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Öğe Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization(Elsevier Brazil, 2017) Akdogan, Ozlem; Ersoy, Yasemin; Kuzucu, Cigdem; Gedik, Ender; Togal, Turkan; Yetkin, FundaThe effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 +/- 21.09 days in the case group and 10.43 +/- 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. (C) 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda.Öğe Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle thatcontains endotracheal tube with subglottic drainage and cuff pressure monitorization(Elsevıer brazıl, r sete setembro, 111-16, rıo de janeıro, rj 20050-006, brazıl, 2017) Akdogan, Ozlem; Ersoy, Yasemin; Kuzucu, Cigdem; Gedik, Ender; Togal, Turkan; Yetkin, FundaThe effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 +/- 21.09 days in the case group and 10.43 +/- 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. (C) 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda.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 Brucella and peritoneal dialysis related peritonitis: case report and review of literature(Dustri-Verlag Dr Karl Feistle, 2014) Koz, Suleyman; Sahin, Idris; Kayabas, Uner; Kuzucu, CigdemIsolated case reports of peritonitis due to Brucella spp. during peritoneal dialysis (PD) continue to surface in the medical literature. However, the optimal treatment regimen for these patients, in particular with regards to the fate of PD catheter, is still largely unknown. We report a case of brucella peritonitis successfully treated with intraperitoneal administration of amikacin, along with oral rifampicin and doxycycline but without catheter removal. Furthermore, we have reviewed the literature up until present day.Öğe Clinical, microbiologic, and epidemiologic characteristics of Pseudomonas aeruginosa infections in a University Hospital, Malatya, Turkey(Mosby-Elsevier, 2006) Yetkin, Gulay; Otlu, Baris; Cicek, Aysegul; Kuzucu, Cigdem; Durmaz, RizaBackground: Pseudomonas aeruginosa strains are generally resistant to many antibiotics, and nosocomial infections because of this species are one of the major problems in many hospitals. Molecular typing provides very useful information about origin and transmission of the strains. The aims of the present study were to investigate clinical and microbiologic characteristics of the nosocomial infections caused by P aeruginosa strains in a medical center and to bring up the cross-transmission level of this opportunistic pathogen in a university hospital by analyzing the clonal relationship among the isolates. Methods: A total of 105 P aeruginosa strains had been identified among the 80 inpatients in a 1-year period from August 2003 to August 2004. Demographic, clinical, and epidemiologic data of the patients were prospectively recorded. The standardized disk-diffusion method was used to determine resistance of the strains to imipenem, ceftazidime, aztreonam, amikacin, gentamicin, mezlocillin, cefepime, tobramycin, meropenem, ceftriaxone, and ciprofloxacin. Clonal relatedness of the strains was investigated by pulsed-field gel electrophoresis (PFGE). Results: Of the 105 P aeruginosa strains identified, 45 (43%) were isolated from the patients hospitalized in intensive care units. Thirteen patients had repeated pseudomonas infection (total 38 infections/13 patients); 26 of these repeated infections in 9 patients showed the same localization. Half of the patients had at least 1 underlying disease such as burn (48%), chronic illness (32%), and malignancy (20%). Fifty-seven patients (71%) had urinary and/or other catheterization. Urinary tract infection (35 %) was the most frequent infection encountered, followed by respiratory tract infection (34%) and sepsis (13%). Resistance to the antibiotics tested was in the 12% to 88% range; amikacin was the most effective and ceftriaxone was the least effective antibiotic, The PFGE typing method showed that 28 of the 80 patients' isolates were clonally related, including 23 indistinguishable or closely related strains (29%), and 5 possibly related strains (6%). Epidemiologic data of the 16 patients (20% of the patients) confirmed a clonal relationship among the