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Öğe The Importance of Gram-stained Smears in the Diagnosis of Nocardia Infections(Ankara Microbiology Soc, 2023) Olmez, Serpil; Otlu, Baris; Sener, Burcin; Sancak, BanuNocardia species are low virulence bacteria found in nature. They can be an infectious agent, es- pecially in patients with risk factors such as underlying immunosuppression, chronic lung disease, and malignancy. They can be easily overlooked because they are not seen frequently and has no pathog- nomonic symptoms. With this study, it was aimed to draw attention to the importance of microscopic examination of Gram-stained smears in the diagnosis of Nocardia infections in routine microbiology laboratories. Cases in which Nocardia spp. were detected in their clinical samples between November 2014-December 2015 in Hacettepe University Medical Faculty Hospital were included in the study. In the direct microscopic examination of Gram-stained smears of the samples arriving to the laboratory, the incubation periods of the cultures of the samples compatible with Nocardia spp. were extended. Then relevant colonies were identified by conventional microbiological methods and also by matrix -as- sisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS, bioMerieux, France) automated system. Species-level identification of Nocardia isolates was performed by 16S rRNA gene sequence analysis. To demonstrate the genetic relationship between Nocardia isolates, pulsed-field gel electrophoresis (PFGE) was performed. In vitro susceptibility of the isolates against amoxicillin-clavula- nate (AMC), linezolid, moxifloxacin, trimethoprim-sulfamethoxazole (TMP-SXT), amikacin, imipenem, clarithromycin, cefepime, cefotaxime, ceftriaxone, and ciprofloxacin was determined using the gradient strip method (E-test). A total of 19 Nocardia spp. strains were isolated from eight patients. Four cases exhibited repeated growth of Nocardia spp. up to a period of nine months. The most frequently isolated species was N.cyriacigeorgica, which was identified in four cases. Other species isolated from patients were N.asteroides, N.transvalensis, N.farcinicia, and N.asiatica/arthritidis. When the results obtained with DNA sequence analysis and MALDI-TOF MS were compared, 16 (84.2%) of 19 isolates were correctly identified to the genus level and 9 (47.4%) to the species level with MALDI-TOF MS, while three (15.8%) isolates could not be identified, and seven (36.8%) isolates were misidentified. According to the PFGE results, it was determined that the strains isolated from the same patient were genetically identical. All isolates were susceptible to amikacin, cefepime, cefotaxime, ceftriaxone, imipenem, linezolid, and except one isolate to TMP-SXT. Among the study isolates, the most common resistance was against ciprofloxacin (62.5%), followed by clarithromycin (37.5%). N.cyriacigeorgica was determined as the most frequently detected and the most resistant species to antibiotics in the study population. Direct microscopic exam- ination of clinical specimens is one of the most valuable methods for the identification of Nocardia-type bacteria, which is difficult to isolate in microbiology laboratories. With this study, the importance of ex- amining Gram-stained clinical samples was emphasized in the identification of Nocardia species, which can emerge with a wide variety of clinical forms and can be easily overlooked. In addition, antibiotic sus- ceptibility profiles of the isolated bacteria were determinedto contribute to species-specific susceptibility profiles. Accurate identification of Nocardia species will contribute to clinical and epidemiological studies.