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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 Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis: Clinical Characteristics, Etiological Agents and Their Antibiotic Susceptibilities(Aves, 2016) Sagmak-Tartar, Ayse; Ozden, Mehmet; Akbulut, Ayhan; Demirdag, Kudbettin; Ozer-Balin, SafakObjective: The objective of this study was to determine clinical characteristics, etiological agents, and their antibiotic susceptibilities in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis encountered in our hospital. Methods: Thirty patients with peritonitis attack among 55 adult patients aged >= 18 years, who applied to Nephrology Clinic of Firat University Hospital between January 2012 and February 2013 and who were monitored in the CAPD unit were included in this prospective study. Cultures were performed on both solid media and blood culture bottles according to the recommendations of International Society for Peritoneal Dialysis. Antibiotic susceptibilities were investigated by disk diffusion method. Results: During clinical evaluation, abdominal guarding (n=28, 93.3%), rebound tenderness (n=4, 13.3%), fever (n=9, 30%), nausea and vomiting (n=13, 43.3%), and diarrhea (n=5, 16.7%) were detected. Turbid dialysis fluid and abdominal pain were noted in all patients. Direct Gram staining yielded positive result in 1 (3.3%) patient. In 28 (93.3%) patients bacterial growth was detected in the cultures. Bacterial growth was detected on solid culture media in 14 (46.7%), and blood culture bottles in 28 (93.3%) patients. In 2 (6.7%) patients, bacterial growth was not detected in both media. The same microorganisms were identified in both methods, and their antibiograms yielded similar results. Gram-positives included coagulase-negative staphylococci (n=16, 57.1%), Staphylococcus aureus (n=4, 14.3%), streptococci (n=4, 14.3%), and enterococci (n=1, 3.6%). Gram-negatives consisted of Escherichia coli (n=2), and Yersinia enterocolitica (n=1). In 46.2% of Gram-positive microorganisms penicillin resistance was detected, while 9.5% of staphylococci were methicillin-resistant. Conclusions: Each health center should have knowledge of its prevalent microbial agents, and their susceptibility profile, which is essential for the determination of suitable alternative empirical treatment. This strategy will obviate unnecessary use of antibiotics, and contribute to the decrease in the potential development of antibiotic resistance.Öğe Does COVID-19-related viral sepsis stimulate angiotensin II levels more than bacterial sepsis?(Bayrakol Medical Publisher, 2023) Demircan, Selcuk; Bulut, Niluefer; Kalkan, Serkan; Duzenci, Deccane; Bicakcioglu, Murat; Ozden, Mehmet; Dogan, ZaferAim: Angiotensin II and its receptors play a role in both COVID and bacterial sepsis. The aim of this study was to compare the levels of serum angiotensin II and its receptors in viral sepsis due to COVID-19 with the levels in bacterial sepsis.Material and Methods: The study included 62 sepsis patients (n=31 COVID and n=31 non-COVID) with similar disease severity in the tertiary ICU. The serum angiotensin II, angiotensin II receptors 1 and 2 (ATR1, ATR2) and other inflammatory parameters were measured. Demographic data and 28-day mortality were recorded.Results: Angiotensin II level was significantly higher in COVID patients than in non-COVID patients (p<0.05). ATR1 and ATR2 did not differ between the two groups. There was a negative correlation between angiotensin II and procalcitonin levels in all patients, and a positive correlation between ATR1 and procalcitonin, APACHE II score, and SOFA score in COVID patients (p<0.05).Discussion: Observation showed that angiotensin II levels were higher in patients with COVID-19 compared to those with bacterial sepsis, and ATR1 level was higher in COVID-19 patients who died. It was thought that the renin-angiotensin cascade could be stimulated differently in bacterial sepsis compared to viral sepsis due to COVID.