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Öğe Aim: We investigated complete blood count parameters as inflammatory biomarkers and compared these to serum creatinine values as early diagnostic criteria of ongoing contrast-induced nephropathy. Contrast-induced nephropathy is an important cause of acute kidney injury. Early diagnosis can reduce morbidity and mortality. There is no clear predictor parameter for the early diagnosis of contrast-induced nephropathy.Material and Methods: Patients who underwent contrast-enhanced computed tomography examination were included in this retrospective study. Contrast-induced nephropathy was defined as 25%, a higher increment or a 0.5 mg/dL elevation above the baseline serum creatinine levels within 72 hours. Patients were divided into contrast-induced nephropathy and non-contrast-induced nephropathy groups. The complete blood count parameters obtained before and within the first 24 hours after contrast-enhanced computed tomography were compared between groups. Results: The post-contrast-enhanced computed tomography neutrophil-to-lymphocyte ratio values were significantly higher in the contrast-induced nephropathy group compared to the non-contrast-induced nephropathy group (11.85±1.56 vs 7.29±0.49; p = 0.000). Comparison of the post-contrast-enhanced computed tomography values of the platelet-to-lymphocyte ratio, mean platelet volume-to-platelet count ratio, and lymphocyte to monocyte ratio revealed no statistically significant differences between the groups (p = 0.283, 0.128, and 0.792 respectively).Conclusions: An increased neutrophil-to-lymphocyte ratio level after a contrast-enhanced computed tomography procedure is associated with the development of contrast-induced nephropathy. The use of the neutrophil-to-lymphocyte ratio in the emergency department as a predictive parameter can significantly improve the diagnostic process, favorably acting on the prognosis of patients developing contrast-induced nephropathy.(2020) Duman, Yucel; Sik, IremAim: 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 (κ) 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 The antimicrobial effects of ketamine combined with propofol: An in vitro study(Elsevier Science Inc, 2013) Begec, Zekine; Yucel, Aytac; Yakupogullari, Yusuf; Erdogan, Mehmet Ali; Duman, Yucel; Durmus, Mahmut; Ersoy, M. OzcanBackground and objectives: Ketamine and propofol are the general anesthetics that also have antimicrobial and microbial growth-promoting effects, respectively. Although these agents are frequently applied together during clinical use, there is no data about their total effect on microbial growth when combined. In this study, we investigated some organisms' growth in a ketamine and propofol mixture. Method: We used standard strains including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in this study. Time-growth analysis was performed to assess microbial growth rates in 1% propofol. Antimicrobial activity of ketamine, alone and in propofol was studied with microdilution method. Results: In propofol, studied strains grew from 103-104 cfu/mL to ?AO cfu/mL concentrations within 8-16 hours depending on the type of organism. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) (for candida, minimal fungicidal concentration) of ketamine were determined as follows (MIC, MBC): E.coli 312.5, 312.5 pg/mL; S.aureus 19.5, 156 pg/mL; P.aeruginosa 312.5, 625 pg/mL; and C.albicans 156, 156 pg/ml. In ketamine+propofol mixture, ketamine exhibited antimicrobial activity to E.coli, P.aeruginosa and C.albicans as MBCs at 1250, 625 and 625 pg/mL, respectively. Growth of S. aureus was not inhibited in this mixture (ketamine concentration=1250 pg/mL). Conclusion: Ketamine has sustained its antimicrobial activity in a dose-dependent manner against some organisms in propofol, which is a strong microbial growth-promoting solution. Combined use of ketamine and propofol in routine clinical application may reduce the risk of infection caused by accidental contamination. However, one must keep in mind that ketamine cannot reduce all pathogenic threats in propofol mixture. