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Öğe Antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infections in a tertiary care hospital(2021) Dogan, Ahmet; Kose, Adem; Gezer, Yakup; Bayindir, Yasar; Ersoy, Yasemin; Ozden, Mehmet; Memisoglu, Funda; Altunisik Toplu, SibelAim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital. Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017. Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli. Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.Öğe Antimicrobial susceptibility pattern of Escherichia coli andKlebsiella pneumoniae isolated from patients with urinarytract infections in a tertiary care hospital(2021) Doğan, Ahmet; Köse, Adem; Gezer, Yakup; Ersoy, Yasemin; Bayindir, Yasar; Özden, Mehmet; Memisoglu, Funda; Altunisik Toplu, SibelAim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital.Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017.Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli.Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.Öğe Challenges in Antifungal Therapy: Therapeutic Drug Monitoring, Drug-Drug Interactions and Approach to Failure After Primary Therapy(Aves, 2019) Memisoglu, FundaAntifungal stewardship programs have been developed to make antifungal use as good as possible. The most important and difficult issues of these program measures are therapeutic drug monitoring (TDM) and drug-drug interactions. TDM of antifungal drugs should be considered when there is an unpredictable drug dose-exposure relationship, a narrow therapeutic range and acceptable safety and efficacy concentration ranges defined. It is recommended for itraconazole, voriconazole, posaconazole and flucytosine in clinical practice. The case for TDM of fluconazole may be beneficial in special circumstances. For isavuconazole, there are insufficient data to support the routine use of TDM. Amphotericin B and echinocandins do not meet the criteria for TDM. Antifungal drugs are involved in many important drug-drug interactions at a high complexity and their management is difficult. Inhibition or induction of cytochrome P450 and P-glycoprotein enzyme systems by azoles is responsible for most drug interactions. There are also interactions that alter the bio-availability of itraconazole and posaconazole. The amphotericin B formulations interact with other drugs primarily by reducing their renal elimination. Echinocandins display a lower potential for drug-drug interactions. The individual approach is the cornerstone in the management of antifungal therapy. Several factors play a role in antifungal therapy response such as the host factors including underlying disease and/or immune status, fungal factors including primary drug resistance or development of resistance under therapy, and drug-related factors (i.e., pharmacokinetics and pharmacodynamics, toxicities, drug-drug interactions, low drug concentration at the site of infection). The patients who do not respond to primary antifungal therapy should be carefully reviewed for these factors.Öğe Comparison of tocilizumab and intravenous immunoglobulin treatment in intensive care unit patients with COVID-19 who developed cytokine storm: A single-center retrospective study(Bayrakol Medical Publisher, 2024) Kalkan, Serkan; Demircan, Selcuk; Disli, Zeliha Korkmaz; Duzenci, Deccane; Memisoglu, Funda; Yalcinsoy, Murat; Bicakcioglu, MuratAim: Coronavirus disease 2019 (COVID-19) may trigger a severe inflammatory response. In the present study, the effects of tocilizumab and intravenous immunoglobulin (IVIG) on mortality in COVID-19 patients with cytokine storms were examined and compared. Material and Methods: This retrospective study included all COVID-19 patients who were diagnosed and followed in the intensive care unit between April 2020 and May 2022. The patients were divided into two groups depending on whether they were receiving IVIG or tocilizumab treatment. In addition to the patients' demographic information, the 28-day mortality was recorded. Their PaO2/FiO2 ratio, CRP, procalcitonin, lymphocyte, ferritin, and D-dimer levels were also recorded before drug administration and on the first day, third day, and first week following the drug administration. Results: Of the 73 patients included in this study, 43 (59%) received tocilizumab (Group T), while 30 (41%) received IVIG treatment (Group IVIG). No significant statistical differences were detected between the groups in terms of demographic data, pre-drug inflammatory parameters, improvement in PaO2/FiO2 ratios, and 28-day mortality. The rate of change in CRP levels was significantly higher in Group T than in Group IVIG on day 3 (p=0.010) and in the first week (p=0.001). The improvement in ferritin levels in the first week was significantly higher in Group T (p=0.018). Discussion: No significant difference was detected between the effects of IVIG and tocilizumab on mortality in COVID-19 patients with cytokine storm. However, tocilizumab suppressed inflammation more strongly than IVIG.