strains. Of the 26 isolates of the 9 patients having repeated infection in the same location, 18 (69%) were in the clonally related groups, whereas 11 of the 12 strains isolated from repeated infections on different body sites were clonally different. Conclusion: Our results indicated that P aeruginosa infections in our hospital mainly affected the patients hospitalized in intensive care units and those having catheterization, burn, and/or chronic illness. Amikacin was the best antibiotic as far as bacterial resistance was considered. Although lack of major PFGE type confirmed no P aeruginosa outbreak, typing results showed that cross transmission and treatment failure are the 2 main problems, which should be consider together to prevent this bacterial infection in medical centers.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 Nosocomial Infections after ABO-Compatible and Incompatible Liver Transplantations(Galenos Yayincilik, 2018) Bayar, Filiz Surucu; Bayindir, Yasar; Isik, Burak; Ozgor, Dincer; Kayabas, Uner; Kuzucu, Cigdem; Yilmaz, SezaiIntroduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABO-compatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO-incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABO-incompatible patients. However, further studies are needed on this topic.Öğe Evaluation of nosocomial ınfections after abo-compatible and ıncompatible liver transplantations(Galenos yayıncılık, erkan mor, molla guranı cad 21-1, fındıkzade, ıstanbul 34093, turkey, 2018) Bayar, Filiz Surucu; Bayindir, Yasar; Isik, Burak; Ozgor, Dincer; Kayabas, Uner; Kuzucu, Cigdem; Yilmaz, SezaiIntroduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABO-compatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO-incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABO-incompatible patients. However, further studies are needed on this topic.Öğe Fungus Ball in Concha Bullosa: An Unusual Cause of Retro- orbital Pain(Lippincott Williams & Wilkins, 2014) Toplu, Yuksel; Toplu, Sibel A.; Can, Sermin; Kuzucu, CigdemFungus ball in the concha bullosa is an extremely rare disease. We described a case of the fungus ball in the concha bullosa in a 22-year-old woman. Preoperative diagnosis was based on nasal endoscopy and computed tomography scanning. The patient was endoscopically operated on. The examination of the removed material was reported as fungal infection. This case was found worth writing because of the location of the concha bullosa and its rare occurrence in this location.Öğe Investigation of Beta-Lactamase Genes and Clonal Relationship Among the Extended-Spectrum Beta-Lactamase Producing Nosocomial Escherichia coli Isolates(Ankara Microbiology Soc, 2015) Gorgec, Sunduz; Kuzucu, Cigdem; Otlu, Baris; Yetkin, Funda; Ersoy, YaseminExtended-spectrum beta-lactamase (ESBL) producing microorganisms currently cause a major problem. Among theseCTX-M beta-lactamase producing Escherichia coli has also disseminated worldwide as an important cause of both nosocomial and community-acquired infections. The aims of this study were to determine the prevalence of the beta-lactamase genes, antibiotic susceptibilities and clonal relationships of ESBL-producing nosocomial E.coli isolates. A total of 76 ESBL-producing E.coli strains isolated from urine (n= 26), blood (n= 25) and wound (n= 25) specimens of hospitalized patients identified as nosocomial infection agents according to the CDC criteria between June 2010-June 2011 were included in the study. Antibiotic susceptibilities of the isolates were detected by Kirby-Bauer disc diffusion method according to CLSI recommendations. ESBL production was tested by double disc diffusion method, and cefotaxime/cefotaxime-clavulanic acid E-test strips (AB Biodisk, Sweden) were used for indeterminate results. Presence of TEM, SHV, CTX-M, OXA-2 group, OXA-10 group, PER, VEB and GES beta-lactamase genes were investigated by polymerase chain reaction (PCR) using specific primers. Pulsed-field gel electrophoresis (PFGE) method was used for the detection of clonal relationships among the strains. Most of the ESBL-producing E.coli strains were isolated from samples of inpatients in intensive care (35%), internal medicine (16%) and