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Bacteria Isolated from Blood Cultures and Their Antimicrobial Susceptibility(Aves, 2011) Duman, Yucel; Kuzucu, Cigdem; Cuogan, Serpil SemihaPurpose: The aim of this study was to analyse the distrubution and antimicrobial susceptibility stream infections in 2009. Material and Methods: The samples were incubated in BACT / ALERT 3D automated systems for five days. Microorganisms were identified by using conventional methods. Antibiotic susceptibility was determined by Kirby-Bauer disk diffusion method according to the recommentations of Clinical Laboratory Standards Institute (CLSI) criteria. Results: The microorganisms isolated were 31.5% Gram-negative and 68.5% Gram-positive bacteria. The most frequently isolated bacteria were Escherichia coli and coagulase negative staphylococcus (CN5). All of the E.coli and Klebsiella were susceptible to imipenem, meropenem and amikacin. imipenem was the most effective antibiotic against Pseudomonas aerugiosa, and tigecycline was the most effective antibiotic against Acinetobacter spp. in this study 30.8% of Staphylococcus aureus isolates were resistant to methicillin, no glycopeptide resistant Staphylococci was encountered. One enterecoccus strain was resistant to glycopeptides. Conclusion: Identification of microorganisms from blood cultures and its antibiotic susceptibility pattern will guide to clinician during the treatment.Öğe Bir Üniversite Hastanesi’nde 2018-2019 Yıllarında İzole Edilen Staphylococcus Aureus İzolatlarının İncelenmesi(2020) Tanriverdi, Elif Seren; Duman, Yucel; Tekerekoglu, MehmetAmaç: Staphylococcus aureus toplum ve sağlık bakım ilişkili cilt ve yumuşak doku enfeksiyonları, üriner sistem enfeksiyonu, endokardit, pnömoni,septik artrit, osteomyelit, sepsis gibi morbidite ve mortalitesi yüksek enfeksiyonlara neden olan en önemli mikroorganizmalardan biridir. Çalışmamızda hastanemiz Tıbbi Mikrobiyoloji laboratuvarına gelen çeşitli klinik örneklerden izole ettiğimiz metisiline dirençli S. aureus (MRSA) ve metisilineduyarlı S. aureus (MSSA) izolatlarının antimikrobiyallere direnç oranlarının belirlenmesi ve hastanemize ait direnç profilinin incelenmesi amaçlandı.Gereç ve Yöntem: 2018- 2019 yılları arasında izole edilen 879 S. aureus izolatı çalışmaya dahil edildi. İzolatlar konvensiyonel yöntemlerle veMALDI-TOF MS (Bio Merieux, Fransa) ile identifiye edildi. İzolatların antimikrobiyal duyarlılık testleri European Committee on AntimicrobialSusceptibility Testing (EUCAST) kriterlerine göre Kirby-Bauer disk düffüzyon ve Gradient düffüzyon methodu ile belirlendi.Bulgular: 2018 yılında %24.2, 2019 yılında ise %22.3 olmak üzere iki yıllık sürede MRSA oranı %23.3 olarak belirlendi. S. aureus izolatlarınındağılımına bakıldığında yara kültürlerinin en sık S. aureus izole edilen klinik örnek olduğu tespit edildi. MRSA ve MSSA izolatlarında vankomisin velinezolide direnç belirlenmedi. En yüksek direnç oranı MRSA ve MSSA izolatlarında sırasıyla %98 ve %82.8 ile penisiline karşı tespit edildi.Sonuç: Hastanemizdeki S. aureus izolatlarının direnç profillerinin bilinmesi; ampirik tedavide yol gösterici olacaktır. Ayrıca etkili enfeksiyon kontrolönlemlerinin alınması, el hijyenine dikkat edilmesi ve kısıtlı antibiyogram uygulaması MRSA enfeksiyonlarının kontrolüne katkı sağlayacaktır.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 Comparison the serologic tests used in the diagnosis of brucellosis; brucellacapt, brucella coombs gel, and brucella coombs tube agglutination tests(2021) Tanriverdi, Elif Seren; Duman, Yucel; Gozukara Bag, Harika Gozde; Tekerekoglu, MehmetAim: 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 (κ) 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. κ = 0.900 for CTA and BCAP, κ = 0.841 for CTA and CJ, κ = 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 (κ = 0.440 for CTA with STA, κ = 0.426 for BCAP with STA, κ = 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 Do mobile phones of patients, companions and visitors carry multidrug-resistant hospital pathogens?(Mosby-Elsevier, 2011) Tekerekoglu, Mehmet Sait; Duman, Yucel; Serindag, Ayfer; Cuglan, Serpil Semiha; Kaysadu, Halim; Tunc, Emine; Yakupogullari, YusufA cross-sectional study was conducted to determine bacterial colonization on the mobile phones (MPs) used by patients, patients' companions, visitors, and health care workers (HCWs). Significantly higher rates of pathogens (39.6% vs 20.6%, respectively; P = .02) were found in MPs of patients' (n = 48) versus the HCWs' (n = 12). There were also more multidrug pathogens in the patents' MPs including methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Escherichia coli, and Klebsiella spp, high-level aminoglycoside-resistant Enterococcus spp, and carabepenem-resistant Acinetobacter baumanii. Our findings suggest that mobile phones of patients, patients' companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs. Specific infection control measures may be required for this threat.