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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 Bloodstream Infections in COVID-19 Positive and COVID-19 Negative Patient Groups Followed Up in the Intensive Care Unit: Case-Control Study(2022) Doğan, Ahmet; Gezer, Yakup; Kalaycı, Hacer ÖzlemAim: Bloodstream infections are one of the most important problems we encounter in patients followed up in intensive care units. In our study, we aimed to comparatively examine the demographic characteristics and bacteremia epidemiology of patients who were followed up for SARS-CoV-2 (COVID-19) positivity or other reasons in the intensive care units. Material and Methods: 192 cases (>18 age) whose blood cultures were studied were included in the study. The blood culture results of a total of 60 cases, 30 of which were positive for COVID-19 in the study group and 30 were negative for COVID-19 in the control group, were examined. Results: Thirteen (43.3%) of the patients in the case group were female, 17 (56.7%) were male, and the mean age of the group was 63.8±19 (22-88). In the control group, 15 (50%) were female, 15 (50%) were male, and the mean age of the group was 76.1±17.6 (48-92). There was no statistically significant difference between the two groups in terms of sex (p=0.605), comorbid conditions (excluding sepsis (p=0.005)), the number of isolates produced (p=0.260), the amount of blood culture set (p=0.118), bacteremia risk factors and mortality rates (p=0.612). However, there were differences in mean age (p=0.000), skin contamination (p=0.028) and prednisolone treatment (p=0.000). Conclusion: The risk of bloodstream infection in patients hospitalized in the intensive care units due to COVID-19 is not different from the group of patients hospitalized for non-COVID-19 reasons.Öğe Diagnosis of tularemia in a university hospital in Türkiye - 11-year evaluation(2023) Gezer, Yakup; Toplu, Sibel; Celık, Dondu; Ersoy, Yasemin; Bayindir, Yasar; Özden, Mehmet; Memişoğlu, FundaAim: Francisella tularensis is a Gram-negative coccobacillus and is the causative agent of tularemia, which is endemic in our country. The most common clinical form in Turkey is the oropharyngeal form. Sensitive lymphadenopathy is the most important finding, and fever, fatigue, and muscle and joint pain may occur in all clinical forms. Rodents such as rabbits, mice, and squirrels are the main reservoirs for humans, and the transmission is through contact with infected animal secretions and organs, contaminated water, and food. This study aimed to examine the socio-demographic, epidemiological, and clinical features of cases diagnosed with tularemia. Materials and Methods: Among the 583 patients whose serum samples were sent with a preliminary diagnosis of tularemia between 2011 and 2021, tularemia microagglutination test result (MAT) ?1/160 titer, 18 years and older cases were included in the study. Results: A total of 24 tularemia cases were detected, with a mean age of 43.3±17 years, 10 (41.7%) were male, and 14 (58.3%) were female. The most common symptoms and findings among the cases were lymphadenopathy (LAP) (95.8%), fatigue (66.7%), sore throat, and high fever (58.3%), and the most common epidemiological history was living in a rural area (91.7%) and dealing with animal husbandry (66.7%), and 18 (75%) cases were referred to as oropharyngeal tularemia. More than half of the cases were detected between October and March. Conclusion: Tularemia is one of the endemic diseases in our country, and the epidemio- logical history should be taken carefully and kept in mind in the differential diagnosis of lymphadenopathy. Since it is the first tularemia study conducted in Malatya, it shows the epidemiological characteristics of the region.Öğe Efficacy of colchicine treatment in COVID-19 patients: A case-control study(2022) Doğan, Ahmet; Karakök, Taliha; Gezer, YakupAim: Various clinical studies have been conducted on many alternative options in treating COVID-19 since the beginning of the pandemic process. This study aimed to investigate the effectiveness of colchicine treatment in patients hospitalized in clinical wards due to COVID-19. Methods: The study was retrospectively planned between October 2020 and October 2021. A total of 110 cases who received colchicine + standard treatment (favipiravir + corticosteroid + anticoagulant + symptomatic treatment) were included in the study group. The control group included randomly selected 220 patients who received only standard treatment. All cases' demographic characteristics, features of antibiotic and corticosteroid