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Öğe Acute interstitial pneumonia associated with vinorelbine usage(Kare Publ, 2023) Atila, Aysenur; Yalcinsoy, Murat; Aytemur, Zeynep Ayfer; Yetkin, FundaVinorelbine, an analogue of vinca alkaloids, has an antineoplastic effect. Adverse effects related to vinca alkaloids are rare. A 57-year-old patient who presented to the emergency room with dyspnea and back pain was hospitalized with the diagnosis of overload related to cardiac decompensation and complicated urinary tract infection due to its acute clinical and radiological findings. While under treatment, his respiratory failure progressed. Considering his history of vinorelbine usage 2 weeks prior, it was thought to be interstitial pneumonia. High-flow oxygen treatment and 250 mg/day pulse methylprednisolone for 3 days was started; after the fourth day, methylprednisolone was reduced and continued at 1 mg/kg/day. His oxygen need decreased on the seventh day of the treatment, and the findings on the chest X-ray regressed almost completely. However, the patient died due to acute gastrointestinal bleeding.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 Cerebrospinal Fluid Viscosity: A Novel Diagnostic Measure for Acute Meningitis(Lippincott Williams & Wilkins, 2010) Yetkin, Funda; Kayabas, Uner; Ersoy, Yasemin; Bayindir, Yasar; Toplu, Sibel Altunisik; Tek, IbrahimIntroduction: Early diagnosis of acute meningitis has paramount importance in clinical practice because of mortality and morbidity of the disease. Examination of cerebrospinal fluid (CSF) has critical value for the diagnosis of acute meningitis and discrimination of bacterial and aseptic meningitis. It has been previously reported that plasma viscosity can be used as an inflammatory marker. In this study we aimed to evaluate the role of CSF viscosity as a complementary measure for diagnosis of meningitis in suspected patients. Methods: Forty-one consecutive patients who underwent lumbar puncture to rule out meningitis were studied prospectively. Twenty-seven patients were diagnosed with meningitis, of whom 13 patients had aseptic meningitis and 14 patients had bacterial meningitis. Meningitis was ruled out in 14 patients. Results: CSF protein and CSF viscosity were significantly higher in patients with meningitis compared to nonmeningitis. Receiver operator characteristic (ROC) analysis revealed that CSF viscosity was highly sensitive (100%) and specific (93%); measures for the diagnosis of meningitis in the study population was comparable to those of CSF protein. Additionally, patients with meningitis were also divided into two groups as having bacterial and aseptic meningitis. CSF viscosity also significantly differed between bacterial and aseptic meningitis. Conclusion: The CSF viscosity is a simple and easy method and can be used as an adjunctive measure for the diagnosis of meningitis. With the support of further and larger clinical studies, CSF viscosity may have a role in the discrimination of bacterial versus aseptic meningitis.Öğe Ciprofloxacin-induced urticaria and tenosynovitis: A case report(Karger, 2008) Kayabas, Uner; Yetkin, Funda; Firat, Ahmet K.; Ozcan, Hamdi; Bayindir, YasarBackground: Tendon disorders are rare events associated with fluoroquinolone congestion. Skin reactions are more frequent than tendon disorders. We reported this case as the combination of ciprofloxacin-induced urticaria and tenosynovitis has been unreported in young women. Case: A 28-year-old woman without underlying disease developed urticarias and tendinopathy 4 days after the initiation of ciprofloxacin treatment for urinary infection. MRI of the left foot revealed increased synovial fluid surrounding the tendon of the flexor hallucis longus muscle representing tenosynovitis. Ciprofloxacin