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Öğe 2011 ve 2015 yıllarında izole edilen çoğul ilaç dirençli acinetobacter baumannii suşlarının, tigesiklinminimum inhibitör konsantrasyon değerlerinin karşılaştırılması(Medicine Science, 2017) Duman, Yücel; Kuzucu, Çiğdem; Tekerekoğlu, Mehmet SaitÖz: Acinetobacter baumannii nozokomiyal enfeksiyonlara neden olan fırsatçı bir patojendir. A. baumannii farklı mekanizmalarla hızlı bir şekilde antimikrobiyallere karşı direnç geliştirebilmektedir. ÇİD'li suşlarının oluşturduğuenfeksiyonlar; morbidite ve mortalitesi yüksek, uzun süreli hospitalizasyon gerektiren enfeksiyonlardır. Tigesiklin, ÇİD profiline sahip A. baumannii suşlarına karşı güçlü aktiviteye sahip birkaç antimikrobiyalden biridir. Yapılan meta-analizler ve klinik çalışma raporlarında bu suşlarında direnç artışı nedeniyle, tigesiklin alan hastalarda mortalite riskinin arttığı bildirilmektedir. Çalışmamızda 2011 ve 2015 yıllarında hastanemizde yatan hastalardan izole edilen ÇİD profiline sahip A. baumannii suşlarında, tigesiklin MİK değerlerinin karşılaştırılması ve direnç gelişim oranlarının belirlenmesi amaçlanmıştır. 2011 ve 2015 yıllarında izole edilen 200 A. baumannii suşunun tigesiklin MİK değerleri broth mikrodilüsyon yöntemiyle araştırıldı. Final konsantrasyonlar 16?g/ml-0.06?g/ml olacak şekilde hazırlandı. Tigesiklin MİK breakpoint değerleri, FDA'nın Enterobacteriaceae için önerdiği breakpoint değerleri esas alınarak yorumlandı. 2011 yılında izole edilen çoğul ilaç dirençli A. baumannii suşlarının MIK50 değeri 0.5 µgr/ml, MIK90 değeri 1µgr/ml, 2015 yılında ise MIK50 değeri 1 µgr/ml, MIK90 değeri 4µgr/ml olarak saptandı. 2011 yılında çalışılan suşların %4'ünün, 2015 yılında ise %16'sının tigesiklin MİK değeri 2 ?g/ml üzerinde belirlendi ve dirençli olarak yorumlandı. Tigesiklin hastanemizde özellikle yoğun bakım ünitelerinde yatan hastaların, A. baumannii suşlarına bağlı enfeksiyonlarının tedavisinde hala etkin olarak kullanılabilecek alternatif bir antimikrobiyaldir. Ancak tigesikline karşı direnç gelişimini önlemek için, irrasyonel antibiyotik kullanımı engellenerek antimikrobiyal duyarlılık testi sonuçlarına göre tedavi uygulanması gerekmektedirÖğe Afşin Devlet Hastanesinde, İdrar Örneklerinden İzole Edilen Toplum Kaynaklı Escherichia Coli Suşlarının Antimikrobiyal Direnç Durumu ve GSBL Varlığının Araştırılması(İnönü Üniversitesi Tıp Fakültesi Tıbbi Mikrobiyoloji ABD, Malatya, Türkiye, 2014) Duman, Yücel; Bozkurt, İlkay; Tekerekoğlu, Mehmet SaitÖz: Escherichia coli toplum kaynaklı üriner sistem enfeksiyonlarından (ÜSE) etken olarak en sık izole edilen mikroorganizmadır. Genişlemiş spektrumlu ?-laktamaz (GSBL) pozitif E.coli suşlarının toplum kaynaklı ÜSE'lerde sıklığının artması ile beraber ampirik tedavide kullanılan antibiyotiklere karşı direnç oranlarının artmasına neden olmaktadır. Bu çalışmanın amacı toplum kaynaklı ÜSE etkenlerinden olan E.coli suşlarının antimikrobiyal paternleri belirlenerek, bölgemizdeki direnç oranlarının ve epidemiyolojik özelliklerinin araştırılmasıdır. Eylül 2011Eylül 2013 tarihleri arasında hastanemiz polikliniklerinden toplum kökenli ÜSE ön tanısıyla mikrobiyoloji laboratuvarımıza gönderilen 3887(2146 kadın, 1741 erkek) idrar kültür örneği incelendi. İdrar kültür örneklerinin 697'sinde(%18) üreme oldu. İdrar kültür örneklerinde üreme saptanan hastaların 423'ü(%61) bayan, 274'ü(%39) erkekti. İzole edilen bakterilerin 352'si(%51) konvansiyonel yöntemlerle E.coli olarak tanımlandı. Tanımlanan E.coli suşlarının antimikrobiyal direnç durumu Clinical Laboratory Standards Institute kriterleri ile belirlendi. GSBL oranları ise çift disk sinerji testi ile araştırıldı. İzole edilen 352 E.coli suşu'nun, %47'si üroloji, %28'i dahiliye ve %25'i pediatri polikliniklerine ayaktan başvuran hastaların idrar kültür örneklerine aitti. E.coli suşlarında %62 ile en yüksek direnç oranı ampisiline karşı görüldü. İmipenem ve amikasine karşı ise direnç saptanmazken fosfomisin trometamole %2 oranında direnç belirlendi. İzole edilen suşların 53'ünde(%15) GSBL varlığı saptandı. Bölgemizdeki antimikrobiyal direnç oranlarının belirlenmesi, ampirik tedavide akılıcı ilaç kullanımına katkıda bulunarak, GSBL üretimi ve direnç gelişimini önleyecek, antibiyotiklerin etkin kullanılmasına katkıda bulunacağı inancındayız. Ayrıca çalışmamızın benzer bölgesel çalışmalara ışık tutarak farklılıkların gösterilebilmesi ve sonuçların karşılaştırılabilmesi açısından yararlı olacağı kanısındayız.