general surgery (13%) units. All of the 76 strains were found susceptible to imipenem, meropenem and amikacin; however all were resistant to cefotaxime and ceftriaxone. The susceptibility rates of the isolates to cefoxitin, ertapenem, cefoperazone/sulbactam, piperacillin-tazobactam, gentamicin, ciprofloxacin, cefepime, amoxicillin-clavulanic acid, aztreonam and ceftazidime were 96%, 83%, 63%, 61%, 50%, 41%, 25%, 21%, 20% and 18%, respectively. Among E.coli isolates, the frequency of CTX-M, TEM, OXA-2 group, PER, SHV and OXA-10 group beta-lactamase genes were found as 89.5%, 59.2%, 15.8%, 14.5%, 11.8% and 3.9%, respectively, while none of the isolates were positive for VEB and GES beta-lactamase genes. In 1 (1.3%) strain none of the investigated genes were detected. PCR analyses of the isolates revealed that 25 harbored CTX-M and TEM genes together, while 20 harbored only CTX-M and two harbored only TEM genes. Single SHV gene was not detected in any of the isolates. PFGE demonstrated no major clonal relationship between ESBL-producing isolates. This study indicated that CTX-M type enzymes were highly endemic among ESBL-producing nosocomial E.coli strains in our hospital, with the polyclonal spread of ESBL-producing bacteria without any dominant epidemic clone. In conclusion, it was considered that further studies are needed to explain the relationship between epidemic clones and plasmids with the use of plasmid analysis and multilocus sequence typing methods.Öğe Investigation of the Susceptibilities of Extended-Spectrum Beta-Lactamase Producing Escherichia coli and Klebsiella spp. Strains to Ertapenem and Other Carbapenems(Ankara Microbiology Soc, 2011) Kuzucu, Cigdem; Yetkin, Funda; Gorgec, Sunduz; Ersoy, YaseminInfections caused by extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella spp. constitute severe problems. Carbapenems are commonly used to treat these infections. However, infections caused by carbapenem-resistant gram-negative bacteria show an increasing trend recently. The aim of this study was to investigate the susceptibilities of ESBL-producing E.coli and Klebsiella spp. to ertapenem and other carbapenems. A total of 239 E.coli, 28 K.pneumoniae and 11 K.oxytoca strains isolated from clinical specimens (208 urine, 16 blood, 26 wound, 17 sterile body fluids, four tracheal aspirates and seven others) of hospitalized patients and outpatients between January 2007-February 2008, were included to the study. The isolates were identified by conventional methods, and antibiotic susceptibility tests were performed by Kirby Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) standards. ESBL production was tested by double disk diffusion method. When ESBL production was indeterminate, cefotaxime-clavulanic acid E test (BioMerieux, France) was used. According to the CLSI standards modified Hodge test was performed for carbapenem resistant isolates and minimal inhibitory concentration (MIC) values were detected for ertapenem (Etest (R), BioMerieux, France), imipenem and meropenem (M.I.C. Evaluator Strips, Oxoid, UK). All of the isolates were found susceptible to amikacin (278/278; 100%), whereas the susceptibility rates for imipenem/meropenem and ertapenem were 99.3% (276/278) and 98.6% (274/278), respectively. When evaluated individually, ertapenem susceptibilities of E.coli, K.pneumoniae and K.oxytoca strains were 99.2%, 96.4% and 90.9%, respectively, while these rates were 100%, 96.4% and 90.9%, respectively, for imipenem/meropenem. Carbapenem resistance was detected in two E.coli, one K.oxytoca and one K.pneumoniae isolates. While two Klebsiella spp. isolates were resistant to all of the tested carbapenems (MIC > 32 mu g/ml), two E.coli isolates were resistant to ertapenem (MIC > 32 mu g/ml) but susceptible to imipenem (MIC= 0.25 mu g/ml) and meropenem (MIC= 0.5 mu g/ml). Carbapenemase production was demonstrated by modified Hodge test in all of the carbapenem-resistant isolates. In conclusion, ESBL-producing gram-negative isolates should be routinely tested with a screening method for carbapenemase activity and confirmation tests should be performed in suspected cases.