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Öğe Analysis of Risk Factors Affecting the Development of Infection in Artificial Vascular Grafts Used for Reconstruction of Middle Hepatic Vein Tributaries in Living Donor Liver Transplantation(Lippincott Williams & Wilkins, 2019) Koc, Cemalettin; Akbulut, Sami; Ozdemir, Fatih; Kose, Adem; Isik, Burak; Yologlu, Saim; Yilmaz, SezaiBackground. To analyze the risk factors affecting the development of infection in artificial vascular grafts (AVGs) used for reconstruction of middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT). Methods. Between January 2009 and January 2018, 1253 right lobe LDLTs were performed at our Transplant Institute, and MHV tributaries of the 640 right lobe liver grafts were reconstructed with AVG. Reconstructed MHV tributaries were removed due to AVG infection in 25 of these patients (case group; n = 25). To determine risk factors for AVG infection, right lobe LDLT patients without AVG infections were selected as control group (n = 615). Both groups were compared about demographic parameter, transcystic catheter usage, bile leakage, type of biliary anastomosis (duct-to-duct, telescopic duct-to-duct), number of graft biliary duct (=1 versus >1), number of biliary anastomosis (=1 versus >1), AVG thrombosis, AVG types (Dacron versus polytetrafluoroethylene). Univariate analyses were used for comparison of different variables, and variables with P <= 0.20 were taken into logistic regression model. Results. Univariate analysis shows that statistically significant differences were found between groups regarding bile leakage (P < 0.001), graft thrombosis (P = 0.002), transcystic catheter (P = 0.049), and AVG types (P = 0.013). Variables with P <= 0.20 were taken into logistic regression model. Multivariate analysis shows that bile leakage (odds ratio, 13.3) and AVG thrombosis (odds ratio, 9.8) were determined as independent and strong risk factors for development of AVG infection. Conclusions. This study revealed that bile leakage and graft thrombosis are independent and strong risk factors for infections of AVGs used for anterior sector drainage reconstruction.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 Clinical Characteristics and Outcomes of Liver Transplantation Recipients With COVID-19 Pneumonia(Elsevier Science Inc, 2021) Kose, Adem; Toplu, Sibel Altunisik; Yalcinsoy, Murat; Yakupogullari, Yusuf; Otlu, Baris; Otan, Emrah; Aydin, CemalettinBackground. We aimed to evaluate the clinical characteristics and outcomes of mild-severe COVID-19 pneumonia cases in liver transplant (LT) recipients. Methods. Ten LT recipients diagnosed as having COVID-19 pneumonia in a 6-month period in our transplantation center were included. Demographic and medical data of the recipients were retrospectively collected; clinical courses, treatment responses, and outcomes were evaluated. Results. Ten LT recipients were male, had a median age of 57 years (min-max, 36-69 years; interquartile range [IQR], 13 years), and had right lobe from living donor LT performed in a median of 11 months (min-max, 1-72 months; IQR, 12 months). Five patients had severe pneumonia, and the remaining patients had mild/moderate pneumonia. The most frequent symptoms were fever (90%) and cough (70%). Favipiravir, enoxaparin sodium, and corticosteroid were initiated at the time of the diagnosis; immunosuppressive drug doses were reduced or discontinued in 3 cases. Lymphopenia median: 510/mL (min-max, 90-1400 mL; IQR, 610 mL), increased levels of C-reactive protein median: 4.72 (min-max, 0.31-23.4; IQR, 8.5), and ferritin median: 641 (min-max, 40 to >= 1650; IQR, 1108) were frequent. Four patients required antibacterial treatments because of emerging bacterial pneumonia and/or sepsis. All patients were hospitalized for a median of 10 days. One patient with sepsis died on the 26th day after intensive care unit admission, and the remaining 9 survived. No further complication was recorded for 1-month follow-up. Conclusions. Commencing favipiravir, enoxaparin sodium, and corticosteroid treatments; close follow-up of the developing complications; the temporary reduction or cessation of immunosuppression; a multidisciplinary approach; early awareness of the bacterial infections; and the initiation appropriate antibiotic treatments can contribute to success.Öğe Cytomegalovirus associated severe pneumonia in three liver transplant recipients(J Infection Developing Countries, 2020) Kose, Adem; Yalcinsoy, Murat; Samdanci, Emine Turkmen; Barut, Bora; Otlu, Baris; Yilmaz, Sezai; Bayindir, YasarIntroduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.