Öğe Bir üniversite hastanesi laboratuvarında beyin omurilik sıvısı'nda izole edilen mikroorganizmaların üç yıllık geriye dönük analizi(2012) Duman, Yücel; Yakupoğulları, Yusuf; Tekerekoğlu, Mehmet Sait; Güçlüer, Nilay; Otlu, BarışAmaç: Bu çalışmada, hastanemizde üç yıllık dönemde beyin omurilik sıvısından (BOS) izole edilen ajanların geriye dönük analizi yapıldı. Gereç ve yöntem: Eylül 2008 ile Eylül 2011 yılları arasında laboratuvarımıza BOS örneği gönderilmiş olan hastaların sonuçları retrospektif olarak incelendi. Soyutlanan bakteri türleri konvansiyonel yöntemler, biyokimyasal testler ve/veya Phonix (BD, US) ticari identifikasyon sistemleri kullanılarak tanımlandı. Elde edilen türlerin antimikrobiyal duyarlılık testleri Clinical Laboratory Standards Institute (CLSI) önerileri doğrultusunda çalışıldı. Bulgular: Toplam 1408 hastaya ait BOS örneğinden 11 Streptococcus pneumoniae, 8 Klebsiella pneumoniae, 7 Pseudomonas aeruginosa, 7 Acinetobacter baumannii, 5 Escherichia coli, 4 Enterococcus spp., 2 Enterobacter spp., 25 koagülaz negatif stafilokok, 1 Morganella morganii, 2 Neisseria meningitidis, 1 Brucella spp., ve 1 Candida albicans olmak üzere toplam 74 (%5.2) üreme saptandı. Yapılan antibiyotik duyarlılık testinde 2 S.pneumoniae suşunda penisilin direnci saptanırken; bir E.coli ve iki K.pneumoniae suşunda genişlemiş spektrumlu beta-laktamaz (GSBL); üç acinetobacter ve bir pseudomonas suşunda ise karbapenem direnci saptandı. Sonuç: Farklı bölgelerde ve hasta topluluklarında etken ve antimikrobiyal direnç epidemiyolojisinin belirlenmesi koruyucu ve tedavi edici sağlık politikaların yapılandırılmasında faydalı olacaktır.Öğe Bir yıllık sürede izole edilen pseudomonas aeruginosa suşlarının antibiyotik duyarlılığının araştırılması: kesitsel bir çalışma(İnönü Üniversitesi Sağlık Bilimleri, 2012) Duman, Yücel; Kuzucu, Çiğdem; Kaysadu, Halim; Tekerekoğlu, Mehmet SaitÖnemli bir hastane patojeni olan Pseudomonas aeruginosa; sepsis, peritonit ve ventilatör ilişkili pnömoni gibi yüksek mortalité ile seyreden infeksiyonlar oluşturmaktadır. Bu kesitsel çalışmada 2011 yılı içinde çeşitli klinik materyallerden soyutlanan P. aeruginosa suşlarının klinik örnek ve antibiyotik duyarlılık özelliklerinin araştırılması amaçlanmıştır. Çalışma süresince toplam 307 izolat elde edildi. Suşların 1/3'ünden fazlası (%34.5) yoğun bakım birimlerinden soyutlandı. İzolatların %26.4'ü idrar ve %21.8'i trakeal aspirat örneklerine aitti. Elde edilen pseudomonaslarda amikasin direnci %1.3, imipenem direnci %11.4 ve piperasilin direnci %21.8 olarak saptandı. Çalışmamızın sonuçlarına göre pseudomonasların hastanelerin yoğun bakım ünitelerinde ve cerrahi servislerinde yoğunlaştığı görülmektedir. Tek başına kullanılmamakla beraber amikasin en etkin antibiyotik durumundadır.Öğe Changing trends of carbapenem resistance of escherichia coli and klebsiella pneumoniae strains isolated from intensive care units, inpatient services and outpatient’s clinics: a five years retrospective analysis(2018) Kaysadu, Halim; Yakupoğulları, Yusuf; Çakıl, Bensu; Tekerekoğlu, Mehmet Sait; Kuzucu, Çiğdem; Duman, YücelAbstract: Carbapenem resistance (CR) was rarely reported in Klebsiella pneumoniae and Escherichia coli strains until ten years ago. In recent years, increasing carbapenem resistance in gram negative bacteria is a substantial concern. Objectives: In this study; we aimed to evaluate the changing frequency of CR in K. pneumoniae and E. coli strains that were isolated from the patients from intensive care units, inpatient services and outpatients’ clinics in the last five years. Data of antimicrobial susceptibility belonging to clinical isolates of K. pneumoniae and E. coli strains determined between 2013 and 2017 were retrospectively collected from Laboratory Information System. Results were statistically analyzed. A total 4002 K. pneumoniae and 13462 E. coli strains were included. The CR of K. pneumoniae strains were found as 11.6%; while of E. coli’s were found as 0.6%. The highest CR frequency was detected among intensive care units’ isolates of K. pneumoniae as 20.1%. We determined that CR significantly increased in intensive care unit isolates of E. coli and K. pneumoniae about 5-10 folds throughout the study period; however, there was no remarkable change in the CR of E. coli strains from the outpatients’ clinics. We determined that the resistances of K. pneumoniae and E. coli strains to carbapenems were progressively increasing by years, especially in intensive care units and inpatient services. Therefore, appropriate antimicrobial use policies sought to be considered against to this growing problem.