Öğe Investigation of Viral and Atypical Pathogens in Patients with Pneumonia Who Need Intensive Care Unit(Bilimsel Tip Yayinevi, 2022) Dogan, Ahmet; Cinar, Yasemin Ersoy; Otlu, Baris; Kuzucu, CigdemIntroduction: Viral pathogens have been reported increasingly in pneumonia patients. There are few studies in Turkey on viral and atypical bacterial etiology in adult patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). In this study, it was aimed to determine atypical and viral pathogens in patients with pneumonia requiring ICU and to research clinical progression. Materials and Methods: Adult patients admitted to adult ICUs between November 2016-October 2017 with either CAP or HAP diagnosis were included prospectively. Viral pathogens and also atypical bacterial pathogens were investigated with the in-house multiplex polymerase chain reaction method. Results: Two hundred patients were enrolled to the study, of whom 63 had CAP (31.5%) and 137 had HAP (68.5%). Viral agents were identified in 31 (15.5%) patients in total, 11 (17.5%) in CAP and 20 (14.6%) in HAP. The most identified viral etiologic agents were rhinovirus, influenza A, and coronavirus HKU. Eight patients (4%) had Mycoplasma pneumoniae. All patients were negative for Legionella pneumoniae and Chlamydophila pneumoniae. Mortality rates were 16.7% for cases with a viral etiology only, 29.2% for cases with bacterial pathogens only, and 23.5% for cases with mixed agents identified. Conclusion: Viral pathogens and M. pneumoniae should be remembered in the etiology of severe pneumonia patients.Öğe Is airborne transmission of Acinetobacter baumannii possible: A prospective molecular epidemiologic study in a tertiary care hospital(Mosby-Elsevier, 2016) Yakupogullari, Yusuf; Otlu, Baris; Ersoy, Yasemin; Kuzucu, Cigdem; Bayindir, Yasar; Kayabas, Uner; Togal, TurkanBackground: Understanding the dynamics of aerial spread of Acinetobacter may provide useful information for production of effective control measurements. We investigated genetic relationships between air and clinical isolates of Acinetobacter baumannii in an intensive care unit (ICU) setting. Methods: We conducted a prospective surveillance study in a tertiary care hospital for 8 months. A total of 186 air samples were taken from 2 ICUs. Clonal characteristics of air isolates were compared with the prospective clinical strains and the previously isolated strains of ICU patients over a 23-month period. Results: Twenty-six (11.4%) air samples yielded A baumannii, of which 24 (92.3%) isolateswere carbapenemresistant. The Acinetobacter concentrationwas the highest in bedside sampling areas of infected patients (0.39 CFU/m(3)). Air isolateswere clustered in 13 genotypes, and 7 genotypes (including 18 air strains) were clonally related to the clinical strains of 9 ICU patients. One clone continued to be cultured over 27 days in ICU air, and air isolates could be clonally related to 7-week retrospective and approximately 15-week prospective clinical strains. Conclusions: The results of this study suggest that infected patients could spread significant amounts of Acinetobacter to ICU air. These strains could survive in air for some weeks and could likely still infect new patients after some months. Special control measurements may be required against the airborne spread of Acinetobacter in ICUs. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Öğe MRSA genotypes in Turkey: Persistence over 10 years of a single clone of ST239(W B Saunders Co Ltd, 2009) Alp, Emine; Klaassen, Corne H. W.; Doganay, Mehmet; Altoparlak, Ulku; Aydin, Kemalettin; Engin, Aynur; Kuzucu, CigdemObjectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of life-threatening human infections. The clinical impact of MRSA is mounting, not only due to the ever-increasing prevalence but also due to the occurrence of new, community-acquired MRSA strains. The aim of this prospective, multi-centre study was to determine the prevalence and genetic relatedness of clinically relevant MRSA isolates, in Turkey. Methods: During a 1-year period, data from 20 successive patients with invasive S. aureus infections were collected from eight university hospitals, geographically distributed over the six main regions of Turkey. Among these S. aureus isolates, the genetic association of