Öğe Evaluation of CD4/CD8 ratio in treatment follow-up of patients with HIV diagnois in an infection clinic(2022) Gezer, Yakup; Toplu, Sibel; Yüksel, Mustafa; Köse, Adem; Memişoğlu, Funda; Ozden, Mehmet; Bayindir, YasarAbstract Aim: Antiretroviral therapy (ART) regimens used in the treatment of HIV are assumed to suppress the virus in plasma indefinitely and restore CD4 lymphocyte count. There is increasing evidence that a reversed CD4/CD8 ratio is associated with immune dysfunction, even in patients who have achieved virological suppression with ART and have elevated CD4 lymphocytes. The CD4/CD8 ratio has emerged as a guiding marker as an indicator of immunoactivation in HIV-infected patients. It was aimed to evaluate the CD4/CD8 ratio of HIV-diagnosed patients at baseline and at follow-up after ART regimen. Materials and Methods: A total of 150 patients were included in the study by retrospectively scanning the CD4/CD8 ratio at the initial and 24th week of follow-up in patients who were diagnosed with HIV and started treatment in the Infectious Diseases and Clinical Microbiology Clinic of the Hospital of the Medical Faculty between 2011-2021. ART treatment regimens were divided into three groups as nucleoside reverse transcriptase inhibitor (NRTI)+protease inhibitor (PI), NRTI+non-nucleoside reverse transcriptase inhibitor (NNRTI) or NRTI+ integrase strand transfer inhibitor (INSTI). Results: A total of 150 patients were included in the study. While the initial CD4/CD8 ratio of the patients was 0.36, it increased to 0.61 at the 24th week of treatment. Among the 144 patients whose baseline values were CD4/CD8<1, the rate of the ones who achieved CD4/CD8?1 value at week 24 after ART regimens was found as 13.2% (19/144). It was observed that the CD4/CD8 ratio in the group receiving INSTI was higher (15.1%) than those of the other groups. The undetectable HIV RNA level after treatment was significantly mostly observed in the group, receiving the integrase-based regimen, with 77.1%. With effective ART, CD4/CD8 normalization is higher in individuals with high CD4 T cell counts before treatment. There was a significant increase in the CD4/CD8 ratio in all three ART regimen groups. However, most of the patients who achieved a CD4/CD8 ratio ?1 were in the INSTI-based ART group. Conclusion: The CD4/CD8 ratio may contribute to clinical evaluation in long-term follow-up as a marker of immunological response in individuals treated with a diagnosis of HIV.Öğe Investigation of a nosocomial outbreak by alginate-producing pan-antibiotic-resistant Pseudomonas aeruginosa(Mosby-Elsevier, 2008) Yakupogullari, Yusuf; Otlu, Baris; Dogukan, Muruvvet; Gursoy, Canan; Korkmaz, Ebru; Kizirgil, Ahmet; Ozden, MehmetBackground: The nosocomial spread of pan-antibiotic-resistant nonfermentative bacteria is an increasing concern. This study investigated the microbiologic and epidemiologic characteristics of a hospital outbreak due to alginate-producing, pan-antibiotic-resistant Pseudomonas aeruginosa (PAR-Pa). Methods: All patients with infection with a P aeruginosa strain that was resistant to all Clinic Laboratory Standards Institute-suggested antimicrobial agents between November 2004 and May 2005 were included in the study. Alginate production detection and pulsed-field gel electrophoresis (PFGE) typing were done for the patient and environmental surveillance isolates. A matched case-control study was performed to identify risk factors and evaluate outcomes. Results: PFGE analysis of a total of 35 PAR-Pa isolates (28 patient and 7 environmental surveillance isolates) identified a single epidemic clone as responsible for the outbreak. All epidemic isolates were alginate-producing and susceptible only to colistin. The Student t-test demonstrated that a longer stay in the intensive care unit (ICU) (6.64 days vs 1.83 days; P < .05) significantly increased the risk of PAR-Pa infection. Systemic PAR-Pa infection resulted in higher mortality (85.7% vs 27.8%; P < .05). Multivariate analysis determined that therapeutic failure (odds ratio 5 24.7; 