Öğe THE EFFECT OF SODIUM DICHLOROISOCYANURATE DIHYDRATE TO PREVENT THE ENVIRONMENTAL TRANSMISSION OF MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII IN HOSPITAL SETTINGS(Parlar Scientific Publications (P S P), 2020) Duman, Yucel; Kuzucu, Cigdem; Ersoy, Yasemin; Otlu, BarisNosocomial infections are a substantial concern as the major cause of morbidity and mortality of hospitalized patients' in the world. Disinfection of inanimate environment, equipment and hospital setting is important to prevent nosocomial infections. Sodium dichloroisocyanurate dihydrate (NaDCC) can he used for disinfection of environment and medical devices. The aims of this study were to determine the efficacy of NaDCC at various concentrations and times against multi-drug resistant Acinetobacter strains. In the first phase of the study, the bactericidal activity of NaDCC to A. baumannii was investigated by quantitative suspension test, In the second phase, the surface activity of NaDCC was tested by surface disinfection application test. In the third phase, before the cleaning of randomly selected patient's room A. baumannii contamination on the inanimate environment objects and equipment was investigated. After the cleaning of the room the effect of NaDCC was tested. As a result of the quantitative suspension test; NaDCC was inhibited the all A. baumannii and ATCC strains. In the surface disinfection application test, it was determined that at the concentration of 1000 ppm and 500 ppm, the activity of NaDCC; at 5th, 30th and 60th minutes was effective to micro-organisms at 5 log level, respectively. But at 100 ppm concentration it was effective to at 5th minutes three. at 30th and 60th minutes seven A. baumannii strains at 5 log levels, while it was effective at log 1 level to other A. baumannii strains and S. aureus, E. colt and P. aeruginosa ATCC. As a result of investigation the A. baumannii contamination in patient's room; before the cleaning, we determined A. baumannii contamination on the inanimate objects of room (such as bed surface, bed edges, control device, nightstand, chair) and on equipment (such as stethoscope, steam appliance, blood pressure device, aspirator heads, ventilator surfaces). After the cleaning it was determined that at 1000 ppm concentration at 5th, 30th and 60th minutes NaDCC was effective to A. baumannii at 5 log levels, However, at 500 ppm concentration at 5th minute it was effective at log 5 level except control device. At 30th and 60th minutes of 500 ppm concentration of NaDCC was effective at log 5 level to A. baumannii, At 100 ppm concentration at 5th, 30th and 60th minutes it was effective to A. baumannii strains at log 1 level on inanimate objects and equipment. In low concentration, NaDCC efficacy was reduced against A. baumannii. The application concentration and time of the disinfectant to clean up the equipment and the environment is very important for preventing nosocomial infections and the spread of A. baumannii. Thus, it is necessary to check and follow up the staff and to create clean and disinfection training programs for educating staff.Öğe The Effects of Colistin on Imipenem MICs in OXA-48 Producing Klebsiella pneumoniae Isolates: An In Vitro Study(Galenos Publ House, 2021) Duman, Yucel; Tekerekoglu, Mehmet Sait; Kuzucu, Cigdem; Yakupogullari, YusufIntroduction: A new approach to carbapenem resistance-K. pneumoniae infections is to use combination drug therapies. However, little data are available about the effectiveness of the in vitro carbapenem plus colistin combination against oxacillinase-48 (OXA-48) producing K. pneumoniae. Therefore, the aim of this study is to assess the potential synergistic activity of imipenem plus colistin in OXA-48-producing K. pneumoniae strains and investigate the changes in the imipenem minimal inhibitory concentrations (MICs) to varying MICs of colistin. Materials and Methods: Carbapenem and colistin resistance (CoIR) genes were investigated by polymerase chain reaction. In the first stage, synergistic properties were determined by the checkerboard combination method. In the second step, at varying colistin concentrations, changes in the imipenem MICs were investigated. Results: Colistin MIC50 2 mu g/ml, MIC90 16 mu g/ml, and imipenem MIC50 32 mu g/ml, MIC90 128 mu g/ml were found, respectively. According to the fractional inhibitor concentration (FIC) formula, 