Öğe Clinical features and follow-up results of the patients with methicillin-resistant Staphylococcus aureus (MRSA) in orthopedic practice(2018) Erdemir, Nuri; Korkmaz, Mehmet Fatih; Duman, Yücel; Arslan, Aydın; Sevimli, ReşitAbstract: Treatment of the infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains in orthopedic patients is a difficult and laborious process for both the patient and physician. Staphylococcus aureus(S. aureus) is one of the leading causes of community-acquired and nosocomial infections. In this study, we aimed to investigate the susceptibilityof the MRSA strainsisolated in orthopedic patients cultured for different reasons in our clinic to various antibiotics, and to evaluate clinical characteristics of the patients and factors affecting the prognosis. A total of 40 patients with MRSAisolated in our orthopedics clinic between December 2012 and November 2016 were retrospectively analyzed. Data including age, sex, comorbidities, previous surgeries, and previous antibiotic treatments were obtained from patients’ files and electronic information system. Of 40 patients, 60% were male, and 56% were over 60 years old. While 80% of the patients underwent an orthopedic surgery, 20% of them received no surgical intervention before the diagnosis. A total of 90% were in-patients, and the mean length of hospital stay was 22 days. The mean time from the date of hospitalization to the isolation of MRSA was 12 days. According to the consultation findings, in the clinical recovery process of the patients and in the treatment algorithm given to those patients, vancomycin and teicoplanin were found to be among the most important treatment options, in addition to significant debridement to be done, for MRSA strains. Our study results suggestthat, in addition to the surgical debridement, timely antibiotherapy is of utmost importance to reduce mortality and morbidity in MRSA-positive orthopedic patients.Öğe Co-Production of OXA-48 and NDM-1 Carbapenemases in Providencia rettgeri: the First Report(ANKARA MICROBIOLOGY SOC, HACETLEPE UNIV FACULTY MEDICINE DEPT MICROBIOLOGY, 06100 ANKARA, TURKEY, 2018) Otlu, Barış; Yakupoğulları, Yusuf; Gürsoy, Nafile Canan; Duman, Yücel; Bayındır, Yaşar; Tekerekoğlu, Mehmet Sait; Ersoy, YaseminOur country is the epicenter of the OXA-48-like carbapenemase-producing Klebsiella and Escherichia coli; and in the recent years, the concern has been increasing due to both spreading of this resistance to other members of Enterobacteriaceae family and acquiring other carbapenemases by the OXA-48-producing strains. In this study, OXA-48 and NDM-1 co-production was presented in Providencia rettgeri. Two P.rettgeri strains that were resistant to all antimicrobials except colistin and tigecyclin, were isolated from two patients in the burn unit of our hospital, including one from the urine sample of a 68 years female in April 2017, and the other from a burn wound swab of a 35 years old male, in November 2017. Minimal inhibitory concentrations (MICs) of the isolates for imipenem and meropenem were measured as >= 32 mu g/ml; and for colistin and tigecyclin were 1 ve 0.5 mu g/ml, respectively. Multiplex PCR analysis showed that both strains were carrying bla(oxA-48 )and bla(NDM-1 )carbapenemases, and bla(TEM) extended spectrum beta-lactamase genes. By using DNA sequence analysis, the TEM gene was typed as bla(TEM-1). The Pulsed Field Gel Electrophoresis (PFGE) analysis indicated that these two strains which were consecutively isolated from two different patients in a single unit within about seven months were genetically indistinguishable. No significant data that could explain the spread of these isolates was obtained from our retrospective analysis of the medical records including the results of environmental surveillance cultures, and patients' history. Nevertheless, hospital infection control committee enforced the infection control measures in that unit, and no further isolation was observed within three months period following the last isolation, neither from environmental nor from clinical samples. With this study, it was emphasized that the co-production of OXA-48 and NDM-1 carbapenemases which was reported from only three Enterobacteriaceae species up to date was ongoing for spreading to other species by using horizontal route, and also showing a potential to be a growing problem in the hospitals, by clonal expansion (vertical route). Effectively using of the molecular epidemiological methods will provide useful data to better understand the transmission dynamics of such rare, but problematic species in hospitals.