Öğe Cytomegalovirus Infection Risk Factors in Allogeneic Hematopoietic Stem Cell Transplantation Can Defibrotide Be a Risk Factor?(Elsevier Science Inc, 2025) Yilmaz, Zeynep Burcin; Memisoglu, Funda; Hidayet, Emine; Kuku, Irfan; Erkurt, Mehmet Ali; Kaya, Emin; Berber, IlhamiIntroduction and Purpose. Cytomegalovirus (CMV) infection is a prevalent complication, affecting 30% to 50% of patients following Allogeneic Hematopoietic Stem Cell Transplantation (allo-AHCT). This study aims to investigate the risk factors contributing to CMV infection development. Materials and Methods. A retrospective analysis was performed on 196 patients with hematological malignancies who underwent allo-HSCT in the Stem Cell Transplantation Unit of Inonu University Faculty of Medicine over a 5-year period. Propensity scores were calculated by matching 1:1 for gender and age variables in individuals with CMV infection and in the control group. Results. Of the 196 patients included in the study, 75 (38.3 %) were female and 121 (61.7 %) were male. According to univariate analysis, CMV infection was seen more frequently in ALL patients than in AML patients (p = .012), while the conditioning regimen (p = 1) did not affect the outcome in terms of risk. Blood cyclosporine levels measured simultaneously with CMV positivity were significant in terms of risk (p = .006). A significant correlation was found between GvHD and CMV infection (p < .001). According to multivariate analysis, receiving defibrotide for VOD prophylaxis posed a risk for CMV positivity. Conclusion. In our study, only defibrotide prophylaxis was noted as a risk factor in multivariate analysis. While there are ongoing studies for the use of defibrotide in GVHD prophylaxis, more studies are needed to say that it is a definite risk factor for CMV. We believe that focusing on prophylactic treatments used during the transplantation process will be guiding in determining risk factors.Öğe Evaluation of Culture-confirmed Extrapulmonary Tuberculosis Cases in a University Hospital(Galenos Yayincilik, 2019) Toplu, Sibel Altunisik; Kayabas, Uner; Otlu, Baris; Bayindir, Yasar; Ersoy, Yasemin; Memisoglu, FundaIntroduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis and can involve any organ, especially the lungs. In recent years, especially in developed countries, the incidence of TB has increased due to the growing number of people with acquired immunodeficiency. This has led to an increase in the incidence of extrapulmonary TB (EPTB). This study examined patients with EPTB confirmed by positive M. tuberculosis culture in Inonu University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Molecular Microbiology Laboratory. Materials and Methods: Patients with positive M. tuberculosis culture in the molecular microbiology laboratory of our hospital between January 1, 2004 and December 31, 2014 were retrospectively evaluated according to culture-confirmed site of involvement, acid-fast bacillus (AFB), polymerase chain reaction (PCR) positivity, drug resistance, and mortality. Results: The study included 132 patients; 41 (31.1%) were male and 91 (68.9%) were female. The mean age was 46.4 +/- 18.5 (17-86) years. Extrapulmonary TB types were TB lymphadenitis in 48 patients (36.4%), musculoskeletal TB in 23 (17.4%), disseminated TB in 17 (12.9%), urinary TB in 11 (8.3%), abdominal TB in 11 (8.3%), TB meningitis in eight (6.1%), pleural TB in six (4.5%), genital TB in five (3.8%), and cutaneous TB in three patients (2.3%). Acid-fast bacillus positivity rates were 21.7% in musculoskeletal samples, 16.6% in pleural samples, 12.5% in cerebrospinal fluid, 9% in urinary tract samples, and 6.2% in lymph nodes. Polymerase chain reaction positivity was not detected in cerebrospinal fluid or skin samples. The rate of resistance to at least one anti-tuberculous drug was 20%. Mortality was 16.1% (n=9) in the 56 patients (42.4%) with available data. Conclusion: Lymphatic TB was the most common form in our patients. According to national data, pleural TB is among the common forms of EPTB in Turkey. However, the rate of pleural TB was low in our study due to the lack of pleural biopsy in our hospital during the study period. In TB-endemic regions such as Turkey, it is important to consider EPTB in the differential diagnosis of patients with relevant clinical findings and to confirm the diagnosis with TB culture primarily, as well as methods such as AFB staining and PCR.