was ceased due to the possibility of ciprofloxacin-induced tendinopathy and urticaria. Complete resolution of her symptoms and findings occurred 3 days after discontinuation of ciprofloxacin without any additional treatment. Conclusion: Early discontinuation of fluoroquinolone therapy when tendinopathy is suspected is the basis of therapy. So, it should be kept in mind that fluoroquinolone-induced tendinopathy may occur in an otherwise healthy young patient with no risk factors and in a site other than the Achilles tendon. Copyright (C) 2008 S. Karger AG, Basel.Öğe Çoğul Direnç veya Ekstrem İlaç Direnci Olan 30 Acinetobacter Suşunda in Vitro Tigesiklin Duyarlılığının Disk Difüzyon, E-test ve Buyyon Mikrodilüsyon Yöntemleri ile Değerlendirilmesi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2011) Mansur, Ahmet; Kuzucu, Çiğdem; Ersoy, Yasemin; Yetkin, FundaAcinetobacter spp. are primarily associated with nosocomial infections and these isolates resistant to most antimicrobial agents. The present study was conducted to evaluate the in vitro susceptibility of tigecyline in multi-drug-resistant (MDR) and extreme-drug resistance (XDR) Acinetobacter strains by three different methods. MDR Acinetobacter isolates described in the study were resistant to at least three of the following antibiotics: imipenem, meropenem, ceftazidime, cefepime, aztreonam, piperacillin tazobactam, ciprofloxacin, tetracycline, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, amikacin, gentamicin and tobramycin. XDR was defined as resistance to all above antibiotics excluding colistin and tigecyline. Identification of Acinetobacter spp. were made conventional methods. Antibiotic susceptibility tests were performed according to the criteria of Clinical and Laboratory Standards Institute (CLSI). All of the isolates were found resistant to carbapenem. Disk diffusion, E-test and broth microdilution methods were used to evaluate the in vitro susceptibility of tigecyline. No tigecycline interpretative criteria universally accepted for Acinetobacter spp, therefore the Food and Drug Administration approved breakpoints for members of the family Enterobacteriaceae have been used. A total of 30 (five strains were MDR and 25 strains were XDR) Acinetobacter strains were isolated from various clinical specimens (8 paracentesis fluid, 8 blood, 7 tracheal aspirates, 5 wound, 2 urine, 2 catheter, 1 sputum) of hospitalized patients in Turgut Ozal Medical Center in 2008 year. All of the MDR and XDR strains were susceptible to tigecyline by broth microdilution method. Against Acinetobacter spp, an MIC range between 0.03 and 0.5 ?g/ml was observed by broth microdilution and MIC50 and MIC90 values were determined as 0.12 ?g/ml and 0.25 ?g/ml, respectively. Twenty five strains (83%) were found susceptible to tigecyline when the disk diffusion brekpoints were considered as ?16mm susceptible and ?12mm resistant. Against Acinetobacter spp, an MIC range between 1 and 8 ?g/ml was observed by E test. MICs of tigecycline determined by E test were 8 to 64 times higher and 30% (9/30) of the isolates were resistant to tigecycline by E test (MIC breakpoint 2 ?g/ml ). Broth microdilution method must to use in the resistant Acinetobacter spp, by E test and disk diffusion method.Öğe Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study(Springer Heidelberg, 2019) Sipahi, Oguz Resat; Kahraman, Hasip; Erdem, Huseyin Aytac; Yetkin, Funda; Kaya, Selcuk; Demirdal, Tuna; Tunccan, Ozlem GuzelPurposeIn this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin).MethodsData and outcomes of adult (aged>18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status.ResultsOverall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72h antibiotic treatment (p=0.25). There was no significant difference in cured, improved and (cured+improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p>0.05). There was also no significant difference (p>0.05), in terms of persistent response in the (D) versus (G) cohorts,ConclusionsThese findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.