Öğe Comparison the serologic tests used in the diagnosis of brucellosis; brucellacapt, brucella coombs gel, and brucella coombs tube agglutination tests(2021) TANRİVERDİ, Elif Seren; Duman, Yücel; Gözükara Bağ, Harika; Tekerekoğlu, Mehmet SaitAbstract: Aim: Brucellosis is the most common bacterial zoonosis in the world and in our country. The definitive diagnosis of the disease is the isolation of the agent in culture, but in routine diagnosis serologic tests are mostly used. In the routine serological diagnosis of brucellosis, rose bengal, standard tube agglutination (STA) and coombs tube agglutination (CTA) tests were used. The aim of this study was to determine the effectiveness of Brucellacapt (BCAP) and Coombs Gel (CJ) tests by comparing with STA and CTA tests. Materials and Methods: A total of 100 samples (47 positive and 53 negative by CTA test) were included in the study between June 2018 and July 2019. Titters detected as ?1 / 160 in STA, CTA, BCAP (METSER Brucella test with Coombs, Savas Medical, Istanbul), CJ (ODAK Brucella Coombs Gel test, Toprak Medical, Istanbul) tests were accepted as positive. Cohen kappa (?) analysis was used to evaluate the consistency between the tests. Results: Out of 100 samples included in the study were found positive, 20 with STA, 48 with CAP and 53 with CJ tests, respectively. Among the 47 patients who were positive with CTA test, 44 were positive with BCAP and CJ tests, also 2 of them were negative with BCAP and 1 with CJ test. Among the samples found negative with the CTA test, 3 were found positive with BCAP and 7 with the CJ test. STA test was negative in 27 samples that were positive by CTA test. ? = 0.900 for CTA and BCAP, ? = 0.841 for CTA and CJ, ? = 0.860 for BCAP and CJ; showed a high level of agreement. The STA test showed a very low level of agreement with all three methods (? = 0.440 for CTA with STA, ? = 0.426 for BCAP with STA, ? = 0.363 for CJ with STA). Conclusion: Compared to CTA testing, the applicability of BCAP and CJ tests is easier. Among the three tests, the CJ test gives the fastest results. In the serologic diagnosis of brucellosis, BCAP and CJ test can be used because of high compatibility with CTA test, and it is thought that the compatibility between the tests should be evaluated with more comprehensive studies.Öğe Counterfeit Probiotic Drugs(2022) Oruç, Mücahit; Duman, Yücel; Altın, İsmail; Celbiş, OsmanAim: Counterfeit drugs are a threat to human health worldwide. It can be seen that insufficient research has been conducted on the subject of counterfeit drugs related to potentially addictive drugs seized by the authorities. The aim of this study was to investigate whether or not there are drugs for sale in the Turkish market, which are counterfeit drugs under the heading of probiotics which are defined as micro-organisms with a positive effect on health when taken in certain quantities. Material and Method: A total of 17 different probiotic products in capsule, drops or sachet form, which were permitted for sale, were obtained from randomly selected chemist’s shops in the province of Malatya. Results: There was nothing missing or counterfeit on the packaging of the 17 products examined. When the contents were investigated, no deficiencies or excess micro-organism production was determined in the first 12 products. In product #13, there was no production of one of the mentioned micro-organisms. In products # 14,15, 16, and 17, more than one micro-organism stated in the prospectus could not be obtained. Conclusion: As the checking of products sold in chemist’s but controlled by the Ministry of Food, Agriculture and Livestock is not easy, there is a need for tighter supervision. This can be provided by sending the samples taken during audits to the correct laboratories, making detailed examinations, and evaluation the amount of active substance.