 screening test was evaluated retrospectively in the HIV-infected patients admitted to Inonu University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology between January 2019 and December 2019.Moreover, the time frame of HLA-B*57:01 tests were evaluated along with the HIV confirmation test completion time. It was evaluated whether there was any effect on the start of treatment and treatment change.Results: Of the 47 HIV-positive patients 44 (93.6%) were male and 3 (6.4%) were female whose HLA-B*57:01 allele was screened. The mean age ± SD of these 47 patients was 37.7 ± 13.5 years. HLA-B*57:01 gene positivity was not detected in any of our cases. After HLA-B*57:01 test detection, ten (21%) of these patients were treated with ABC sulfate plus dolutegravir sodium plus lamivudine. Five of the patients were naive patients, while the other five patients were treatment experienced. HLA-B*57: 01 allele test completion time of the patients (mean ± SD) was 4.02 ± 2.35 days. HLA-B*57:01 completion time did not differ statistically in patients with and without treatment change (p=0.243). Conclusion: HIV infected individuals should be started to treat with ART soon after their diagnosis. To detect the HLA-B*57:01 allele in genomic DNA is important in this period. The fact that this procedure can be performed in centers following HIV-infected patients will positively affect the process of starting treatment.Öğe Follow-up and treatment of primary HIV infection in Pregnancy(2022) Sağlam Kandemir, Esra; Altunisik Toplu, Sibel; Ersoy, YaseminThe pregnant population infected with "human immunodeficiency virus" (HIV), an important member of the retrovirus family, are encountered with increasing frequency in our clinical experience today. Early and effective suppression of HIV viremia will reduce the risk of mother-to-child transmission of HIV. In the light of the case we aimed to review the antiretroviral treatment (ART) options that can be used in HIV-positive pregnant women and to share an our clinical experience.Öğe The importance of procalcitonin in early diagnosis of sepsis(2017) Yetkin, Funda; Altunisik Toplu, SibelAbstract: Despite the advances and a wide range of studies conducted, sepsis is one of the most frequent causes of death in patients with critical health condition. Early diagnosis, rapid and effective treatment are extremely important. Use of procalcitonin (PCT) for this purpose has become widespread and notable recently. Procalcitonin is an important test as “point-of-care testing (POCT)” just like C-reactive protein (CRP). Procalcitonin is the prohormone of calcitonin. It is released from the parenchymal cells of the liver, kidneys and muscles, and in response to bacterial toxins, it is released from the adipocytes. As a response to bacterial infection, the serum procalcitonin level may increase by 5000-fold within 2-4 hours. C- reactive protein is synthesized in the liver as a result of interleukin-6 (IL-6) trigger due to tissue injury, inflammation and/or infections. The aim of our study was to emphasize the importance of PCT as an indicator in patients suspicious of sepsis in the early period. A total of 66 patients with critical situation were included in the study conducted at the İnönü University Medical Faculty Turgut Özal Medical Center Investigation Hospital between February 2007 and August 2008. These patients were appropriate for the diagnostic criteria of systemic inflammatory response syndrome (SIRS). Appropriate antibiotiotherapy was begun for the patients. The PCT and CRP levels were investigated on the first day after having been included in the study, and on the third and seventh days. The mean C-reactive protein levels were 132.41, 108.39 and 83.47 mg/l on the 1, 3rd and 7th days, respectively. The minimum level of procalcitonin was 0.095 ng/ml on the first day, and the maximum level was 316.054 ng/ml. The minimum/maximum levels were 0.091 and 306.043 ng/ml on the 3rd day, and 0.081 and 12.15136 ng/ml on the 7th days, respectively. No statistically significant difference was observed betweern the serum procalcitonin levels on the 1st and the 3rd days ( p<0.229), whereas a significant difference was observed between its levels between the 1st and the 7th days (p<0.002). Likewise, the difference between the 3rd and the 7th days was statistically significant (p<0.005). C-reactive protein levels revelaed a significant difference between the 1st and the 7th days (p<0.013) and between the 3rd and the 7th days (p<0.010). The Wilcoxon Signed test was used to investigate statistical significance. The diagnostic value of procalcitonin has been widely used in septic patients. Although conflicting results have been obtained in different studies, despite the fact that some studies have not found PCT supportive for the diagnosis of