Öğe Device-associated nosocomial infection surveillance in the neurosurgery intensive care unit of the Inonu University Turgut Ozal Medical Center(Doc Design Informatics Co Ltd, 2008) Yetkin, Funda; Ersoy, Yasemin; Karaman, Perihan; Kayabas, Uner; Bayindir, Yaflar; Kocak, AyhanPatients in the intensive care units (ICUs) have a high risk of infection due to the severity of illness of the patients treated and the high number of medical devices used. For patients requiring neurosurgical intensive care there are certain risk factors (e.g. altered consciousness, impaired protective reflexes, head injury) of acquiring nosocomial infections (NIs). In this study, we prospectively investigated NIs, device utilization ratios and device-associated infection rates, isolated agents and their antimicrobial susceptibilities in the neurosurgery intensive care unit of the Inonu University Turgut Ozal Medical Center between May 2006-April 2007. 613 patients with a total of 3561 patient days were enrolled. The overall incidence of NIs was 13.9% per 100 patients and the incidence density 23.8 per 1,000 patient days. Pneumonia (65.8%), bloodstream infections (16.5%), and urinary tract infections (15.3%) were the most frequent NIs recorded. The rate of ventilator-associated pneumonia was 67.2 infections per 1,000 ventilator-days, the rate of catheter-associated bloodstream infection was 8.1 per 1,000 central line-days, and the rate of catheter-associated urinary tract infection was 3.9 infections per 1,000 urinary catheter-days. Of the bacteria determined 56.8% were Gram-negative. In this group Pseudomonas aeruginosa was the most frequently isolated (25%). Staphylococcus aureus (20.4%) was the most frequently found Gram-positive bacteria (38.6%). We aim to investigate the causes of ventilator-associated pneumonia and catheter-associated bloodstream infections and to determine necessary preventive measures in an observative and multidisciplinary studies.Öğe Efficacy and Tolerability of Antibiotic Combinations in Neurobrucellosis: Results of the Istanbul Study(Amer Soc Microbiology, 2012) Erdem, Hakan; Ulu-Kilic, Aysegul; Kilic, Selim; Karahocagil, Mustafa; Shehata, Ghaydaa; Eren-Tulek, Necla; Yetkin, FundaNo data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 +/- 2.47 months in P1, 6.52 +/- 4.15 months in P2, and 5.18 +/- 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/ 117) and P3 (6.1%, n = 3/ 49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.Öğe Enfeksiyon Bulguları İle Acil Servis’e Başvuran Hastaların Kültür Sonuçlarının Değerlendirilmesi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2010) Yücel, Neslihan; Kuzucu, Çiğdem; Yetkin, Funda; Tunç, EmineBu çalışmada, enfeksiyon bulguları ile İnönü Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’na başvuran hastalardan alınan kültür sonuçları retrospektif olarak değerlendirilmiştir. Acil Tıp Anabilim Dalı’na Mayıs 2009 - Şubat 2010 tarihleri arasında müracaat eden 1485 hastadan mikrobiyoloji laboratuvarına, 1062 idrar, 985 kan, 56 gaita, 55 beyin omurilik sıvısı, 44 yara yeri, 30 asit sıvısı, 28 boğaz, 10 apse, yedi balgam, altı plevral sıvı, altı eklem sıvısı ve dört kateter olmak üzere toplam 2293 örnek gönderilmiştir. Gönderilen bu örneklerin 392’ünde (%17) patojen bakteri, 317’sinde (%14) normal flora elemanı üremiş, 151’ü (%7) kontaminasyon olarak değerlendirilmiştir, örneklerin 1433’ünde (%62) ise hiçbir üreme olmamıştır. En sık üreyen bakteriler Esherichia coli (%47), koagülaz negatif stafilokoklar (%14), Klebsiella spp. (%6), Staphylococcus aureus (%6), Pseudomonas aeruginosa (%5), Candida spp (%5) ve Streptococcus spp (%4) olarak değerlendirilmiştir.