treatment, comorbidities, and clinical courses were recorded. Patients who received treatment for less than three days due to COVID-19, patients aged >95 years and <18 years, and those transferred to the clinical wards from the intensive care unit were excluded from the study. The groups were compared regarding treatment failure, including the number of intensive care unit admissions and mortality due to COVID-19 infection. Results: While the mean age was 59.4 years in the study group, it was 65.0 years in the control group (p=0.001). The most common coexisting disease was hypertension (63%). There were significant differences between the groups in the proportions of antibiotic use (p=0.002) and high-dose corticosteroid use (p=0.004). The values of white blood cell count (p=0.003), urea (p=0.029), D-dimer (p=0.021), creatine kinase-myocardial band (p=0.003) and troponin (p<0.001) were statistically different. There was no difference in terms of intensive care unit admission (p=0.174), the mortality rate (p=1.000), and treatment failure (p=0.505). Conclusions: According to the results of our study, colchicine treatment does not affect the prognosis of COVID-19 patients. There is a need for prospective studies investigating the role of colchicine treatment in COVID-19 infections.Öğe Evaluation of CD4/CD8 ratio in treatment follow-up of patients with HIV diagnois in an infection clinic(2022) Gezer, Yakup; Toplu, Sibel; Yüksel, Mustafa; Köse, Adem; Memişoğlu, Funda; Ozden, Mehmet; Bayindir, YasarAbstract Aim: Antiretroviral therapy (ART) regimens used in the treatment of HIV are assumed to suppress the virus in plasma indefinitely and restore CD4 lymphocyte count. There is increasing evidence that a reversed CD4/CD8 ratio is associated with immune dysfunction, even in patients who have achieved virological suppression with ART and have elevated CD4 lymphocytes. The CD4/CD8 ratio has emerged as a guiding marker as an indicator of immunoactivation in HIV-infected patients. It was aimed to evaluate the CD4/CD8 ratio of HIV-diagnosed patients at baseline and at follow-up after ART regimen. Materials and Methods: A total of 150 patients were included in the study by retrospectively scanning the CD4/CD8 ratio at the initial and 24th week of follow-up in patients who were diagnosed with HIV and started treatment in the Infectious Diseases and Clinical Microbiology Clinic of the Hospital of the Medical Faculty between 2011-2021. ART treatment regimens were divided into three groups as nucleoside reverse transcriptase inhibitor (NRTI)+protease inhibitor (PI), NRTI+non-nucleoside reverse transcriptase inhibitor (NNRTI) or NRTI+ integrase strand transfer inhibitor (INSTI). Results: A total of 150 patients were included in the study. While the initial CD4/CD8 ratio of the patients was 0.36, it increased to 0.61 at the 24th week of treatment. Among the 144 patients whose baseline values were CD4/CD8<1, the rate of the ones who achieved CD4/CD8?1 value at week 24 after ART regimens was found as 13.2% (19/144). It was observed that the CD4/CD8 ratio in the group receiving INSTI was higher (15.1%) than those of the other groups. The undetectable HIV RNA level after treatment was significantly mostly observed in the group, receiving the integrase-based regimen, with 77.1%. With effective ART, CD4/CD8 normalization is higher in individuals with high CD4 T cell counts before treatment. There was a significant increase in the CD4/CD8 ratio in all three ART regimen groups. However, most of the patients who achieved a CD4/CD8 ratio ?1 were in the INSTI-based ART group. Conclusion: The CD4/CD8 ratio may contribute to clinical evaluation in long-term follow-up as a marker of immunological response in individuals treated with a diagnosis of HIV.Öğe The positivity rates of a novel test in the patients with suspected clostridioides difficile associated diarrhea(2020) Gürsoy, Nafia Canan; Gezer, YakupAbstract: Aim: To evaluate the positivity rates of Clostridioides difficile infection (CDI) in the stool samples with a novel test and clinical features of positive cases. Material and Methods: The frequency of C. difficile in a total of 654 stool samples were examined with the BD Max Cdiff Test (Becton Dickinson, USA) between January 2014 and June 2019, and the clinical/demographic characteristics of the positive cases were evaluated in a university hospital. Results: A total 56 (8.56%) samples belonging to 49 cases aged 3-84 year were determined as positive for CDI among total 654 stool samples. Forty-one (89.1%) out of 46 positive cases whose clinical reports were