Öğe Demographics and clinical characteristic of patients diagnosed with hen’s egg allergy(2019) Topal, Erdem; Arga, Mustafa; Celiksoy, Mehmet Halil; Kaynak, Mustafa Sinan; Duman, Yücel; Demirtas, Semih; Alatas, Cem; Tonbul, Hayrettin; Dalkilic, Huri MaralAim: To assess the demographics, clinical characteristics and natural course of patients diagnosed with hen’s egg allergy.Material and Methods: Patients who were diagnosed with hen’s egg allergy were included in this study. The patients’ medical records were analyzed to collect demographic and clinical data.Result: 88 patients diagnosed with hen’s egg allergy were included in the study. 46 (52.3%) of the patients were male, their median age was 33 months and their median follow-up period was 18 months. 44 (50%) of the patients had comorbid atopic disease. 49 (55.7%) of the children’s parents had a diagnosis of atopic disease, while 5 (5.7 %) had a diagnosis of food allergy. In terms of the patients’ clinical symptoms, 86 (97.7%) had cutaneous symptoms, 16 (18.2%) had gastrointestinal system symptoms, 13 (14.8%) had respiratory system symptoms. In the follow-up, 43 (48.9%) of the patients were found to develop tolerance. When the patients allergic to egg white and those allergic to egg yolk were compared in terms of clinical findings, atopic eczema exacerbation was found to be more frequent (p=0.012) in patients allergic to egg white; while urticaria (p=0.005) and cough (p=0.012) were found to be more frequent in patients allergic to egg yolk.Conclusion: In clinical presentations that develop as a result of egg allergy, the most frequent symptoms are dermatological, gastrointestinal system and respiratory system symptoms, respectively. However, while atopic eczema exacerbations are more frequent in patients allergic to egg white, symptoms related with respiratory tract are more common in patients allergic to egg yolk. Keywords: Allergy; Cow’s Milk; Persistence; Predictive Factors; Tolerance.Öğe Demographics and clinical characteristic of patients diagnosed with hen’s egg allergy(2019) Topal, Erdem; Arga, Mustafa; Çeliksoy, Mehmet Halil; Kaynak, Mustafa Sinan; Duman, Yücel; Demirtaş, Hasan; Alataş, Cem; Tonbul, Hayrettin; Maral Dalkılıc, HuriAbstract: Aim: To assess the demographics, clinical characteristics and natural course of patients diagnosed with hen’s egg allergy. Material and Methods: Patients who were diagnosed with hen’s egg allergy were included in this study. The patients’ medical records were analyzed to collect demographic and clinical data. Result: 88 patients diagnosed with hen’s egg allergy were included in the study. 46 (52.3%) of the patients were male, their median age was 33 months and their median follow-up period was 18 months. 44 (50%) of the patients had comorbid atopic disease. 49 (55.7%) of the children’s parents had a diagnosis of atopic disease, while 5 (5.7 %) had a diagnosis of food allergy. In terms of the patients’ clinical symptoms, 86 (97.7%) had cutaneous symptoms, 16 (18.2%) had gastrointestinal system symptoms, 13 (14.8%) had respiratory system symptoms. In the follow-up, 43 (48.9%) of the patients were found to develop tolerance. When the patients allergic to egg white and those allergic to egg yolk were compared in terms of clinical findings, atopic eczema exacerbation was found to be more frequent (p=0.012) in patients allergic to egg white; while urticaria (p=0.005) and cough (p=0.012) were found to be more frequent in patients allergic to egg yolk. Conclusion: In clinical presentations that develop as a result of egg allergy, the most frequent symptoms are dermatological, gastrointestinal system and respiratory system symptoms, respectively. However, while atopic eczema exacerbations are more frequent in patients allergic to egg white, symptoms related with respiratory tract are more common in patients allergic to egg yolk.