MRSA isolates was investigated by pulsed-field get electrophoresis (PFGE) and spa typing. A selected number of isolates were also analyzed by multilocus sequence typing (MLST). Furthermore, Panton Valentine leucocidin (PVL) genes were examined. Results: In this study, the rate of methicillin resistance in S. aureus in patients with apparent infections (sepsis, meningitis, lung abscess or septic arthritis) ranged from 12 to 75% within the seven participating centres. Typing by pulsed-field get electrophoresis and spa typing revealed the presence of 22 closely related genotypes. According to the PFGE and spa typing results, 53 out of 54 MRSA isolates were closely related. These isolates were of spa type t030 or a related spa type, contain an SCC mec type III element and belong to sequence type ST239. None of the isolates contained the PVL genes. Conclusions: Despite the broad surface area of Turkey, a single predominant clone of ST239 circulates in hospitals in different regions and only few new types of MRSA were introduced over the past years. These results place Turkey in the epicenter of ST239 prevalence. (C) 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved.Öğe An outbreak associated with multidrug-resistant Pseudomonas aeruginosa contamination of duodenoscopes and an automated endoscope reprocessor(Allied Acad, 2017) Yetkin, Funda; Ersoy, Yasemin; Kuzucu, Cigdem; Otlu, Baris; Parmaksiz, Nalan; Seckin, YukselBackground: Duodenoscopes are semi-critical devices used for endoscopic retrograde cholangiopancreatography (ERCP). Disinfection of these instruments is usually based on high-level disinfection procedures with a manual or automated endoscope reprocessor (AER). Duodenoscopes and AER are reported very rarely as a source of infection and outbreaks. Aim: To investigate an outbreak caused by Pseudomonas aeruginosa in a Gastroenterology Department and ERCP unit in a university hospital and its underlying risk factors. Method: Three patients in the gastroenterology unit were diagnosed as infected by multidrug-resistant P. aeruginosa and a case control study was conducted for detection of the risk factors. Our infection control team commenced active epidemiological surveillance to determine the cause of these infections. Clonal relationship of the strains was investigated by pulsed field gel electrophoresis (PFGE). Results: Eight patients were affected in the gastroenterology unit during the period November 2007-February 2008. The case-control analysis confirmed that undergoing ERCP was significantly associated with isolation of P. aeruginosa (P=0.0001) in this unit. Six patients' isolates and seven environmental isolates had an indistinguishable PFGE profile, confirming cross-transmission. The healthcare worker implemented infection control measures to resolve the outbreak and no further cases occurred. Conclusions: This outbreak resulted from failure of AER and inadequate high level disinfection procedures. AERs can cause contamination of duodenoscopes and can be related P. aeruginosa outbreaks. Reuse of ancillary materials of ERCP play a critical role in outbreak development.Öğe An outbreak associated with multidrug-resistant pseudomonas aeruginosa contamination ofduodenoscopes and an automated endoscope reprocessor(Allıed acad, 40 bloomsbury way, lower ground flr, london, wc1a 2se, england, 2017) Yetkin, Funda; Ersoy, Yasemin; Kuzucu, Cigdem; Otlu, Baris; Parmaksiz, Nalan; Seckin, YukselBackground: Duodenoscopes are semi-critical devices used for endoscopic retrograde cholangiopancreatography (ERCP). Disinfection of these instruments is usually based on high-level disinfection procedures with a manual or automated endoscope reprocessor (AER). Duodenoscopes and AER are reported very rarely as a source of infection and outbreaks. Aim: To investigate an outbreak caused by Pseudomonas aeruginosa in a Gastroenterology Department and ERCP unit in a university hospital and its underlying risk factors. Method: Three patients in the gastroenterology unit were diagnosed as infected by multidrug-resistant P. aeruginosa and a case control study was conducted for detection of the risk factors. Our infection control team commenced active epidemiological surveillance