Öğe Diagnostic approach of tuberculous lymphadenitis in a multicenter study(J Infection Developing Countries, 2024) Yenilmez, Ercan; Ozakinsel, Duygu; Kose, Adem; Olcar, Yildiz; Duman, Zehra; Ceylan, Mehmet R.; Bozkurt, FatmaIntroduction: Tuberculous lymphadenitis (TBLN) is the most common infectious etiology of peripheral lymphadenopathy in adults, in Turkiye. This study aimed to identify the demographic, clinical, and laboratory variables that differentiate TBLN from non-tuberculous lymphadenitis (NTBLN), as well as the etiology of lymphadenopathy in adults. Methodology: Patients who were over 18 years old and were referred to the infectious disease outpatient clinics with complaints of swollen peripheral lymph nodes, and who underwent lymph node biopsy between 1 January 2010 and 1 March 2021, were included in this multicenter, nested case-control study. Results: A total of 812 patients at 17 tertiary teaching and research hospitals in Turkiye were included in the study. TBLN was the most frequent diagnosis (53.69%). The proportion of patients diagnosed with TBLN was higher among females; and among those who had a higher erythrocyte sedimentation rate, positive purified protein derivative test, and positive interferon -gamma release test result ( p < 0.05). However, TBLN was less frequent among patients with generalized lymphadenopathy, bilateral lymphadenopathy, axillary lymphadenopathy, inguinal lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, and moderately increased C reactive protein levels ( p < 0.05). Conclusions: Identifying the variables that predict TBLN or discriminate TBLN from NTBLN will help clinicians establish optimal clinical strategies for the diagnosis of adult lymphadenopathy.Öğe Evaluation of clinical characteristics and outcomes of postoperative infections in living liver donors(Wiley, 2021) Kose, Adem; Altunisik Toplu, Sibel; Akbulut, Sami; Yasar, Seyma; Sarici, Kemal Baris; Duman, Yucel; Kutlu, RamazanAim To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). Methods Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. Results The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum beta-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 +/- 2 (min 1-max 30, IQR:1) and hospitalization days was 14 +/- 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. Conclusion Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.Öğe Evaluation of Cytomegalovirus Infections in Liver Transplant Recipients Under Universal Prophylaxis: A Single Centre Experience(Kowsar Publ, 2021) Toplu, Sibel Altunisik; Kose, Adem; Karakas, Serdar; Bayindir, Yasar; Otlu, Baris; Yilmaz, SezaiBackground: Cytomegalovirus (CMV) is one of the leading viral agents that can pave the way for serious complications and organ damage in solid organ transplant (SOT) recipients after transplantation. Strategies have been developed to protect at-risk patients from CMV infection following transplantation. Since more than 90% of adults in Turkey were positive for CMV IgG, universal CMV prophylaxis was applied, and the results were evaluated. Objectives: This study aimed to evaluate the results of universal CMV prophylaxis after liver transplantation in the long term. Methods: A total of 1,090 liver transplant patients were evaluated in terms of CMV infection in the Organ Transplantation Institute of Inonu University, Malatya, Turkey, from October 2014 to December 2019. In order to identify the CMV infections, quantitative nucleic acid amplification (QNAT) was used to detect potential CMV DNA. The cut-off value of CMV DNA was determined to be 1000 copies/mL after transplantation. Results: According to the clinical and laboratory assessments, 33 (3%) patients were diagnosed with CMV infection, and 25 (2.3%) patients were evaluated as possibly having CMV syndrome. Also, eight of the 33 patients were assessed as having end-organ CMV disease and 25 as probable CMV syndrome. In the late period following prophylaxis, CMV infection was observed in 10 (0.9%) cases. The infection rate after prophylaxis (0.9%) was lower than the infection rate (2.1%) seen during prophylaxis. Conclusions: Close clinical follow-up with CMV prophylaxis and strict monitoring of CMV DNA by determining a specific cut-off point are important in the follow-up of liver transplant patients.Öğe Everolimus induced pneumonitis in a liver transplant patient: Dilemma in the discrimination of pneumonia(Turkish Surgical Assoc, 2025) Saglam, Kutay; Kose, Adem; Yalcinsoy, Murat; Bayindir, Yasar; Yilmaz, SezaiEverolimus is one of the immunosuppressive drugs used in solid organ transplantation. Many side effects have been described for these immunosuppressive drugs, similar to other drugs in this category. The purpose of this case presentation is to draw attention to drug-induced pneumonitis, which is a rare and life-threatening side effect of everolimus. A nineteen-year-old female patient who received liver transplantation for toxic hepatitis was admitted to our institute with cough and dyspnea. Everolimus had been started in conjunction with tacrolimus therapy 6 months prior to admission. Her chest imaging were consistent with pneumonitis. Markers of infection and cultures were all negative. After discontinuation of everolimus, symptoms and radiological findings resolved.The adverse effects of the drug should be kept in mind while investigating possible infectious agents in liver transplant recipients who are prone to opportunistic infections.