62.2% of the isolates were synergistic, and 37.8% were indifference. When the colistin was fixed at 0.125 mu g/ml, 0.25 mu g/ml, 0.5 mu g/ml, 1 mu g/ml, and 2 mu g/ml, respectively. Significant decreases were observed in the imipenem Mies, especially of colistin-sensitive isolates. However, imipenem MICs of CoIR isolates did not decrease to susceptible levels. Conclusion: This information will facilitate the design of antibiotic regimens that are more suitable for treating infections due to such pathogens producing OXA-48 and prolong these antibiotics' efficacy. Further in vitro research is required to determine which treatment combination is best and its optimal use as combination therapy to treat these infections.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 Independent predictive factors for the persistence and tolerance of cow's milk allergy(Wiley, 2019) Topal, Erdem; Celiksoy, Mehmet Halil; Arga, Mustafa; Kaynak, Mustafa Sinan; Duman, Yucel; Demirtas, Semih; Alatas, CemBackground Cow's milk protein allergy (CMPA) is usually transient, with most children tolerating ingested cow's milk by 3 years of age. This study aimed to determine factors that promote or hindering the development of tolerance to CMPA. Methods A logistic regression model was used to determine independent risk factors associated with tolerance and persistence of CMPA. Result A total of 178 children diagnosed with CMPA were included in the study. The patients' median age was 32 months (minimum-maximum, 14 to 144 months), and their median follow-up period was 30 months (minimum-maximum, 12 to 54 months). In the follow-up, CMPA persisted in 62 (34.8%) patients. The patients were divided into 2 groups according to patient's age. Group I was <3 years old and group II was >= 3 years old. The factors independently associated with the persistence of CMPA for group I were as follows: comorbid food allergies (p = 0.021), the presence of an immunoglobulin E (IgE)-mediated reaction (p = 0.001), and respiratory system symptoms (ie, tachypnea) (p = 0.036). The presence of gastrointestinal-related discomfort (p = 0.001) was an independent risk factor associated with the development of tolerance. The presence of comorbid food allergies (p = 0.03) was the only independent predictive factor for CMPA persistence for group II. Conclusion The prognosis in cases of CMPA, a food allergy, is good, with tolerance developing over time. The presence of IgE-mediated CMPA, respiratory-related symptoms (ie, tachypnea), and the presence of comorbid food allergies have negative effects on tolerance.Öğe Intravesical hyaluronic acid and chondroitin sulfate alone and in combination for urinary tract infection: Assessment of protective effects in a rat model(Wiley, 2012) Tasdemir, Seda; Tasdemir, Cemal; Vardi, Nigar; Yakupogullari, Yusuf; Duman, Yucel; Parlakpinar, Hakan; Sagir, MustafaObjective: To determine the protective effects of hyaluronic acid and chondroitin sulfate in treating urinary tract infections in a rat model. Methods: A total of 28 rats, which were induced with urinary tract infections through intravesical administration of Escherichia coli, were included in the study. By random selection, they were equally divided into four groups as control (no treatment), hyaluronic acid, chondroitin sulfate and hyaluronic acid + chondroitin sulfate. Bacteriological cultures of the urine and bladder tissue samples were carried out, and the data for each group were statistically compared. Results: In the urine cultures, there were significant differences in median bacterial growth rates in hyaluronic acid (5 x 103 cfu/mL) and chondroitin sulfate (1 x 104 cfu/mL) groups relative to the control group (5 x 104 cfu/mL). However, a significantly lower rate of bacterial colony growth was observed in the hyaluronic acid + chondroitin sulfate group (8 x 102 cfu/mL; P < 0.05). In the bladder tissues, statistically significant decreases in median bacterial growth rates were detected in the hyaluronic acid and hyaluronic acid + chondroitin sulfate groups (both 0 cfu/mg tissue; P < 0.05). Also, transitional epithelium damage decreased in the treatment groups. However, this effect was prominent in hyaluronic acid + chondroitin sulfate group. Conclusion: Our experimental findings show that the hyaluronic acid + chondroitin sulfate combination has a potential benefit in reducing the bacterial load in urine and the thickness of the transitional epithelium.