Öğe An Evaluation of Percutaneous Injuries of Healthcare Personnel: An Eigth-Year Data Analysis(2015) Aydın, Fatma; Cantürk Kaplan, Elif; Kuzucu, Çiğdem; Parmaksız, Nalan; Çelik, Tülay; Yetkin, Funda; Ersoy, YaseminÖz: Amaç: Kesici delici alet yaralanmaları sağlık çalışanları için önemli bir problemdir. Bu çalışmada hastanemizde sekiz yıl içinde oluşan perkütan yaralanmaların retrospektif yıllara göre dağılımının irdelenmesi amaçlanmıştır. Gereç ve Yöntemler: Hastanemizde 2006-2013 yılları arasında oluşan perkütan yaralanma olayları retrospektif incelenmiştir. Bulgular: Sekiz yıllık dönemde 144 personelde perkütanöz yaralanma kaydedilmiştir. Bunların %44\\\'ü (63 kişi) temizlik çalışanı, %17\\\'si (25) hemşire, %12\\\'si (17) tıp öğrencisi, %12\\\'si (17) hasta bakıcı, %6\\\'sı (9) öğrenci hemşire, %5\\\'i (7) teknisyen ve %4\\\'ü (6) doktordur. Perkütan yaralanmaların 126\\\'sı (%87) iğne batması, 11\\\'i (%8) bistürü kesisi, 7\\\'si (%5) mukozal temas (göze sıçrama) şeklinde gerçekleşmiştir. Yıllar içerisinde toplam yaralanma olaylarında ve temizlik çalışanı, hasta bakıcı ve hemşire yaralanmalarında anlamlı düşüş olduğu görülmüştür (p<0.001). Sonuç: Sekiz yıl içerisinde sağlık çalışanlarında perkütan yaralanma olaylarının anlamlı olarak azaldığı saptanmıştır. Hastanemizde Sağlık çalışanlarına eğitimlerin düzenli verilmesi ve geri bildirimlerin takip edilmesi planlanmıştırÖğe The Evaluation of Procalcitonin as a Diagnostic and Prognostic Marker of Bacterial Infections in Febrile Neutropenic Patients(Aves, 2011) Yetkin, Funda; Senol, Esin; Yalcin, Selim; Haznedar, RaufObjective: The aim of this study was to evaluate the role of procalcitonin (PCT) in the diagnosis, prognosis and follow-up of bacterial infections in febrile neutropenic patients in comparison to the standard parameter, C-reactive protein (CRP). Methods: 40 febrile neutropenic episodes of 37 patients with cancer undergoing chemotherapy were classified as fever of unknown origin (FUO), microbiologically or clinically documented infection. Four sequential serum samples were obtained at the onset of neutropenia, on the first and third days of fever and on the day of defervescence, or on day 5 or 7 of an unresolved fever. Results: At the onset of neutropenia, the PCT levels were found to be normal whereas CRP levels were found to be elevated in all patients. With the febrile episode, PCT levels were elevated in all types of infections which were significantly higher for documented infections compared to FUO (p< 0.05). Procalcitonin levels differed significantly between patients with and without severe sepsis (p<0.001), and the highest levels were seen on the third day of fever. PCT levels decreased rapidly in afebrile patients treated successfully, whereas they remained significantly higher for patients unresponsive to therapy (p<0.001). Conclusions: In conclusion, PCT could be suggested as a useful marker, and was superior to CRP for early diagnosis of documented infections, assessment of the severity of infection and response to therapy in febrile neutropenic patients.