to determine the cause of these infections. Clonal relationship of the strains was investigated by pulsed field gel electrophoresis (PFGE). Results: Eight patients were affected in the gastroenterology unit during the period November 2007-February 2008. The case-control analysis confirmed that undergoing ERCP was significantly associated with isolation of P. aeruginosa (P=0.0001) in this unit. Six patients' isolates and seven environmental isolates had an indistinguishable PFGE profile, confirming cross-transmission. The healthcare worker implemented infection control measures to resolve the outbreak and no further cases occurred. Conclusions: This outbreak resulted from failure of AER and inadequate high level disinfection procedures. AERs can cause contamination of duodenoscopes and can be related P. aeruginosa outbreaks. Reuse of ancillary materials of ERCP play a critical role in outbreak development.Öğe Pathogens of Intensive Care Unit-Acquired Infections and Their Antimicrobial Resistance: A 9-Year Analysis of Data from a University Hospital(Kowsar Publ, 2018) Yetkin, Funda; Yakupogullari, Yusuf; Kuzucu, Cigdem; Ersoy, Yasemin; Otlu, Baris; Colak, Cemil; Parmaksiz, NalanBackground: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive actions in healthcare settings. Objectives: We investigated the causative agents of intensive care unit (ICU)-acquired infections and their antimicrobial resistance in a university hospital over a nine-year period. Methods: An active, prospective surveillance was conducted in the ICUs of a tertiary care hospital between 2007 and 2015. The changing patterns in the frequency of pathogens and their antimicrobial resistance by the time were statistically evaluated with Mann-Whitney U test. Results: A total of 3044 pathogens were isolated from 4272 healthcare-associated infections attacks in 3437 patients. The most frequently detected organisms were Acinetobacter spp. (n = 1060, 34.8%), Pseudomonas aeruginosa (n = 622, 20.4%), Escherichia coli (n = 340, 11.1%), Klebsiella pneumoniae (n = 331, 10.8%), and Candida spp. (n = 285, 9.3%). Carbapenem resistance among Acinetobacter spp., P. aeruginosa, E. coli, and K. pneumoniae was found as 82%, 30.7%, 2%, and 9.3%, respectively. The prevalence of extended-spectrum betalactamase (ESBL) among E. coli and K. pneumoniae was 49.7% and 41.3%, orderly, and methicillin resistance in Staphylococcus aureus was 81.8%. Substantial reductions occurred in the rates of E. coli (16.8% to 8.9%), S. aureus (11% to 3.2%), coagulase-negative staphylococci (7.9% to 0), and Stenotrophomonas maltophilia (4.2% to 0.3%) during the study period by the applied infection control measures while the rate of Acinetobacter spp. (9.7% to 51%) significantly increased. Furthermore, the increases in the carbapenem resistance among Acinetobacter spp. (52.5% to 91.4%), Pseudomonas spp. (25.7% to 51.6%), E. coli (0 to 12.7%), and K. pneumoniae (2.6% to 9%) and the decrease in the prevalence of ESBL-producing E. coli (57% to 27.2%) were statistically significant. Conclusions: Despite the decreases in the frequencies of staphylococci and some Gram-negative bacteria, the current infection control measures have been unable to limit the spread of carbapenem-resistant Gram-negative bacteria in our facility. Additional precautions are required to control such pathogens in the intensive care units.Öğe Pathogens of ıntensive care unit-acquired ınfections and their antimicrobial resistance: a 9-yearanalysis of data from a university hospital(Ahvaz jundıshapur unıv med scı, po box 6357-33118, ahvaz, 00000, ıran, 2018) Yetkin, Funda; Yakupogullari, Yusuf; Kuzucu, Cigdem; Ersoy, Yasemin; Otlu, Baris; Colak, Cemil; Parmaksiz, NalanBackground: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive actions in healthcare settings. Objectives: We investigated the causative agents of intensive care unit (ICU)-acquired infections and their antimicrobial resistance in a university hospital over a nine-year period. Methods: An active, prospective surveillance was conducted in the ICUs of a tertiary care hospital between 2007 and 2015. The changing patterns in the frequency of pathogens and their antimicrobial resistance by the time were