Öğe Investigation of the Presence of Panton-Valentine Leukocidin and Clonal Relationship of Community- and Hospital-Acquired Clinical Isolates of Staphylococcus aureus(Ankara Microbiology Soc, 2013) Duman, Yucel; Tekerekoglu, Mehmet Sait; Otlu, BarisStaphylococcus aureus is one of the most important pathogens that cause community- and hospitalacquired infections by its toxins and enzymes. Panton-Valentine leukocidin (PVL), a cytotoxin which is especially produced by community-acquired S.aureus strains that cause soft tissue and skin infections and pneumonia. PVL leads to the destruction on polymorphonuclear cells by necrosis or induce apoptosis, so that it has great importance in the virulence of the organism. PVL can also exacerbate the clinical course of S.aureus infections and may lead to severe complications. Studies show that communityacquired PVL-positive S.aureus strains have become prevalent in hospital environments. In this study, we aimed to investigate the presence of PVL from hospital- and community-acquired S.aureus strains and to determine the clonal relationship between the PVL-positive strains. A total of 265 S.aureus strains isolated from different clinical samples (wound, blood, tracheal aspirate, urine, drainaige, catheter, parasynthesis fluid) of which 88 were community-acquired and 177 were hospital-acquired according to the CDC criteria were included in the study. Methicillin resistance of the strains were investigated by conventional methods, the presence of PVL and mecA gene regions by polymerase chain reaction, and clonal relationship among the PVL positive S.aureus strains by pulsed-field gel electrophoresis (PFGE). Community-acquired 12.5% (11/88) and hospital-acquired 43% (76/177) of the strains were found resistant to methicillin. Community-acquired (CA) strains were most commonly isolated from wound samples (86%), while 34% of hospital-acquired (HA) strains were isolated from wound, and 33% were from blood samples. The rate of PVL positivity among CA- and HA-strains were found as 15% and 3%, respectively. Hospital-acquired PVL-positive strains were isolated from the samples originating from pediatric (n= 1) and neurology inpatient clinics and intensive care unit (n= 3). Thirty nine percent of PVL-positive CAS.aureus strains were isolated from samples originated from internal medicine, 23% from general surgery, 15% from dermatology, 15% from orthopedic surgery and 8% from pediatrics outpatient clinics. Ninety two percent of PVL-positive CA-S.aureus strains have been isolated from wound samples, while 67% of HA-S.aureus strains from wound and 33% from blood samples. Five PVL-positive HA- methicillin-sensitive S.aureus strains were found clonally-related with each other by PFGE. When the macrorestriction patterns were evaluated according to Tenover criteria; three of those isolates were indistinguishable, and two were clonally unrelated. There was no clonal relationship between community-acquired strains. In conclusion we observed that PVL could be detected not only in community-acquired strains but also in hospital-acquired strains. The spread of PVL-positive strains in the hospital environment and even create epidemics, increases the risk of mortality and morbidity. Epidemiological studies will help us to understand the clonal spread of CA and HA-S.aureus strains.Öğe Investigation of the VISA and hVISA Presence in Methicillin- Resistant Staphylococcus aureus Isolates by Various Methods(Ankara Microbiology Soc, 2022) Ucar, Serife; Duman, Yucel; Tanriverdi, Elif Seren; Tekerekoglu, Mehmet Sait; Otlu, BarisStaphylococcus aureus is an important human pathogen that causes community and hospital-acquired infections. The role of vancomycin in the treatment of methicillin-resistant S.aureus infections is indisput- able. However, vancomycin intermediate susceptible S.aureus (VISA) and heterogeneously VISA (hVISA) isolates, that cause treatment failures during the use of vancomycin, cannot be detected by routine labo-ratory methods. The gold standard method for the detection of these isolates is the population profile analysis-area under the curve (PAP-AUC) method. In this study, it was aimed to determine the presence of mecA and mecC gene regions that cause methicillin resistance, the clonal relationship between iso- lates, and the presence of VISA and hVISA. A total 68 methicillin-resistant S.aureus (MRSA) strains were included in this study which were isolated in the microbiology laboratory of the hospital between 2015-2020. Identification of the isolates were determined