Öğe Febril nötropenik hastalarda bakteriyel infeksiyonların tanısal ve prognostik bir göstergesi olarak prokalsitoninin değerlendirilmesi(Klimik Dergisi, 2011) Yetkin, Funda; Şenol, Esin; Yalçın, Selim; Haznedar, RaufÖz: Amaç: Maligniteli hastalardaki febril nötropeni ataklarında prokalsitonin (PCT) in bakteriyel infeksiyonların tanısal ve prognostik bir göstergesi olarak standard bir parametre olan C-reaktif protein (CRP) ile karşılaştırılıp değerlendirilmesi amaçlandı. Yöntemler: Kemoterapiye bağlı 37 hastadaki 40 febril nötropenik atak üç gruba ayrıldı: nedeni bilinmeyen ateş (NBA), mikrobiyolojik olarak tanımlanmış infeksiyon ve klinik olarak tanımlanmış infeksiyon. Nötropeni başlangıcında, ateşin ilk ve üçüncü günü, ateşin düştüğü gün ya da tedaviye yanıtsız hastalarda tedavinin 5-7. günü olmak üzere toplam dört kan örneği alındı. Bulgular: Tüm ataklarda nötropeni başlangıcında PCT düzeyleri normal değerlerde bulunurken, CRP düzeyleri normal değerlerin üzerinde saptandı. Ateşin üçüncü günü PCT deki yüksekliğin tanımlanmış infeksiyonu olan gruplarda, NBA grubuna göre daha fazla olduğu gözlendi (p<0.05). Sepsisi olan ve olmayan gruplarda PCT düzeyleri farklı bulundu (p<0.001) ve en yüksek değerlerine sepsis grubunda ateşin 3. gününde ulaştı. Tedaviye yanıtsız grupta PCT düzeylerindeki artış anlamlı ölçüde sürerken, tedaviye yanıtı olan grupta, ateşin düşmesi ile birlikte hızla normal değerlere geriledi (p<0.001). Sonuçlar: Bu bulgular ışığında, febril nötropenik hastalarda PCT nin, dokümante infeksiyonların erken tanısında, infeksiyonun şiddetini ve tedaviye yanıtı belirlemede yararlı olacağı ve CRP den daha üstün olduğu sonucuna varıldı.Öğe Genişlemiş spektrumlu beta-laktamaz üreten escherichia coli ve klebsiella spp. suşlarının ertapenem ve diğer karbapenemlere karşı duyarlılıklarının araştırılması(Mikrobiyoloji Bülteni, 2011) Kuzucu, Çiğdem; Yetkin, Funda; Görgeç, Sündüz; Ersoy, YaseminÖz: Genişlemiş spektrumlu beta-laktamaz (GSBL) üreten Escherichia coli ve Klebsiella spp. suşlarıyla oluşan enfeksiyonlar ciddi bir sorun teşkil etmekte olup, bunların tedavisinde sıklıkla karbapenemler kullanılmaktadır. Bununla birlikte son yıllarda karbapenemlere dirençli E.coli ve Klebsiella spp. enfeksiyonları görülmektedir. Bu çalışmada, GSBL üreten E.coli ve Klebsiella spp. klinik izolatlarının ertapenem ve diğer karbapenemlere karşı duyarlılığının araştırılması amaçlanmıştır. Çalışmaya, Ocak 2007-Şubat 2008 tarihleri arasında hastanede yatan ve polikliniklere başvuran hastalara ait 208 idrar, 16 kan, 26 yara, 17 steril vücut sıvısı, dört trakeal aspirat ve yedi diğer örneklerden izole edilen GSBL pozitif 239 E.coli, 28 Klebsiella pneumoniae ve 11 Klebsiella oxytoca suşu dahil edilmiştir. Bakterilerin tanımlanmasında konvansiyonel yöntemler kullanılmış; antibiyotik duyarlılıkları “Clinical and Laboratory Standards Institute (CLSI)” standartlarına göre Kirby-Bauer disk difüzyon yöntemiyle çalışılmıştır. İzolatların GSBL üretimi çift disk sinerji yöntemiyle araştırılmış, şüpheli olgularda sefotaksim-klavulanik asit E test şeritleri (BioMerieux, Fransa) kullanılmıştır. Karbapeneme dirençli suşlarda CLSI tarama kriterlerine göre modifiye Hodge testi çalışılmış ve ertapenem (Etest®, BioMerieux, Fransa), imipenem ve meropenem (M.I.C. Evaluator Strips, Oxoid, İngiltere) için minimum inhibitör konsantrasyonu (MİK) değerleri belirlenmiştir. Çalışılan tüm suşlar (278/278; %100) amikasine duyarlı bulunmuş; imipenem/meropenem duyarlılığı %99.3 (276/278), ertapenem duyarlılığı %98.6 (274/278) olarak saptanmıştır. E.coli, K.pneumoniae ve K.oxytoca suşları ayrı ayrı değerlendirildiğinde; ertapenem duyarlılığı sırasıyla %99.2, %96.4 ve %90.9, imipenem/meropenem duyarlılığı ise sırasıyla %100, %96.4 ve %90.9 olarak saptanmıştır. Çalışmamızda iki E.coli, bir K.oxytoca ve bir K.pneumoniae suşunda karbapenem direnci saptanmıştır. İki Klebsiella spp. suşu çalışılan tüm karbapenemlere dirençli bulunmuş (MİK > 32 ?g/ml); iki E.coli suşunun ertapeneme dirençli (MİK > 32 ?g/ml), ancak imipenem (MİK= 0.25 ?g/ml) ve meropeneme (MİK= 0.5 ?g/ml) duyarlı olduğu izlenmiştir. Karbapeneme dirençli olan dört suşta modifiye Hodge testi ile karbapenemaz üretimi gösterilmiştir. Sonuç olarak, son yıllarda karbapenemaz üreten suşların artması nedeniyle, GSBL üreten gram-negatif izolatların karbapenemaz üretimi açısından