Öğe From awareness to action: A nationwide survey of infectious diseases and clinical microbiology physicians' perspectives on artificial intelligence in clinical practice(Sage Publications Ltd, 2025) Gulten, Ezgi; Derin, Okan; Arslan, Eyup; Atasoy Tahtasakal, Ceren; Temocin, Fatih; Memisoglu, Funda; Aktug Demir, NazlimBackground: The integration of artificial intelligence (AI) into clinical practice is gaining momentum globally, yet specialty-specific perspectives remain underexplored. This study aimed to assess the awareness, knowledge, attitudes, expectations, and concerns of infectious diseases and clinical microbiology (IDCM) physicians regarding AI applications in their field. Methods: A cross-sectional, online survey was distributed between May and June 2025 to IDCM physicians across T & uuml;rkiye. The questionnaire included multiple-choice, Likert-type, and open-ended items assessing sociodemographic characteristics, AI familiarity, clinical use, and perceptions. Descriptive and inferential statistics, along with thematic analysis of qualitative responses, were employed. Results: In total, 387 IDCM physicians completed the survey. While 0.5% (n = 2) reported prior long-term/extensive AI training, 88.9% (n = 344) agreed that IDCM physicians should be actively involved in AI system development. Notably, 23.0% (n = 89) had already used AI tools, primarily ChatGPT (n = 69, 77.5%). Regarding accountability, 68.2% (n = 264) assigned responsibility for erroneous AI-generated decisions to physicians. Familiarity with AI showed a strong association with academic title (p < .001). Total knowledge scores were significantly higher among university hospital physicians (p < .001), whereas total attitude scores differed across age (p = .003), academic title (p = .001), and years of experience (p = .006). Thematic analysis of 97 open-ended responses revealed high expectations for AI in enhancing decision support, timeliness, and operational efficiency. However, major concerns included ethical risks, algorithmic bias, data reliability, and potential erosion of clinical autonomy. Conclusions: This study provides comprehensive insights into IDCM physicians' perspectives on AI. Findings highlight strong interest but limited preparedness, underscoring the need for targeted education, ethical safeguards, and inclusive policy frameworks to ensure responsible AI integration.Öğe Management of cytomegalovirus infection after liver transplantation(Baishideng Publishing Group Inc, 2024) Yilmaz, Zeynep Burcin; Memisoglu, Funda; Akbulut, SamiCytomegalovirus (CMV) infection is one of the primary causes of morbidity and mortality following liver transplantation (LT). Based on current worldwide guidelines, the most effective strategies for avoiding post-transplant CMV infection are antiviral prophylaxis and pre-emptive treatment. CMV- IgG serology is the established technique for pretransplant screening of both donors and recipients. The clinical presentation of CMV infection and disease exhibits variability, prompting clinicians to consistently consider this possibility, particularly within the first year post-transplantation or subsequent to heightened immunosuppression. At annual symposia to discuss CMV prevention and how treatment outcomes can be improved, evidence on the incorporation of immune functional tests into clinical practice is presented, and the results of studies with new antiviral treatments are evaluated. Although there are ongoing studies on the use of letermovir and maribavir in solid organ transplantation, a consensus reflected in the guidelines has not been formed. Determining the most appropriate strategy at the individual level appears to be the key to enhancing outcomes. Although prevention strategies reduce the risk of CMV disease, the disease can still occur in up to 50% of high-risk patients. A balance between the risk of infection and disease development and the use of immunosuppressants must be considered when talking about the proper management of CMV in solid organ transplant recipients. The objective of this study was to establish a comprehensive framework for the management of CMV in patients who have had LT. © The Author(s) 2024.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.