by matrix assisted laser desorption ionization-time of flight mass spectrophotometry (VITEK MS, BioMerieux, France). Methicillin resistance was investigated by disk diffusion method using cefoxitin (30 mu g, Bioanalyse, Turkiye) disk and vancomycin MIC values were determined by broth microdilution method. mecA and mecC gene regions were investigated by polymerase chain reaction (PCR) method. The presence of VISA and hVISA were investigated by modi- fied agar screening, macro gradient diffusion test and confirmated by PAP-AUC methods, and the clonal relationship between isolates were investigated by pulsed field gel electrophoresis method. The mecA gene region was determined in all isolates, but the mecC gene region was not found in any of the iso- lates. The MIC50 value of the isolates was determined as 1 mu g/mL and the MIC90 value was determined as 2 mu g/mL by broth microdilution method. Six VISA and four hVISA suspected strains were detected by a modified agar screening method. Among the isolates identified as suspicious by the modified agar screening method, one isolate was evaluated as VISA and one isolate was evaluated as hVISA by the gold standard PAP-AUC method. No dominant epidemic isolate has been identified by PFGE. As a result, VISA and hVISA were determined in the hospital. The increase in these isolates is a serious concern. For this reason, it is believed that it would be beneficial to investigate the VISA/hVISA ratios in MRSA isolates at certain periods, and to take necessary infection control measures to implement measures and practices to prevent the spread of these isolates in the community and hospital environment.Öğe Laboratory-acquired skin infections in a clinical microbiologist: Is wearing only gloves really safe?(Mosby-Elsevier, 2016) Duman, Yucel; Yakupogullari, Yusuf; Otlu, Baris; Tekerekoglu, 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. (C) 2016 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.Öğe Novel and Revised Terms in the EUCAST 2019 Guideline: Susceptible, Increased Exposure and Area of Technical Uncertainty(Galenos Yayincilik, 2019) Tanriverdi, Elif Seren; Duman, Yucel[Abstract Not Available]Öğe Oral colonization of Acinetobacter baumannii in intensive care units: Risk factors, incidence, molecular epidemiology, association with the occur of pneumonia and sepsis, and infection control measures(Mashhad Univ Med Sciences, 2022) Duman, Yucel; Ersoy, Yasemin; Tanriverdi, Elif Seren; Otlu, Bans; Toplu, Sibel Altunisik; Goziikara, GOzde; Tekerekoglu, Mehmet SaitObjective(s): Oral colonization of Acinetobacter baumannii can lead to infections such as pneumonia and sepsis. We aimed to evaluate oral colonization of hospitalized patients in ICUs and to examine risk factors for oral colonization, molecular epidemiology, and incidence of pneumonia and sepsis. Materials and Methods: The study began in February 2021. Oral cultures were taken. The microorganisms were identified by a Maldi-tof MS mass spectrometry device. Colistin resistance genes were investigated by polymerase chain reaction. Clonal relationships were determined by pulsed-field gel electrophoresis. Results: A. baumannii was found in 21 of 96 patients' oral cultures. Pneumonia and sepsis due to A. baumannii were detected in 14 and 5 patients, respectively. The mean growth time of A. baumannii from oral cultures was 11.8 days, and the meantime for the occurrence of pneumonia after oral growth was 5.2 days. We determined a plasmid mediated mcr-2 colistin resistance gene in a colistin susceptible A. baumannii strain. It is the first report of the plasmid mediated mcr-2 colistin resistance gene in our country. In total, fourteen different A. baumannii genotypes were determined in PFGE. It was determined that the effects of antibiotic use, oral motor dysfunction, mechanical ventilation, intubation, orogastric tube use, and total parenteral nutrition intake on oral colonization were statistically significant. Conclusion: Oral colonization of A. baumannii is a significant concern in ICUs. We believe that it is important to take oral cultures and follow the risk factors and take infection control measures to prevent oral colonization of resistant isolates in ICUs.Öğe quency of positive samples collectively indicated that the frequencies of both pathogens substantially reduced during the pandemic because of infection control measures. Conclusion: The fact that the COVID-19 pandemic forces us to comply with infection control rules and change our lifestyle shows us that these rules are very important not only in controlling the pandemic, but also in controlling other viral infections.