Öğe Knowledge and Awareness of Physicians About Rational Antibiotic Use and Antimicrobial Resistance Before and After Graduation: A Cross-Sectional Study Conducted in Malatya Province in Turkey(Dove Medical Press Ltd, 2021) Kose, Adem; Colak, CemilBackground: We aimed to evaluate the level of theoretical knowledge of rational antibiotic use and awareness about emergence of multidrug resistance (MDR) among the senior students at a medical school and the actively-working family physicians. Methods: This cross-sectional research was carried out between 1 February and 30 April 2019 in Malatya province. Two-hundred twenty-five senior students in the Inonu University Medical School (Group 1) and 230 actively-working family physicians in Malatya primary health care services who were found to be eligible (Group 2) were included in this study. Power analysiscalculated the minimum of 240 participants with a proportion differ-ence of 0.18 between the groups, a type I error of 0.05 and a type II error of 0.20. A questionnaire including seven sections and 28 questions was applied to the participants. Results: Doctors were more hesitant in pre-graduation and more self-confident in the post-graduation period for the decision to start antibiotic treatment. In addition, doctors forget their theoretical knowledge of antibiotics over time and are unable to follow current developments after graduation. The most important concern in the pre-graduation period was the choice of antibiotics from the wrong group, while in the post-graduation period it is the fear of the presence of unproven infection. Conclusion: Physicians' antibiotic prescribing habits, attitudes and behaviors vary before and after graduation. Sustainable education for antibiotic use for physicians after graduation can contribute positively to reduce of antimicrobial resistance rates and to increase awareness about the use of rational antibiotics.Öğe Management of Chronic Hepatitis B Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2023 Update (vol 36, pg 1, 2023)(Doc Design Informatics Co Ltd, 2025) Demirturk, Nese; Kose, Adem; Ural, Onur; Asan, Ali; Barut, Sener; Sumer, Sua; Simsek, Funda[No abstract available]Öğe Meropenem-Associated Acute Hepatocellular Liver Injury: A Rare Case Report(Bilimsel Tip Yayinevi, 2026) Salduz, Ekrem; Avcu, Atakan; Kose, Adem; Yilmaz, Zeynep BurcinDrug-induced liver injury (DILI) is a serious and commonly encountered clinical complication, the diagnosis of which is usually established by exclusion. Antibiotics, particularly beta-lactam agents, are among the leading causes of DILI. Meropenem is a widely used broad-spectrum carbapenem antibiotic. This report presents a case of acute hepatocellular liver injury that developed within 24 hours after initiation of meropenem for the treatment of pneumonia in an 85-year-old patient. Viral hepatitis, autoimmune diseases, and other potential causes of liver injury were comprehensively excluded. In the presence of marked elevations in liver enzymes, meropenem was discontinued, after which the biochemical abnormalities were observed to resolve spontaneously without any specific treatment. Reports of meropenem-induced liver injury are rare in the literature; the rapid onset and reversibility observed in this case underscore the importance of drug discontinuation in management. In clinical practice, awareness of the risk of hepatotoxicity associated with meropenem use and adoption of a multidisciplinary approach in similar cases are of great importance.Öğe Onychomycosis Caused by Phoma glomerata: The First Reported Case from Turkiye(Ankara Microbiology Soc, 2026) Tanriverdi, Elif Seren; Yakupogullari, Yusuf; Isik, Fatih Emin; Yakut, Eda; Kose, Adem; Otlu, BarisOnychomycosis is a nail infection most commonly caused by dermatophytes. However in recent years, non-dermatophyte molds have also been increasingly reported as causative agents of onychomycosis. Phoma glomerata is a saprophytic fungus commonly found in nature, which rarely causes infections in humans and to date, only one case has been reported in another country as a causative agent of onychomycosis. In this case report, a case of onychomycosis caused by P.glomerata was presented. A 67-year-old female patient admitted to the dermatology outpatient clinic of our hospital with a oneyear history of discoloration, thickening and fragility of the left big toenail. In the potassium hydroxide microscopic examination of the specimen taken from the nail bed, septate and branched hyphae were observed. Dark brown pigmented, slow-growing mold colonies were observed within 10 days of culture on Sabouraud dextrose agar. Microscopic examination revealed the presence of pycnidial structures. The fungus isolated from the patient was identified as P.glomerata using the