sepsis, we believe that PCT is an appropriate and important indicator in the early diagnosis and follow-up of sepsis as CRPÖğe Retrospective Review of Patients with Staphylococcus aureus Bacteremia(Bilimsel Tip Yayinevi, 2024) Yilmaz, Zeynep Burcin; Duman, Yuecel; Altunisik Toplu, Sibel; Memisoglu, Funda; Kose, Adem; Ozden, Mehmet; Bayindir, YasarIntroduction: Staphylococcus aureus causes community-acquired and healthcare-associated infections with high morbidity and mortality. It is critical to initiate appropriate and effective treatment considering the risk factors for S. aureus bacteremia. There is insufficient data available regarding this patient group in our region. This study aimed to assess the focus of infection, resistance status, and clinical course in patients with S. aureus bacteremia detected in blood culture. Materials and Methods: Patients with healthcare-associated or community-acquired S. aureus bacteremia who were hospitalized in a tertiary hospital during the one year between January 2020 and December 2020, and microbiological data were retrospectively analyzed. The distribution of Staphylococcus aureus bacteremia was evaluated based on the organ involved, the clinics where it was observed, and its resistance status. Results: OStaphylococcus aureus isolate growth was detected in the blood cultures of 66 adult patients within one year. The mean age of the patients was 56.5 +/- 16.8 (18-84) years, and 76% were male. While bacteremia was community-acquired in 12 (18.2%) of the patients, it was healthcare-related in 54 (81.8%) and methicillin resistance rates were 8.3% and 25.9%, respectively. The most common focus of infection was catheter-related bloodstream infection in 21.2% and pneumonia in 21.2% of patients. No focus was detected in 34.8% of the bacteremias. In terms of methicillin-resistant S. aureus (MRSA) distribution, the difference between intensive care and wards was 20% and 80%, respectively. No statistically significant difference was found (p> 0.05). While the 14-day mortality in MRSA bacteremia was 33.6%, the 14-day mortality in methicillin-susceptible S. aureus was 27.5% (p= 0.731). Conclusion: It was found that Staphylococcus aureus bacteremia was predominantly nosocomial, with pneumonia and catheter infections being the most common causes. The conclusion drawn suggests a need for heightened infection control measures, particularly focusing on improving hand hygiene practices. To guide empirical treatment effectively, it is crucial to monitor resistance changes that may have occurred over the years, consider risk factors for MRSA, and elucidate the resistance profiles specific to individual healthcare facilities.Öğe The role of procalcitonin and C-reactive protein in predicting candidemia in reanimation intensive care unit and burn unit patients(2021) Altunisik Toplu, Sibel; Ersoy, Yasemin; Duman, Yucel; Parmaksiz, Emine Nalan; Ozer, Ayse Belin; Firat, CemalAim: Predicting the diagnosis of candidemia remains a challenge for physicians. It is difficult to distinguish candidemia from other potential conditions, especially in patients under intensive care. Although blood culture is the gold standard in diagnosis, there is continued search for other markers that may be used for early prediction.This study intended to assess if procalcitonin (PCT) and C-reactive protein (CRP) may be able to guide the course of Candidemia.Materials and Methods: The study included patients over the age of 18 admitted to the Reanimation Intensive Care Unit and Burn Unit between June 2018 and June 2019 whose blood cultures exhibited growth of Candida species (spp.). Moreover, the patients’ blood cultures were also tested for Gram negative and Grow positive bacterial growth that may accompany Candida species (spp.). For all patients, we recorded the PCT and CRP values three times.Results: This study examined sixty-six patients exhibiting growth of Candida spp. in their blood cultures; 42 (64%) cases had no accompanying bacterial growth in their culture (Group 1). In addition to the growth of Candida spp., the blood cultures showed that 16 patients also had Gram-negative bacteremia (Group 2), and eight patients had Gram-positive bacteremia (Group 3). When a cut-off value of 0.5 ng/mL was considered for all candidemia patients, the first assessments did not show a statistically significant high value (p=0.053). However, when evaluated with bacteremia, the first PCT results were higher in patients with Gram-negative bacteremia. PCT and CRP changes over time were statistically significant based on two-way repeated measures comparisons (p0.05). There was a positive correlation between PCT values and mortality (p0.01).Conclusion: We believe that the decrease in PCT and CRP values are helpful while clinically monitoring patients with candidemia.