rutin olarak taranması, gerekli durumlarda doğrulama testinin yapılmasının uygun olacağı kanısına varılmıştır. Başlık (İngilizce): Investigation of the susceptibilities of extended-spectrum beta-lactamase producing escherichia coli and klebsiella spp. strains to ertapenem and other carbapenems Öz (İngilizce): Infections 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®, 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 μg/ml), two E.coli isolates were resistant to ertapenem (MIC > 32 μg/ml) but susceptible to imipenem (MIC= 0.25 μg/ml) and meropenem (MIC= 0.5 μg/ml). Carbapenemase production was demonstrated by modified Hodge test in all of the carbapenem-resistant isolates. In conclusion, ESBL-producing gramnegative isolates should be routinely tested with a screening method for carbapenemase activity and confirmation tests should be performed in suspected cases.Öğe Genişlemiş spektrumlu beta-laktamaz üreten nozokomiyal escherichia coli izolatlarında beta-laktamaz gen oranları ve klonal ilişkinin araştırılması(2015) Görgeç, Sündüz; Kuzucu, Çiğdem; Otlu, Barış; Yetkin, Funda; Ersoy, YaseminÖz: Genişlemiş spektrumlu beta-laktamaz (GSBL) üreten mikroorganizmalar günümüzde önemli bir sorun oluşturmaktadır. Özellikle CTX-M beta-laktamazı üreten Escherichia coli, tüm dünyada yayılarak hem nozokomiyal hem de toplumsal kaynaklı enfeksiyonlara neden olmaktadır. Bu çalışmanın amacı, GSBL üreten hastane kökenli E.coli izolatlarında beta-laktamaz gen prevalansı, antibiyotik duyarlılıkları ve klonal ilişkilerinin araştırılmasıdır. Çalışmaya, Haziran 2010-Haziran 2011 tarihleri arasında hastanede yatan has- taların idrar (n= 26), kan (n= 25) ve yara (n= 25) örneklerinden izole edilen ve CDC kriterlerine göre has- tane enfeksiyonu etkeni olarak tanımlanan toplam 76 GSBL pozitif E.coli suşu dahil edilmiştir. İzolatların antibiyotik duyarlılıkları, CLSI önerilerine göre Kirby-Bauer disk difüzyon yöntemiyle araştırılmıştır. GSBL varlığı çift disk sinerji testi ile saptanmış, şüpheli olgularda sefotaksim/sefotaksim klavulanik asit E-test şeriti (AB Biodisk, İsveç) kullanılmıştır. TEM, SHV, CTX-M, PER, VEB, GES, OXA-2 grup ve OXA-10 grup beta-laktamaz genlerinin varlığı bu bölgelere özgül primerler kullanılarak polimeraz zincir reaksiyonu (PCR) ile araştırılmıştır. Suşlar arasındaki klonal ilişkilerin tespiti için PFGE (pulsed-field gel electropho- resis) yöntemi kullanılmıştır. GSBL üreten E.coli suşlarının en sık yoğun bakım (%35), dahiliye (%16) ve genel cerrahi (%13) bölümlerinden gönderilen örneklerden izole edildiği belirlenmiştir. Suşların tamamı imipenem, meropenem ve amikasine duyarlı olarak saptanmış; tüm izolatların sefotaksim ve seftriaksona dirençli olduğu izlenmiştir. Sefoksitin, ertapenem, sefoperazon/sulbaktam, piperasilin/tazobaktam, gen- tamisin, siprofloksasin, sefepim, amoksisilin/klavulanik asit, aztreonam ve seftazidime duyarlılık oranları ise sırasıyla; %96, %83, %63, %61, %50, %41, %25, %21, %20 ve %18dir. Çalışmaya alınan E.coli suşlarında CTX-M, TEM, OXA-2 grup, PER, SHV ve OXA-10 grup beta-laktamaz gen pozitifliği sırasıyla; %89.5, %59.2, %15.8, %14.5, %11.8 ve %3.9 olarak bulunmuş; izolatların hiçbirinde GES ve VEB beta- laktamaz genine rastlanmamış; 1 (%1.3) izolatta ise araştırılan genlerden hiçbirisi saptanmamıştır. PCR analizi sonucu, 25 izolatta TEM ve CTX-M genlerinin birlikte bulunduğu belirlenmiş; 20 izolatta yalnız CTX-M ve iki izolatta yalnız TEM geninin varlığı tespit edilmiştir. SHV geni hiçbir izolatta tek başına saptanmamıştır. PFGE yöntemi ile GSBL üreten izolatlar arasında belirgin bir klonal ilişki gözlenmemiştir. Sonuç olarak bu çalışmada, hastanemizde nozokomiyal GSBL üreten E.coli suşları arasında CTX-M tipi enzimin yüksek sıklıkta olduğu gösterilmiş; GSBL pozitif suşların poliklonal olarak yayıldığı belirlenmiş ve baskın olan bir epidemik suş tanımlanamamıştır. Bununla birlikte, epidemik klonlar ile plazmidler arasındaki ilişkiyi açıklayacak plazmid analizi ve multilokus dizi tiplendirme yöntemleri ile daha ileri çalışmalara gereksinim olduğu düşünülmüştür.