95% confidence interval 5 4.144 to 147.221; P < .05) was the independent risk factor related to this high mortality. Localized PAR-Pa infections were associated with longer hospital stays (46.2% vs 14.4%; P < .05) and higher rates of surgery (85.7% vs 15.4%; P < .05) and amputation (42.8% vs 0%; P < .05). The recovery of the pathogen from staff hands and frequently handled surfaces suggests possible handborne transmission. Improved hygienic standards and application of strict contact precautions, including isolation, reduced the spread of the pathogen. Conclusion: This study illustrates the ability of pan-antibiotic-resistant P aeruginosa to cause an outbreak with significant mortality and stresses the need for precautions to prevent the spread of such highly resistant strains.Öğe IS TIGECYCLINE EFFECTIVE IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS RELATED PERITONITIS(Carbone Editore, 2017) Tartar, Ayse Sagmak; Ozden, Mehmet; Dogukan, Ayhan; Akbulut, Ayhan; Demirdag, Kutbeddin; Tartar, TugayIntroduction: To compare conventional intraperitoneal vancomycin-amikacin and intravenous tigecycline treatments for continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Materials and methods: Patients diagnosed with CAPD-related peritonitis were randomized into two groups as intravenous tigecycline group (n = 10) and intraperitoneal vancomycin-amikacin group (n = 20). Patients accompanied by peritonitis exit site infection, peritonitis based on Pseudomonas or fungi were excluded from the study. Results: As for 24th and 48th hours peritoneal fluid leukocyte count of patients, significant difference was not observed in tigecycline group at 24th hours, while significant reduction was observed in vancomycin-amikacin group (p < 0.05). A significant reduction was observed at 48th hours in both groups. As for the treatment response, abdominal pain decreased in 18 (90%) patients in vancomycin-amikacin group, decreased in 8 (80%) patients in tigecycline group at 48th hours. It was detected that dialysate leukocyte count decreased significantly (p > 0.05). Relapse was observed in 4 (40%) patients in tigecycline group, while not observed in vancomycin-amikacin group (p < 0.05). Conclusion: Tigecycline proved its effectiveness in the clinical use for complicated intra-abdominal infections. However, it was considered that tigecycline cannot be alternative to vancomycin-amikacin treatment for continuous ambulatory peritoneal dialysis related peritonitis.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 A waterborne outbreak of epidemic diarrhea due to group A rotavirus in Malatya, Turkey(Edizioni Int Srl, 2011) Koroglu, Mehmet; Yakupogullari, Yusuf; Otlu, Baris; Ozturk, Serhat; Ozden, Mehmet; Ozer, Ali; Sener, KemalWe characterized an outbreak of acute diarrheal disease caused by group A rotavirus that occurred during the Autumn of 2005 in Malatya City Turkey A total 9907 patients between 0 to 91 years old (mean age: 25.05 +/- 19.67) were included in the epidemic. The patients' data were prospectively collected and statistically analyzed. Microbiologic analyses were performed to determine the etiologic agent. Rapid onset diarrhea (98.36%), abdominal cramps (69%), fever (44.4%) and vomiting (69.6%) were the most common symptoms observed in patients. Rotavirus antigen was detected in 52.7% of the studied patients. RT-PCR analysis led to identification of Group A rotavirus as the causative agent of this epidemic. Simultaneous measurements of the drinking water samples yielded very low chlorine levels; as low as 0 to 0.05 mg/L. The outbreak investigation team indicated possible contamination of a large water depository from a water well, which supplies drinking water to two major districts of the city Effective chlorination and blockage of the passage between the well and the water depository stopped the outbreak. This outbreak shows the high epidemic potency of rotavirus in large human populations, including all age groups, and underlines the importance of water safety in pipeline systems.