statistically evaluated with Mann-Whitney U test. Results: A total of 3044 pathogens were isolated from 4272 healthcare-associated infections attacks in 3437 patients. The most frequently detected organisms were Acinetobacter spp. (n = 1060, 34.8%), Pseudomonas aeruginosa (n = 622, 20.4%), Escherichia coli (n = 340, 11.1%), Klebsiella pneumoniae (n = 331, 10.8%), and Candida spp. (n = 285, 9.3%). Carbapenem resistance among Acinetobacter spp., P. aeruginosa, E. coli, and K. pneumoniae was found as 82%, 30.7%, 2%, and 9.3%, respectively. The prevalence of extended-spectrum betalactamase (ESBL) among E. coli and K. pneumoniae was 49.7% and 41.3%, orderly, and methicillin resistance in Staphylococcus aureus was 81.8%. Substantial reductions occurred in the rates of E. coli (16.8% to 8.9%), S. aureus (11% to 3.2%), coagulase-negative staphylococci (7.9% to 0), and Stenotrophomonas maltophilia (4.2% to 0.3%) during the study period by the applied infection control measures while the rate of Acinetobacter spp. (9.7% to 51%) significantly increased. Furthermore, the increases in the carbapenem resistance among Acinetobacter spp. (52.5% to 91.4%), Pseudomonas spp. (25.7% to 51.6%), E. coli (0 to 12.7%), and K. pneumoniae (2.6% to 9%) and the decrease in the prevalence of ESBL-producing E. coli (57% to 27.2%) were statistically significant. Conclusions: Despite the decreases in the frequencies of staphylococci and some Gram-negative bacteria, the current infection control measures have been unable to limit the spread of carbapenem-resistant Gram-negative bacteria in our facility. Additional precautions are required to control such pathogens in the intensive care units.Öğe Species distribution, antifungal susceptibility and clonal relatedness of Candida isolates from patients in neonatal and pediatric intensive care units at a medical center in Turkey(Edizioni Int Srl, 2008) Kuzucu, Cigdem; Durmaz, Riza; Otlu, Baris; Aktas, Elif; Gulcan, Hande; Cizmeci, ZaynepThe aim of this study was to assess species distribution, antifungal susceptibility and clonal relationships among Candida strains isolated from a group of pediatric/neonatal intensive care (PICU/NICU) patients that had a very high mortality rate (76%). The cases of 21 patients (19 with candidemia, 2 with Candida meningitides) treated over a 1-year period in a Turkish hospital PICU and NICU were retrospectively analyzed. Twenty-eight Candida isolates were detected from blood (20), cerebrospinal fluid (CSF) (2) and other specimens (6). Candida species were identified using the API ID 32C System. Susceptibility testing was done (all 28 isolates) for amphotericin B, fluconazole and itraconazole using the broth microdilution method. Arbitrarily primed polymerase chain reaction (AP-PCR) was used for molecular typing of the 3 most common ones; C. albicans (15), C. parapsilosis (6), and C. pelliculosa (4). Electrophoretic karyotyping (EK) was done to check clonal identity obtained by AP-PCR. Of the 20 blood isolates, 8 (40%) were C. albicans, 12 (60%) were non-albicans Candida, and one of the 2 CSF isolates was C. albicans. The overall species distribution was as follows: 15 C. albicans isolates, 6 C. parapsilosis isolates, 4 C. pelliculosa isolates, 2 C. famata isolates and I C. tropicalis isolate. Amphotericin B had the best antifungal activity with a MIC90 of 0.125 mu g/ml, and the rates of susceptibility to fluconazole and itraconazole were 93% and 82%, respectively AP-PCR revealed 11 genotypes (4 were identical pairs, 7 were distinct) among the 15 C albicans isolates, 2 genotypes (5 were classified in the same type) among the 6 C. parapsilosis isolates, and 4 separate genotypes for the 4 C. pelliculosa isolates. Karyotyping results correlated well with the AP-PCR findings. As indicated in the previous research, our results confirmed that non-albicans Candida species have become more frequently causative agents for invasive fungal infections in the ICU. Transmission of C. albicans and C pelliculosa was relatively low, but transmission of C. parapsilosis was high, suggesting that more effective control and very strict treatment protocols are needed for patients having high mortality and invasive fungal infection in ICU.