Öğe İnce Barsak İskemi Reperfüzyonunda Reperfüzyon Süresinin Biyokimyasal Değişiklikler ve Anastomoz İyileşmesine Etkisi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2006) Ekingen, Gülsen; Ceran, Canan; Demirtola, Arzu; Demiroğulları, Billur; Sancak, Banu; Poyraz, Aylar; Sönmez, Kaan; Basaklar, A.Can; Kale, NuriBu çalışmada ince barsak dokusunda iskemi sonrası değişen reperfüzyon süresinin, biyokimyasal değişiklikler ve anastomoz iyileşmesine olan etkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Geçici barsak iskemisi oluşturulan 36 adet Wistar-Albino rat altı gruba ayrıldı: Kontrol grubu (sadece laparatomi), grup I (40 dk. iskemiyi takiben 20 dk. reperfüzyon), grup II (40 dk. iskemiyi takiben 24 sa. reperfüzyon), kontrol-A (ince barsak anastomozu), grup I-A (40 dk. iskemi, 20 dk. reperfüzyon ve ince barsak anastomozu), grup II-A (40 dk. İskemi, 24 sa. Reperfüzyon ve ince barsak anastomozu). Kontrol grubu, grup I ve II de reperfüzyon süresi bitince histopatolojik ve biyokimyasal değerlendirmeler için ince barsak doku örnekleri alındı. Kontrol grubu, grup I ve grup II de dokuda Myeloperoksidaz ve Süperoksit Dismutaz enzim düzeyleri ölçüldü. Kontrol-A grubu, grup I-A ve II-A da ise ince barsak anastomozu oluşturuldu. Anastomoz iyileşmesi, 4. gün patlama basıncı ve kollojen kontenti ölçülerek değerlendirildi. Bulgular: İnce barsak dokusunda myeloperoksidaz ve süperoksit dismutaz enzim düzeylerinin reperfüzyonun erken evrelerinde artarken 24. saatte azaldığı (p<0,05) saptandı. Geç dönemde yapılan anastomozlarda patlama basınçları ve hidroksiprolin kontentinin erken dönemdekine kıyasla daha düşük olduğu saptandı (p<0,05). Sonuç: İskemi/Reperfüzyon hasarı geç dönemde ince barsak anastomozlarının güvenilirliğini azaltmaktadır. İnce barsak anastomozları yapılırken bu durumun göz önünde bulundurulması gerekir.Öğe A RARELY ISOLATED GRAM- NEGATIVE BACTERIUM IN MICROBIOLOGY LABORATORIES: LECLERCIA ADECARBOXYLATA(Akademiai Kiado Zrt, 2018) Cicek, Muharrem; Tuncer, Ozlem; Bicakcigil, Asiye; Gursoy, Nafia Canan; Otlu, Baris; Sancak, Banu[Abstract Not Available]Öğe A rarely ısolated gram- negatıve bacterıum ın mıcrobıology laboratorıes: leclercıaadecarboxylata(Akademıaı kıado zrt, budafokı ut 187-189-a-3, h-1117 budapest, hungary, 2018) Cicek, Muharrem; Tuncer, Ozlem; Bicakcigil, Asiye; Gursoy, Nafia Canan; Otlu, Baris; Sancak, BanuÖğe A retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic setting(Elsevier, 2022) Aslan, Abdullah Tarik; Kirbas, Ekin; Sancak, Banu; Tanriverdi, Elif Seren; Otlu, Baris; Gursoy, Nafia Canan; Yilmaz, Yakut AkyonThis study aimed to characterize the epidemiology and clinical outcomes of patients with bloodstream infections (BSIs) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in an OXA-48-predominant environment. This was a retrospective single-centre cohort study including all consecutive patients with CRKP BSIs treated between 1 January 2014 and 31 December 2018. Multivariate analysis, subgroup analysis and propensity-score-matched analysis were employed to analyse 30-day mortality as the primary outcome. Clinical cure at day 14 was also analysed for the whole cohort. In total, 124 patients with unique isolates met all the inclusion criteria. OXA-48 was the most common type of carbapenemase (85.5%). Inappropriate therapy was significantly associated with 30-day mortality [70.6% vs 39.7%, adjusted odds ratio (aOR) 4.65, 95% confidence interval (CI) 1.50-14.40, P=0.008] and 14-day clinical failure (78.5% vs 56.2%, aOR 3.14, 95% CI 1.09-9.02, P=0.033) in multivariate analyses. Among those treated appropriately, the 30-day mortality rates were similar in monotherapy and combination therapy arms (OR 2.85, 95% CI 0.68-11.95, P=0.15). INCREMENT CPE mortality score (aOR 1.16, 95% CI 1.01-1.33, P=0.029), sepsis at BSI onset (aOR 2.90, 95% CI 1.02-8.27, P=0.046), and inappropriate therapy (aOR 4.65, 95% CI 1.50-14.40, P= 0.008) were identified as independent risk factors for 30-day mortality. Colistin resistance in CRKP had no significant impact on 30-day mortality. These results were also confirmed in all propensity-scorematched analyses and sensitivity analyses. Appropriate regimens were associated with better clinical outcomes than inappropriate therapies for BSIs with CRKP predominantly possessing OXA-48. (c) 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.