VITEK MS Mould Kit with the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (VITEK MS, bioM & eacute;rieux, France) system and DNA sequencing analysis was performed to confirm the diagnosis. Following genomic DNA extraction, the 28S rRNA gene region was amplified by polymerase chain reaction (PCR) using the NL1 and NL4 primers. After agarose gel electrophoresis of the PCR products, the amplicons were sequenced using the SQK-NBD114.96 kit on the MinION (Oxford Nanopore, United Kingdom) platform. The obtained data were analyzed using the BLAST algorithm in the National Center for Biotechnology Information GenBank database. The sequence was submitted to the NCBI GenBank under the accession number PV975047. The patient was treated with oral terbinafine (250 mg/day) and topical antifungal therapy. Clinical improvement was observed after two months of follow-up. In this study, we present a case of onychomycosis caused by P.glomerata in an elderly diabetic patient living in a rural area. According to our literature review, this is the first case reported from T & uuml;rkiye and the second worldwide. Current scientific data suggest that Phoma species can cause infections in the skin, subcutaneous tissues or other organs, especially in immunocompromised or debilitated individuals, or following penetrating trauma. Classical phenotypic methods pose significant challenges in identifying this agent and MALDI-TOF MS or molecular methods may be useful for accurate identification.Öğe Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection(Int Inst Anticancer Research, 2017) Gur, Ali; Oguzturk, Hakan; Kose, Adem; Turtay, M. Gokhan; Ersan, Veysel; Bayindir, Yasar; Ince, VolkanBackground/Aim: Infections are one of the most important causes of mortality and morbidity after liver transplantation as in all transplantations. Infectious complications are known to be among the preventable causes with appropriate diagnosis and treatment. So early prediction of the risk of infections will provide an effective approach to determine the local antimicrobial resistance and prevention of specific risk factors. The aim of this study was to deterimne whether specific markers are useful or not to deterimne a suspected infection in patients that have undergone liver transplantation. Patients and Methods: The study included 65 patients with liver transplantation admitted to emergency room with suspicion of infection. These patient's CRP, procalsitonin (PCT), lactate, SAA and IL-6 levels were initially measured in the emergency department. The patients were classified to three categories according to culture results; culture-negative, culture-positive and control group. Studying parameters were investigated according to whether the culture was positive or negative in these patients. Results: CRP, PCT, lactate, SAA and IL-6 levels were significanlty high in patients with suspected infeciton when compared to the control group (p<0.05). CRP, PCT and IL-6 levels were higher in the culture-positive group than in the culture-negative group and there was a significant variation (p<0.05). When suspecting an infection evaluating the parameters CRP, PCT and IL-6 was very meaningfull (p<0.05). Conclusion: We can use CRP, PCT, lactate, SAA and IL-6 parameters to identify presence of infection at the liver transplantation patients admitted to the emergency department with suspected infection. If CRP, PCT and IL-6 levels are significantly high we can guess the patient's positive culture.Öğe Prognostic Value of Routine Biochemistry Profile of Liver Transplant Patients Admitted to the Emergency Department with a Suspected Infection(Tehran Univ Medical Sciences, 2021) Gur, Ali; Kose, Adem; Oguzturk, HakanIntroduction: Since patients who have undergone liver transplantation should take immunosuppressants for life, the prevalence of systemic infections after this procedure is very high. These infections are associated with increased mortality and morbidity. Objective: This study aimed to investigate the prognostic value of routine biochemistry profile and its relationship with mortality in liver transplant patients admitted to the emergency department (ED) with a suspected infection. Methods: Patients who had undergone liver transplantation were included in the study. The patients were divided into three groups of culture-negative, culture-positive and control. White blood cell (WBC) count, hemoglobin (Hb), platelet (Plt), international normalized ratio (INR), creatinine (Cr), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values as well as vital sign findings were comparatively evaluated in terms of their ability to show the presence of any infection and their correlation with mortality. Results: Totally, 142 patients were enrolled and were divided into the following three groups: 41 cases in culture-negative group, 30 cases in culture-positive group, and 71 cases in control group. There was not any significant difference between study groups in terms of age and sex ratio (p>0.05). The Hb and Plt values of the culture-positive patients were significantly lower, and their INR was significantly higher compared to those in control group (p<0.05). Fever, Hb, Plt, INR, AST and ALT values were factors that had a significant correlation with mortality in patients with an infection whethere culture-positive or culture-negative ones (p<0.05). Conclusions: In patients admitted to the ED with a history of liver transplantation, we recommend the evaluation of vital signs and Hb, PLt, and INR values to determine whether there is an infection or not. We can also state that mortality risk is higher in cases with low Hb and Plt levels and high INR, ALT, and AST values.