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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 Brucella spp.'ye karşı kullanılan antibiyotiklerin etest kombinasyon metodu ile sinerjik, aditif ve antagonist etkilerinin araştırılması(İnönü Üniversitesi, 2013) Kaysadu, HalimÖzellikle retiküloendotelial sistem hücreleri içinde yerleşerek süregen infeksiyonlara neden olan brusellalar, insanlar için önemli bir morbidite ve bazen de mortalite nedenidir. Klinikte brusellozis tedavisi için genellikle ikili veya üçlü antibiyotik kombinasyonu uygulanmakla birlikte bu kombinasyonların in vitro etkinlikleri hakkında yeterince bilgi mevcut değildir. Bu çalışmada, Brucella spp. türlerine karşı kullanılan antibiyotik kombinasyonlarının in vitro etkinliklerinin araştırılması amaçlanmıştır. Çalışmamıza 2010-2012 yılları arasında İnönü Üniversitesi Tıp Fakültesi Turgut Özal Tıp Merkezi Tıbbi Mikrobiyoloji Anabilim Dalı Laboratuvarında kan kültürlerinden izole edilen 40 Brucella spp. suşu alındı. Bu suşlara karşı doksisiklin, rifampin, ko-trimoksazol, streptomisin ve siprofloksasin olmak üzere toplam 5 farklı antibiyotiğin etkinliği Etest ile çalışıldı. Bu antibiyotiklerden klinik uygulamada en sık kullanılmakta olan doksisiklin-rifampin; rifampin-kotrimoksazol; doksisiklin-streptomisin; siprofloksasin-kotrimoksazol ve siprofloksasin-streptomisin olmak üzere toplam 5 farklı kombinasyonun in vitro aktivitesi Etest kombinasyon yöntemi ile araştırıldı. Elde edilen sonuçlar fraksiyone inibitör konsantrasyon İndeksi (FIC) kullanılarak değerlendirildi ve sinerjistik, aditif ve antagonist etkileri hesaplandı. Çalışmamıza alınan 40 izolata karşı MIK düzeyi en düşük antibiyotik kotrimoksazol (0.016 ?g/ml) olarak bulunurken, MIK düzeyi en yüksek antibiyotik rifampin (1.5 ?g/ml) olarak saptandı. MIK50 ve MIK90 değerleri dikkate alındığında suşlara karşı çalışılan antibiyotiklerden en etkin bulunandan en az etkin olana doğru sıralama şöyle bulundu: Ko-trimoksazol 0.032 ?g/ml ve 0.064 ?g/ml; doksisiklin 0.064 ?g/ml ve 0.094?g/ml; siprofloksasin 0.094 ?g/ml ve 0.75 ?g/ml; streptomisin 0.25 ?g/ml ve 0.50 ?g/ml; ve rifampin 0.50 ?g/ml ve 0.75 ?g/ml. Doksisiklin-rifampin kombinasyonu çalışılan tüm suşlarda (%100) sinerjistik etki gösterirken, rifampin-kotrimoksazol kombinasyonu iki suşta antagonist (%5) etki gösterdi. Siprofloksasin-streptomisin ve rifampin-kotrimoksazol kombinasyonlarının suşlara karşı sinerjistik etki oranları sırasıyla %57.5 ve %52.5 olarak saptandı. Doksisiklin-streptomisin ve siprofloksasin-kotrimoksazol kombinasyonlarının sinerjistik etki oranları ise sırasıyla %32.5 ve %25 olarak saptandı. Çalışmamızda in vitro en etkin antibiyotik olarak kotrimoksazol saptanmışken en yüksek MİK düzeyleri rifampinde görülmüştür. Ancak, kotrimoksazolün diğer antibiyotiklerle olan kombinasyonlarında sinerjistik etkisi düşük olarak saptanmış, aksine, rifampinin doksisiklin kombinasyonu ise tüm suşlara karşı sinerjistik etki göstermiştir. Bu bağlamda brusella türlerine karşı antimikrobiyal duyarlılık testlerinde tekli antibiyotik duyarlılığının yanında kombinasyon aktivitelerinin in vitro saptanması faydalı olabilir.