Öğe The importance of procalcitonin in early diagnosis of sepsis(2017) Yetkin, Funda; Altunisik Toplu, SibelAbstract: Despite the advances and a wide range of studies conducted, sepsis is one of the most frequent causes of death in patients with critical health condition. Early diagnosis, rapid and effective treatment are extremely important. Use of procalcitonin (PCT) for this purpose has become widespread and notable recently. Procalcitonin is an important test as “point-of-care testing (POCT)” just like C-reactive protein (CRP). Procalcitonin is the prohormone of calcitonin. It is released from the parenchymal cells of the liver, kidneys and muscles, and in response to bacterial toxins, it is released from the adipocytes. As a response to bacterial infection, the serum procalcitonin level may increase by 5000-fold within 2-4 hours. C- reactive protein is synthesized in the liver as a result of interleukin-6 (IL-6) trigger due to tissue injury, inflammation and/or infections. The aim of our study was to emphasize the importance of PCT as an indicator in patients suspicious of sepsis in the early period. A total of 66 patients with critical situation were included in the study conducted at the İnönü University Medical Faculty Turgut Özal Medical Center Investigation Hospital between February 2007 and August 2008. These patients were appropriate for the diagnostic criteria of systemic inflammatory response syndrome (SIRS). Appropriate antibiotiotherapy was begun for the patients. The PCT and CRP levels were investigated on the first day after having been included in the study, and on the third and seventh days. The mean C-reactive protein levels were 132.41, 108.39 and 83.47 mg/l on the 1, 3rd and 7th days, respectively. The minimum level of procalcitonin was 0.095 ng/ml on the first day, and the maximum level was 316.054 ng/ml. The minimum/maximum levels were 0.091 and 306.043 ng/ml on the 3rd day, and 0.081 and 12.15136 ng/ml on the 7th days, respectively. No statistically significant difference was observed betweern the serum procalcitonin levels on the 1st and the 3rd days ( p<0.229), whereas a significant difference was observed between its levels between the 1st and the 7th days (p<0.002). Likewise, the difference between the 3rd and the 7th days was statistically significant (p<0.005). C-reactive protein levels revelaed a significant difference between the 1st and the 7th days (p<0.013) and between the 3rd and the 7th days (p<0.010). The Wilcoxon Signed test was used to investigate statistical significance. The diagnostic value of procalcitonin has been widely used in septic patients. Although conflicting results have been obtained in different studies, despite the fact that some studies have not found PCT supportive for the diagnosis of sepsis, we believe that PCT is an appropriate and important indicator in the early diagnosis and follow-up of sepsis as CRPÖğe Increased membrane turnover in the brain in cutaneous anthrax without central nervous system disorder: A magnetic resonance spectroscopy study(Churchill Livingstone, 2012) Bayindir, Yasar; Firat, Ahmet K.; Kayabas, Uner; Alkan, Alpay; Yetkin, Funda; Karakas, Hakki M.; Yologlu, SaimCutaneous anthrax, caused by Bacillus anthracis contacting the skin, is the most common form of human anthrax. Recent studies implicate the presence of additional, possibly toxin-related subtle changes, even in patients without neurological or radiological findings. In this study, the presence of subtle changes in cutaneous anthrax was