(Aves Yayincilik, Ibrahim Kara, 2022) Duman, Yucel; Yakupogullari, Yusuf; Gunduz, AytenObjective: The coronavirus disease 2019 pandemic has caused many changes in our lifestyle, such as the flow of our daily lives, communication between individuals, traveling, eating, and drinking habits. These changes have reduced the risk of viral infections. In this study, it was aimed to examine the changes in the frequency of rotavirus and enteric adenovirus in children due to changes in lifestyle such as hand hygiene, physical distance and eating habits in individuals before and during the COVID-19 pandemic.Material and Methods: We analyzed data obtained from the laboratory electronic records of hospitals in our region to assess the changes of rotavirus and adenovirus frequency and number of patients admitted to the hospital during the COVID-19 pandemic period compared to pre-pandemic years. Rotavirus and enteric adenovirus antigens were studied using a qualitative immunochromatographic method. Results: Between January 2018 and July 2021, a total of 68.504 patient samples were tested, 60.513 (88.3%) before the COVID-19 pandemic and 7.991 (11.7%) during the pandemic. Mean age of the patients was deter-mined as 4.7 years. Before the pandemic, a total of 6.815 (11.3%) sam-ples for rotavirus and 1.873 (3.1%) samples for adenovirus were found positive. During the pandemic period, a total the 598 (7.5%) samples for rotavirus and 164 (2%) samples for adenovirus were found positive. Monthly median test numbers for rotavirus and adenovirus significant-ly fell about 75% (1.926 vs 493, p< 0.001). In addition, monthly median positivity rates of rotavirus (10.9% vs 7.1%, p= 0.002) and adenovirus (2.9% vs 1.8%, p< 0.001) reduced about 35% and 38%, respectively, after the onset of the pandemic as compared to the pre-pandemic years. The decrease in mean monthly test numbers and the reduction in the fre- quency of positive samples collectively indicated that the frequencies of both pathogens substantially reduced during the pandemic because of infection control measures.Conclusion: The fact that the COVID-19 pandemic forces us to comply with infection control rules and change our lifestyle shows us that these rules are very important not only in controlling the pandemic, but also in controlling other viral infections.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.Öğe A silent outbreak due to Klebsiella pneumoniae that co-produced NDM-1 and OXA-48 carbapenemases, and infection control measures(Mashhad Univ Med Sciences, 2020) Duman, Yucel; Ersoy, Yasemin; Gursoy, Nafia Canan; Toplu, Sibel Altunisik; Otlu, BarisObjective(s): ): Infections due to carbapenemase-producing Klebsiella pneumoniae are associated with high morbidity and mortality. In this study, we report a hospital outbreak due to co-producing OXA-48 and NDM-1 K. pneumoniae clone. The aim of the study is to investigate the clonal relationship of strains, risk factors of outbreak and infection control measures. Materials and Methods: Once an outbreak was suspected at the end of December 2017 in our intensive care unit (ICU), carbapenem resistance K. pneumoniae identified in patients' specimens. An outbreak analysis was begun to determine the risk factors and dissemination of the cases. A case-control study was conducted to determine the risk factors. To control the outbreak; tight contact prevention, good clean-up the medical devices and hospital environment, were done. Staff training programs such as hand hygiene, disinfection, wearing aprons, good cleaning were created. Carbapenem resistance genes determined by PCR. Clonal relationships of strains investigated by PFGE. Results: We investigate 21 carbapenem-resistant K. pneumonia strains. Nine of them were found co-produced NDM-1 and OXA-48, 11 strains produced OXA-48, and one strain produced NDM-1. Seven strains of co-producing NDM-1 and OXA-48 were found clonally related with PFGE. We could not determine any risk factor except rectal colonization in the case-control study. Conclusion: The interventions that successfully controlled this outbreak were hand hygiene, tight contact prevention, good clean-up of the hospital environment and medical devices. As a result, we believe that it would be beneficial to take infection control measures to prevent the spread of these strains to the community and hospital settings.