Öğe A Rapidly Fatal Sepsis Caused by Listeria Monocytogenes Type-4b in A Patient with Chronic Renal Failure(Kowsar Publ, 2015) Kose, Adem; Yakupogullari, YusufIntroduction: Listeria monocytogenes is a significant zoonosis causing invasive infections in the susceptible persons. The current paper presented a patient who died due to a rapidly-progressing multiple organ failure (MOF) as a result of severe sepsis caused by L. monocytogenes. Case Presentation: A 70-years-old patient with chronic renal failure was admitted to the infectious diseases clinic due to diarrhea for one day. He was hospitalized and the body fluid samples were collected for laboratory analyses. Within few hours, his vital findings worsened, and he developed respiratory arrest. Ceftriaxone and gentamycin were administrated. However, he died due to disseminated intravascular coagulation, septic shock and meningoencephalitis at the 22nd hour of admission. Causative agent was identified as L. monocytogenes serotype-4b in post-mortem period. Discussion: L. monocytogenes can cause progressive and rapidly fatal infections in the vulnerable persons, with multisystem involvement. Since this bacterium is not susceptible to cephalosporines, it will be better to consider effective antimicrobials in the treatment of the possible cases.Öğe Retrospective Review of Patients with Staphylococcus aureus Bacteremia(Bilimsel Tip Yayinevi, 2024) Yilmaz, Zeynep Burcin; Duman, Yuecel; Altunisik Toplu, Sibel; Memisoglu, Funda; Kose, Adem; Ozden, Mehmet; Bayindir, YasarIntroduction: Staphylococcus aureus causes community-acquired and healthcare-associated infections with high morbidity and mortality. It is critical to initiate appropriate and effective treatment considering the risk factors for S. aureus bacteremia. There is insufficient data available regarding this patient group in our region. This study aimed to assess the focus of infection, resistance status, and clinical course in patients with S. aureus bacteremia detected in blood culture. Materials and Methods: Patients with healthcare-associated or community-acquired S. aureus bacteremia who were hospitalized in a tertiary hospital during the one year between January 2020 and December 2020, and microbiological data were retrospectively analyzed. The distribution of Staphylococcus aureus bacteremia was evaluated based on the organ involved, the clinics where it was observed, and its resistance status. Results: OStaphylococcus aureus isolate growth was detected in the blood cultures of 66 adult patients within one year. The mean age of the patients was 56.5 +/- 16.8 (18-84) years, and 76% were male. While bacteremia was community-acquired in 12 (18.2%) of the patients, it was healthcare-related in 54 (81.8%) and methicillin resistance rates were 8.3% and 25.9%, respectively. The most common focus of infection was catheter-related bloodstream infection in 21.2% and pneumonia in 21.2% of patients. No focus was detected in 34.8% of the bacteremias. In terms of methicillin-resistant S. aureus (MRSA) distribution, the difference between intensive care and wards was 20% and 80%, respectively. No statistically significant difference was found (p> 0.05). While the 14-day mortality in MRSA bacteremia was 33.6%, the 14-day mortality in methicillin-susceptible S. aureus was 27.5% (p= 0.731). Conclusion: It was found that Staphylococcus aureus bacteremia was predominantly nosocomial, with pneumonia and catheter infections being the most common causes. The conclusion drawn suggests a need for heightened infection control measures, particularly focusing on improving hand hygiene practices. To guide empirical treatment effectively, it is crucial to monitor resistance changes that may have occurred over the years, consider risk factors for MRSA, and elucidate the resistance profiles specific to individual healthcare facilities.