Öğe Escherichia coli suşlarında antimikrobiyal duyarlılık ve genişlemiş spektrumlu-?eta laktamaz (GSBL) varlığı(2010) Duman, Yücel; Güçlüer, Nilay; Serindağ, Ayfer; Tekerekoğlu, Mehmet SaitÖz: Amaç: Bu çalışma Mart 2009 - Mart 2010 tarihleri arasında hastanemiz Merkez Laboratuvarı Klinik Mikrobiyoloji bölümünde izole edilen E.coli suşlarının antimikrobiyal duyarlılık profili ve GSBL oranlarının belirlenmesi amacıyla yapılmıştır. Gereç ve Yöntemler: Mart 2009 - mart 2010 tarihleri arasında çeşitli örneklerden konvansiyonel yöntemler ve otomatize sistemle tanımlanan E.coli suşlarının antimikrobiyal duyarlılık durumu Clinical Laboratory Standards Institute (CLSI) kriterleriyle belirlendi. Bulgular: İzole edilen edilen 2459 E.coli suşu'nun, 747'si ayaktan tedavi gören, 1712'si yatarak tedavi gören hastalara aitti. Yatan hastalarda %84.8, ayakta tedavi gören hastalarda ise %77.3 ile en yüksek direnç oranı ampisiline karşı görülmüştür. En düşük direnç oranı imipenem ve amikasine karşı saptanmıştır. Ayaktan tedavi gören hastalardan izole edilen suşların 104'ünde (%13.9), yatan hastalardan izole edilen suşlardan ise 471'inde (%27.5) genişlemiş spektrumlu beta-laktamaz (GSBL) belirlenmiştir. Sonuç: Hastanemizdeki antimikrobiyal direnç oranlarının belirlenmesiyle, antimikrobiyal tedavilerin bu sonuçlara göre seçilmesi, GSBL üretimi ve direnç gelişimini önleyecektir.Öğe Evaluation of the compatibility of phenotypic and molecular methods used to determine carbapenem resistance in enterobacterales isolates(2020) Duman, Yücel; Şık, İremAbstract: Aim: Carbapenems are one of the most important options for clinicians with few treatment options in the clinic due to their low side effects, rapid diffusion into tissues and use in all age groups. Therefore, it is important to be able to detect carbapenemase-producing isolates at an early stage for appropriate patient management and for infection prevention and control procedures. Antibiotic resistance genes and enzymes of microorganisms can be determined by phenotypic and molecular methods in clinical microbiology laboratories. Phenotypic methods are cheap, easy and easy to repeat but determination of resistance gene regions by molecular methods is costly, requires labour-experienced personnel and is time consuming. Determining whether the isolates possess the carbapenemase enzyme by phenotypic tests will provide convenience both for the patient and early initiation of the treatment and directing the clinician to the treatment. In this study, we aimed to evaluate the compatibility of phenotypic methods (carbapenemase inactivation method and Rapidec Carba NP) and molecular methods (Polymerase Chain Reaction) used to determine carbapenem resistance in Enterobacterales isolates. Material and Methods: Carbapenem resistant 60 and sensitive 20 Enterobacterales isolates were included in the study. E-test agar gradient diffusion, CIM, Rapidec Carba NP methods and PCR were studied. The agreement between the methods was determined by using the kappa (?) coefficient with the cohen kappa analysis method. Results: In carbapenem resistant isolates, meropenem MİK50 and MİK90 determined as 32µg/ml, 64µg/ml, imipenem MİK50 and MİK90 determined as 32µg/ml, 128µg/ml, respectively. OXA-48 was positive in 54 (90%) isolates and NDM-1 in 6 (10%) isolates. The susceptibility of the isolates with OXA-48 carbapenemase gene region was 94.4% by CIM test and 92.6% by Rapidec Carba NP test, respectively. When the Kappa coefficient was evaluated, a very good agreement was observed between both tests and OXA-48. However, in the isolates with NDM-1 gene region, no compliance with CIM test was observed but Rapidec Carba NP test showed very good agreement. Conclusion: Rapid carbapenemase testing, such as Rapidec Carba NP and CIM, can play an important role in preventing the development of health-related outbreaks caused by carbapenemase-producing isolates, enabling faster prevention and control of infection.Öğe Fusarium Fungemia After Electric Burn: A Case Report(2023) Ersoy, Yasemin; Doğan, Ahmet; Duman, Yücel; Fırat, CemalFusarium bloodstream infections, which are mostly seen in immunosuppressive patients, are serious life-threatening infec- tions. Here, we present a 35-year-old male patient who was being followed up for electric shock due to Fusarium fungemia, which developed while receiving antibacterial therapy. It was thought that the patient’s central venous catheter, use of broad-spec- trum antibiotics, and severe burn could be the most important risk factors. The patient was successfully treated by withdraw- ing the catheter and administering Liposomal Amphotericin-B 3 mg/kg daily for 3 weeks. Blood culture is critical in burn patients, and Fusarium infections should also be considered.