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 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 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 nvestigation of Synergistic, Additive and Antagonist Effect of Antimicrobial Combinations Used for Brucella spp, with E-test Combination Method(Eastern Journal of Medicine, 2019) Kaysadu, Halim; Duman, Yücel; Yakupoğulları, YusufÖz: Brucella spp. is a significant cause of morbidity and mortality in human. Though combination therapy is recommended in the patients with brucellosis, there is very less data about the in vitro efficacy of the combined antimicrobials. In this study, we aimed to investigate the in vitro activities of antimicrobial combinations used against the Brucella spp. strains. A total 40 human isolates of Brucella spp. strains were included in this study. In vitro activities of doxycycline, rifampin, cotrimoxazole, streptomycin and ciprofloxacin were studied by E-test (Bio Mérieux, France) strips. In vitro effectiveness of doxycycline-rifampin, rifampin-cotrimoxazole, doxycycline-streptomycin, ciprofloxacin-cotrimoxazole, and ciprofloxacin-streptomycin were investigated by E-test combination method, and the results were evaluated with Fractional Inhibitor Concentration Index. Cotrimoxazole was found as the most active antimicrobial against to tested Brucella isolates with the lowest Minimal Inhibitory Concentration (MIC) (as, 0.016 µg/ml), while rifampin was the least active drug with highest MIC (as 1.5 µg/ml). The MIC50 and MIC90 values of the tested antibiotics were as follows: cotrimoxazole 0.032 ?g/ml and 0.064 ?g/ml, doxycycline 0.064 ?g/ml and 0.094 ?g/ml, ciprofloxacin 0.094 ?g/ml and 0.75 ?g/ml, streptomycin 0.25 ?g/ml and 0.50 ?g/ml, and rifampin 0.50 ?g/ml and 0.75 ?g/ml, respectively. Doxycycline-rifampin combination showed a remarkable synergistic activity to all tested strains (%100), but rifampin-cotrimoxazole combination exhibited antagonist activity to two strains (5%). The ratios of synergistic activities were as follows: ciprofloxacin-streptomycine 57.5%, rifampin-cotrimoxazole 52.5%, doxycycline-streptomycin 32.5%, and ciprofloxacin-cotrimoxazole 25%. In this study, though cotrimoxazole was the highest in vitro active against to tested strains, its combination showed low synergistic effect with other antimicrobials. On the contrary, though rifampin showed low in vitro activity alone, it exhibited excellent synergistic effect when combined with doxycycline. Therefore, when the treatment is planned for a patient with Brucellosis, it will be benefit for testing the combination effectiveness of the drugs irrespective of their in vitro activities alone.Öğe Oral amoxicillin clavulanic acid treatment in ürinary tract infections caused by extended spectrum beta lactamase producing organisms(Jundishapur Journal of Microbiology, 2014) Beytur, Ali; Yakupoğulları, Yusuf; Oğuz, Fatih; Otlu, Barış; Kaysadu, HalimBackground: Extended-spectrum β-lactamases (ESBLs) are increasing problems. The involvement of ESBL-producing organisms is associated with higher rates of carbapenem usage in urinary tract infections (UTIs). Though some strains are susceptible to amoxicillin-clavulanic acid (AMC) in vitro, there is very less data about the consequences of AMC usage for such infections. Objectives: The purpose of this study was to evaluate the clinical and microbiological outcomes of AMC treatment in UTIs caused by AMC-susceptible ESBL-producing organisms. Patients and Methods: A retrospective cohort study was conducted in a tertiary care hospital. Forty-six out of 652 patients (F/M ratio: 32/14; mean age: 43.9 years) with ESBL-positive UTIs were eligible for this study. These patients had cystitis (n = 23), vesicoureteral reflux (n = 7), hyperactive bladder (n = 6), and prostatitis (n = 10). Data was collected via chart review and was statistically analyzed. Results: AMC-susceptible ESBL-producing Escherichia coli, Klebsiella pneumoniae and K. oxytoca were identified as the causative agents in 31, 14, and 1 patients, respectively. Thirty-nine (84.7%) out of 46 patients were successfully treated with oral AMC. Additionally, 2 (4.3%) patients’ urine cultures turned to be negative, though their clinical complaints and leukocyturia had continued. In the remaining 5 (10.8%) patients, no positive clinical and microbiological response was obtained. Increased minimum inhibitory concentration levels of AMC (from 4 to > 256 µg/mL) were detected in these patients and the treatment failures were attributed to this developing resistance. We found that therapeutic failure was significantly more frequent in Klebsiella spp. than in E. coli (33.3% vs 6.5%, P = 0.029). Furthermore, no treatment failure was observed in pathogens with minimum inhibitory concentrations (MICs) ≤ 2 mg/mL, and the high AMC MIC (8 mg/mL) was associated with resistance development and therapeutic failure (71.4% vs. 5.1%, P = 0.0001). Conclusions: Our results suggested that amoxicillin-clavulanic acid may be a good oral antimicrobial which can be used for treatment of ESBL-positive UTIs, if the causative agent is susceptible to this antibiotic. However, some strains may develop resistance during therapy, especially in those exhibiting high AMC MICs.Öğe Oral Amoxicillin-Clavulanic Acid Treatment in Urinary Tract Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Organisms(Ahvaz Jundishapur Univ Med Sci, 2015) Beytur, Ali; Yakupogullari, Yusuf; Oguz, Fatih; Otlu, Baris; Kaysadu, HalimBackground: Extended-spectrum beta-lactamases (ESBLs) are increasing problems. The involvement of ESBL-producing organisms is associated with higher rates of carbapenem usage in urinary tract infections (UTIs). Though some strains are susceptible to amoxicillin-clavulanic acid (AMC) in vitro, there is very less data about the consequences of AMC usage for such infections. Objectives: The purpose of this study was to evaluate the clinical and microbiological outcomes of AMC treatment in UTIs caused by AMC-susceptible ESBL-producing organisms. Patients and Methods: A retrospective cohort study was conducted in a tertiary care hospital. Forty-six out of 652 patients (F/M ratio: 32/14; mean age: 43.9 years) with ESBL-positive UTIs were eligible for this study. These patients had cystitis (n = 23), vesicoureteral reflux (n = 7), hyperactive bladder (n = 6), and prostatitis (n = 10). Data was collected via chart review and was statistically analyzed. Results: AMC-susceptible ESBL-producing Escherichia coli, Klebsiella pneumoniae and K. oxytoca were identified as the causative agents in 31, 14, and 1 patients, respectively. Thirty-nine (84.7%) out of 46 patients were successfully treated with oral AMC. Additionally, 2 (4.3%) patients' urine cultures turned to be negative, though their clinical complaints and leukocyturia had continued. In the remaining 5 (10.8%) patients, no positive clinical and microbiological response was obtained. Increased minimum inhibitory concentration levels of AMC (from 4 to > 256 mu g/mL) were detected in these patients and the treatment failures were attributed to this developing resistance. We found that therapeutic failure was significantly more frequent in Klebsiella spp. than in E. coli (33.3% vs 6.5%, P = 0.029). Furthermore, no treatment failure was observed in pathogens with minimum inhibitory concentrations (MICs) <= 2 mg/mL, and the high AMC MIC (8 mg/mL) was associated with resistance development and therapeutic failure (71.4% vs. 5.1%, P = 0.0001). Conclusions: Our results suggested that amoxicillin-clavulanic acid may be a good oral antimicrobial which can be used for treatment of ESBL-positive UTIs, if the causative agent is susceptible to this antibiotic. However, some strains may develop resistance during therapy, especially in those exhibiting high AMC MICs.