Öğe Secondary infections after cytotoxic chemotherapy in patient with hematological malignancies(J Infection Developing Countries, 2017) Buyuktuna, Seyit Ali; Saba, Rabin; Gozel, Mustafa Gokhan; Turhan, Ozge; Inan, Dilara; Asik, Zahide; Kose, AdemIntroduction: This study was initiated to investigate the risk factors of secondary infections in febrile neutropenic patients following chemotherapy, and to evaluate the clinical, microbiological, and mortality outcomes of these infections. Methodology: An evaluation was done on all patients with hematological malignancy who developed a febrile neutropenic episode (FNE) after cytotoxic chemotherapy in the Department of Hematology, Akdeniz University Faculty of Medicine, between January 2007 and December 2008. Results: A total of 294 primary FNEs that responded to the initial empirical or targeted treatment were included in the study, and secondary infections developed after 72 (24.5%) of 294 primary FNEs. Risk factors for secondary infections were determined as acute leukemia as the underlying disease, salvage chemotherapy for refractory/relapse diseases, prolonged neutropenia (10 days and over), Multinational Association of Supportive Care in Cancer (MASSC) score < 21, and fungal infection during the primary episode. The mortality rate of patients who developed secondary infections was significantly higher compared to patients without secondary infections (27.8% and 5.4%, respectively; p = 0.001). Conclusions: The development of secondary infections in patients with hematological malignancy was not very rare. Greater concern should be shown for these infections to increase patient survival rates.Öğe Short-term experiences of a liver transplant centre before and after the COVID-19 pandemic(Wiley-Hindawi, 2021) Toplu, Sibel Altunisik; Bayindir, Yasar; Yilmaz, Sezai; Yalcinsoy, Murat; Otlu, Baris; Kose, Adem; Sahin, Tevfik TolgaBackground/Aim With the COVID-19 pandemic, managing the process of solid organ transplantation has become a significant matter for transplant centres. In this study, we report our experiences on evaluating the effects of COVID-19 in patients with recent liver transplants. Materials and Methods We evaluated patients who received liver transplants during three close consecutive periods of time. For transplants conducted between October 1 and December 31, 2019, January 1 and March 10, 2020 and March 11 and June 22, 2020, the lung tomographies of patients were inspected for radiological signs of viral pneumonia. For patients after March 11, 2020, the hospital's electronic database system was scanned for preoperative and postoperative SARS-CoV-2 testing from Real-time Polymerase Chain Reaction (RT-PCR) of the respiratory tract samples. Results A total of 149 patients over the age of 18 who received liver transplants at our centre between October 1, 2019 and June 22, 2020 were evaluated. During this time span, our centre conducted liver transplants on patients from 34 different provinces and also abroad. Within this time period, a total of nine patients had respiratory samples with a positive SARS-CoV-2 RT-PCR test. PCR of respiratory tract samples was performed in 21 (14%) patients to identify the other potential infective agents in the respiratory tracts; Rhinovirus and Influenza A were detected in two and respiratory syncytial virus (RSV) was detected in one patient. During the transplant periods, 99 (67.1%) patients were evaluated with computed tomography (CT). The CT findings of 18 (12%) patients were consistent with viral pneumonia. There was a statistically significant difference between the groups only in terms of air bronchogram findings (P = .012). Conclusion The clinical status of our short-term liver transplant patients was far better than we originally anticipated, but it remains obvious that the necessary precautions should continue to be taken.Öğe Therapeutic effects of dexpanthenol on the cardiovascular and respiratory systems following cecal ligation and puncture-induced sepsis in rats(Taylor & Francis Ltd, 2020) Kose, Adem; Parlakpinar, Hakan; Ozhan, Onural; Ermis, Necip; Yildiz, Azibe; Vardi, Nigar; Cigremis, YilmazCecal ligation and puncture (CLP) is a commonly used model of sepsis in vivo. We investigated the effects of dexpanthenol (DXP) on heart, lung and aorta in CLP-induced sepsis in rats. Rats were divided into four groups of eight: group 1, sham (SH); group 2 (DXP), 500 mg/kg DXP injected intraperitoneally (i.p.); group 3 (CLP), CLP performed; group 4 (CLP + DXP), 500 mg/kg DXP injected i.p. after CLP. Heart, lung and aorta specimens were harvested for histopathological and biochemical analysis. Heart rate increased in group 3 compared to group 1; DXP administration to group 4 did not alleviate this change. In heart tissue samples, MDA levels were decreased signi?cantly in groups 2 and 4 compared to group 3. The levels of GSH in groups 2 and 3 were elevated compared to groups 1 and 2. SOD activity was increased significantly in group 4 compared to group 3. CAT activity for group 4 was increased significantly compared to groups 1 and 3. We found that caspase-9 and caspase-3 activity was increased after application of CLP. Also, DXP treatment decreased the number of caspase-positive cells significantly compared to group 3. DXP appears to be promising for reducing sepsis-related mortality.