Öğe Hepatit B Virüsü İnfeksiyonunun Seroprevalansı(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2009) Duman, Yücel; Kaysadu, Halim; Tekerekoğlu, Mehmet S.Çalışmamızda Ağustos 2008-Ağustos 2009 tarihleri arasında hastanemize başvuran hepatit şüphesi bulunan 14280 kişi, sürekli hemodiyaliz işlemlerine maruz kalan 59 hasta ve hastanemiz kan merkezine başvuran 16080 kan donörleri arasındaki; Hepatit B seroprevalansı belirlenip, karşılaştırıldı. Hepatit şüphesi bulunan hastaların 1896’sı (%13), hemodiyaliz hastalarının 3’ü (%5,1) ve kan donörlerinin ise 382’si (%2,3) HBsAg pozitif bulundu.Öğe Hepatit B virüsü infeksiyonunun seroprevalansı(2009) Tekerekoğlu, Mehmet S.; Kaysadu, Halim; Duman, YücelÇalışmamızda Ağustos 2008-Ağustos 2009 tarihleri arasında hastanemize başvuran hepatit şüphesi bulunan 14280 kişi, sürekli hemodiyaliz işlemlerine maruz kalan 59 hasta ve hastanemiz kan merkezine başvuran 16080 kan donörleri arasındaki; Hepatit B seroprevalansı belirlenip, karşılaştırıldı. Hepatit şüphesi bulunan hastaların 1896’sı (%13), hemodiyaliz hastalarının 3’ü (%5,1) ve kan donörlerinin ise 382’si (%2,3) HBsAg pozitif bulundu.Öğe Investigation of Compatibility Between Serological Tests Used in Laboratory Diagnosis of Brucellosis(2021) Ay, Selma; Güzel, Bensu; Duman, YücelAbstract: Aim: In the diagnosis of brucellosis, the production of microorganisms in blood orbone marrow culture is considered the gold standard. But it is not always possible toproduce the microorganism. For this reason, serological tests are used to diagnosebrucellosis. Rose Bengal test (RB), Standard Tube Agglutination test (STA),Coombs Test (CT) and 2-Mercaptoethanol (2-ME) tests are common methods.Immunocapture-agglutination test (ICA) and Brucella Coombs Gel test (BCGT) aretests that can detect blocking antibodies along with total antibodies. The aim of ourstudy was to determine whether there is compatibility between the tests used indiagnosis and the ICA and BCGT tests.Material and Methods: Serum samples were taken from patients with a preliminarydiagnosis of brucellosis. RBT testing was performed primarily on all samples. FortyRBT positive and 40 RBT negative sera were included in the study. All serum sampleswere studied by STA, CT, 2-ME, ICA and BCGT methods. The compatibility betweenthe tests were determined by using the kappa (?) coefficient with the Cohen kappaanalysis method.Results: 28 of 40 patients with RBT positive were detected as positive with STA and2-ME and 30 of them were positive with CT. BCGT and ICA test results were foundpositive in all RBT positive samples. All tests results were found to be negative in 40RBT negative samples. Cohen Kappa analysis found that compliance between RBTand BCGT and ICA (Kappa 1.0 <0.001) was excellent. Compliance between STA,BCGT and ICA tests was found to be good (Kappa 0.7 p< 0.001). CT testing showeda very good level of compatibility between ICA and BCGT (Kappa 0.8 p<0.001).There is a very good compatibility between the 2ME test, ICA and BCGT tests (kappa0.7 0.001), Compliance between BCGT and ICA was also found to be very good(Kappa 1.0, p<0.001).Conclusion: According to these results, with the use of ICA and BCGT tests, both thenumber of tests will be reduced and the time to receive results will be reduced. Butfurther studies are needed to determine the sensitivity and specificity of these testsbased on culture results. But after that, we believe it can be used as a diagnostic test.Öğe Investigation of the presence of pantone-valentine leukocidin in staphylococcus aureus strainsısolated from orthopedic surgical site ınfections(ANKARA MICROBIOLOGY SOC, HACETLEPE UNIV FACULTY MEDICINE DEPT MICROBIOLOGY, 06100 ANKARA, TURKEY, 2018) Duman, Yücel; Sevimli, ReşitStaphylococcus aureus is one of the most clinically important bacteria causing infection in humans. It is an important pathogen in surgical site infections (SSIs), especially after orthopedic surgery. Pantone-valentine leukocidin (PVL) has a great importance in the virulence of S.aureus because it can destroy polymorphonuclear cells by necrosis or apoptosis. The spread of PVL positive S.aureus is a great concern, since it may become an important factor for increased morbidity and mortality in SSIs, especially after surgery. In this study, we aimed to investigate the presence of PVL in S.aureus strains isolated from patients who had surgical site infections after orthopedic surgery, and