available had a history of hospitalization in the last three months with an average 14.9 days, and 39 patients (84.7%) received antimicrobial treatment in the last three months for an average 12.2 days. It was observed that 40 (86.9%) out of 46 positive cases had at least one underlying chronic disease; and 38 (82.6%) patients used anti-acid agents. Conclusion: In this study, although the risk factors similar to those reported in the international literature were also found for our patients, the incidence of CDI was found to be lower than that reported worldwide. In this context, it is required that the patients in the risk group for CDI must be identified well, and correct and fast methods should be used for diagnosing the infection.Öğe The positivity rates of a novel test in the patients with suspected clostridioides difficile associated diarrhea(2020) Gursoy, Canan; Gezer, YakupAim: To evaluate the positivity rates of Clostridioides difficile infection (CDI) in the stool samples with a novel test and clinical features of positive cases. Material and Methods: The frequency of C. difficile in a total of 654 stool samples were examined with the BD Max Cdiff Test (Becton Dickinson, USA) between January 2014 and June 2019, and the clinical/demographic characteristics of the positive cases were evaluated in a university hospital.Results: A total 56 (8.56%) samples belonging to 49 cases aged 3-84 year were determined as positive for CDI among total 654 stool samples. Forty-one (89.1%) out of 46 positive cases whose clinical reports were available had a history of hospitalization in the last three months with an average 14.9 days, and 39 patients (84.7%) received antimicrobial treatment in the last three months for an average 12.2 days. It was observed that 40 (86.9%) out of 46 positive cases had at least one underlying chronic disease; and 38 (82.6%) patients used anti-acid agents. Conclusion: In this study, although the risk factors similar to those reported in the international literature were also found for our patients, the incidence of CDI was found to be lower than that reported worldwide. In this context, it is required that the patients in the risk group for CDI must be identified well, and correct and fast methods should be used for diagnosing the infection.Öğe Screening for Fosfomycin Resistance Genes in Carbapenem- Resistant Isolates of Enterobacterales from the Bloodstream of Liver Transplant Patients(Galenos Publ House, 2022) Gezer, Yakup; Tanriverdi, Elif Seren; Otlu, Baris; Yilmaz, Sezai; Bayindir, YasarIntroduction: Interest in fosfomycin, an old antibiotic, has been reignited because of the use of its intravenous formulation (fosfomycin sodium) in resistant infections. The aim of this study was to screen for carbapenem resistance in Enterobacterales isolates from the bloodstream, and determine the frequency of carbapenamases types and fosfomycin resistance genes in carbapenem-resistant Enterobacterales (CRE) strains.Materials and Methods: Enterobacterales isolates from the bloodstream of liver transplant patients aged 18 years and older were screened for carbapenem resistance between 2017 and 2019. In isolates that were resistant to at least one carbapenem antibiotic were further screened for fosfomycin susceptibility. Carbapenem susceptibility was tested for by the E-test, fosfomycin susceptibility was tested for by the agar dilution methods, and evaluated in accordance with European Committee on Antimicrobial Susceptibility Testing criteria. The frequency of OXA-48, NDM, KPC, VIM, and IMP type carbapenemases and fosA, fosA3, and fosC2 fosfomycin resistance genes were screened for using the polymerase chain reaction method.Results: A total of 115 Enterobacterales isolates from bloodstream infections were obtained. Carbapenem resistance was detected in 34 (29.3%) isolates, 41.2% of them were Escherichia coliand 58.8% of them were Klebsiella pneumoniae. Out of the 34 isolates, 61.8% produced carbapenemases, and OXA-48 was the most common type of carbapenemase. The fosfomycin resistance rate was 73.5%. Among the 34 carbapenem-resistant isolates, the frequency of the fosA gene was 5.9%. The genes fosA3 and fosC2 were not detected in any isolates. FosA + OXA-48 and fosA + NDM genes were detected in CRE isolates.Conclusion: This is the first study reporting on the screening for fosfomycin resistance genes in blood isolates of liver transplant patients in Turkey. Despite high fosfomycin resistance, detection of only two resistance genes reveals that there may be fosfomycin resistance due to other resistance mechanisms.