also the clinical status of these patients. Between 2013 and 2017, 101 patients who had SSIs due to S.aureus after orthopedic surgery were included in the study. Identification of the strains was determined by conventional methods and "Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry" (MALDI-TOF MS). Methicillin resistance was determined by Kirby-Bauer disc diffusion method and automated system (Vitek 2, bioMerieux, France). The PVL gene region was investigated by polymerase chain reaction (PCR) method by using the primers Luk-PV-1 and Luk-PV-2. The duration of the patients' hospitalization, C-reactive protein (CRP) and sedimentation levels and clinical status were obtained from the hospital information system, retrospectively. Fifteen (14.9%) of the isolates were methicillin resistance S.aureus (MRSA) and 86 (85.1%) were methicillin susceptibility S.aureus (MSSA). PVL positivity was detected in 14 (13.9%) isolates (3 MRSA, 11 MSSA). The mean hospital stays in PVL-negative patients were 17 (5-73) days and 46 (21-103) days in PVL-positive patients. It was observed that the serologic markers CRP and sedimentation were between 5-7 and 40-60 in PVL negative patients, and between 11-20 and 90-110 in PVL positive patients, respectively. In PVL-negative patients, serologic markers improved in 7-10 days, while in PVL-positive patients they were improved in 17-32 days. Osteomyelitis occurred in six patients (2 PVL positive MRSA, 1 PVL positive MSSA and 3 PVL negative MRSA). In two of the patients who have developed osteomyelitis with PVL-positive MRSA, PVL gene positive S.aureus isolates were observed in their orthopedic SSIs. We also determined that these isolates increased the hospitalization days, improvement time of serological markers and mortality. It is worrisome to isolate PVL-positive S.aureus strains in SSIs. Therefore, we believe that it would be useful to take infection control measures to prevent the spread of these strains in the hospital setting.Öğe Kan kültürlerinden izole edilen bakteriler ve antimikrobiyal duyarlılıkları(Erciyes Tıp Dergisi, 2011) Duman, Yücel; Kuzucu, Çiğdem; Çuğlan, Serpil SemihaÖz: Amaç: Bu çalışmada 2009 yılı içerisinde kan dolaşım enfeksiyonlarından izole edilen bakterilerin tanımlanması ve antimikrobiyal duyarlılıklarının saptanması amaçlandı. Gereç ve Yöntem: Laboratuvarımıza gönderilen örnekler BACT /ALERT 3D (Becton Dickinson, Maryland, USA) otomatize sisteminde 5 gün süre ile inkübe edildi. Mikroorganizmaların identifikasyonu konvansiyonel yöntemlerle yapıldı, gerekli olduğunda BBL (Bio Merieux) tanımlama kitleri kullanıldı. İzole edilen bakterilerin antibiyotik duyarlılık testleri Kirby-Bauer disk difüzyon yöntemi ile Clinical Laboratory Standarts Institute (CLSI) kriterlerine göre yapıldı. Bulgular: İzole edilen bakterilerin %31,5'i gram-negatif, %68,5'i gram-pozitif olarak tanımlandı. Gram negatif bakterilerden en sık Escherichia coli, gram pozitif bakterilerden ise koagülaz negatif stafilokok (KNS) izole edildi. E.coli ve Klebsiella türlerininin hepsi imipenem, meropenem ve amikasine karşı duyarlıydı. Pseudomonas aerugiosa'da en etkili antibiyotik imipenem, Acinetobacter spp.'de tigesiklin olarak saptandı. Metisilin dirençli Staphylococcus aureus (MRSA) oranı %30,8 olarak belirlendi. Stafilokoklarda glikopeptid direncine rastlanmadı. İzole edilen bir enterekok suşu glikopeptidlere dirençli bulundu. Sonuç: Kan kültürlerinden izole edilen mikroorganizmaların dağılımının izlenmesi ve antimikrobiyal duyarlılıklarının belirlenmesi tedaviye başlama sırasında klinisyene yol gösterecektir.Öğe Laboratory acquired skin infections in a clinical microbiologist Is wearing only gloves really safe(American Journal of Infection Control, 2016) Duman, Yücel; Yakupoğulları, Yusuf; Otlu, Barış; Tekerekoğlu, Mehmet SaitLaboratory-acquired infection is one of the leading occupational health hazards. On a laboratory worker’s hands, carbuncles occurred. Staphylococcus aureus was isolated from pus samples of the carbuncles, with the same pulsed field gel electrophoresis band pattern with one of the recently studied strains in the laboratory. Incorrect or inadequate application of infection control measures may result in pathogen acquisition from the clinical samples, and wearing only gloves is not sufficient for the biosafety of laboratory workers in clinical diagnostic laboratories.