investigated at the metabolite level using magnetic resonance spectroscopy. Study subjects were consisted of 10 patients with cutaneous anthrax without co-morbid disease and/or neurological findings, and 13 healthy controls. There were no statistical differences in age and gender between two groups. The diagnosis of cutaneous anthrax was based on medical history, presence of a typical cutaneous lesion, large gram positive bacilli on gram staining and/or positive culture for B. anthracis from cutaneous samples. Brain magnetic resonance imaging examination consisted of conventional imaging and single-voxel magnetic resonance spectroscopy. Magnetic resonance spectroscopy was performed by using point-resolved spectroscopy sequence (TR: 2000 ms, TE: 136 ms, 128 averages). Voxels of 20 mm x 20 mm x 20 mm were placed in normal-appearing parietal white matter to detect metabolite levels. Cerebral metabolite peaks were measured in normal appearing parietal white matter. N-acetyl aspartate/creatine and choline/creatine ratios were calculated using standard analytical procedures. Patients and controls were not statistically different regarding parietal white matter N-acetyl aspartate/creatine ratios (p = 0.902), a finding that implicates the conservation of neuronal and axonal integrity and neuronal functions. However, choline/creatine ratios were significantly higher in patient groups (p = 0.001), a finding implicating an increased membrane turnover. In conclusion, these two findings point to a possibly anthrax toxins-related subtle inflammatory reaction of the central nervous system at the cellular level. (C) 2012 Elsevier Ltd. All rights reserved.Öğe İnönü Üniversitesi Turgut Özal Tıp Merkezinde 2008 yılında yatan hastalardan izole edilen acınetobacter suşlarının antibiyotik duyarlılıkları(ANKEM Dergisi, 2009) Mansur, Ahmet; Kuzucu, Çiğdem; Ersoy, Yasemin; Yetkin, FundaÖz: Hastanemizin tüm ünitelerinde yatmakta olan hastalardan 2008 yılında izole edilen Acinetobacter suşlarının antibiyotik duyarlılıkları değerlendirilmiştir. Acinetobacter izolatları konvansiyonel yöntemler ve BD Phoenix System (Beckton Dickinson, ABD) kitleri ile tanımlanmış, antibiyotik duyarlılık testleri Clinical and Laboratory Standards Institute (CLSI) standartlarına göre Kirby-Bauer disk difüzyon yöntemi kullanılarak yapılmıştır. Doğrulama gerektiğinde E test (AB Biodisk, İsveç) ve buyyon mikrodilüsyon yöntemleri kullanılmıştır. Suşların en sık izole edildikleri üniteler Genel Cerrahi Servisi (% 16), Reanimasyon Yoğun Bakım Ünitesi (% 14), Dahiliye Yoğun Bakım Ünitesi (% 10), Organ Nakli Ünitesi (% 8); en sık izole edildikleri örnekler trakeal aspirat (% 29), kan (% 26), parasentez sıvısı (% 13), yara örnekleri (% 12) ve idrar (% 11) olmuştur. Bu dönemde 120 hastanın çeşitli klinik örneklerinden 147 Acinetobacter suşu izole edilmiştir. Bu suşlarda tigesiklin duyarlılığı % 100, kolistin duyarlılığı % 91 olarak bulunmuş, bu iki antibiyotik arasında anlamlı etkinlik farkı saptanmamış (p>0.10) ve bu iki antibiyotik tüm diğerlerinden ileri derecede anlamlı olarak daha etkin bulunmuştur (p<0.001). Karbapenemlere dirençli 37 suşun denendiği tigesiklin tamamına etkili bulunmuştur. İmipenem ve meropenem arasında da anlamlı etkinlik farkı bulunmamış (p>0.10) ve bu iki antibiyotik tobramisin dışında diğer antibiyotiklerden anlamlı olarak daha etkin bulunmuştur (p<0.01-0.001). Amikasin gentamisinden (p: 0.04) ve tobramisinden anlamlı olarak (p<0.001) daha az etkin bulunmuştur.Hastanemizde izole edilen Acinetobacter suşlarının en duyarlı oldukları antibiyotikler sırasıyla tigesiklin, kolistin, imipenem ve meropenem olmuştur. Antibiyotiklere direnç oranlarının yüksekliği ile tigesiklin ve kolistinin bu dirençli suşlardaki etkinliği dikkat çekicidir.Öğe Investigation of beta lactamase genes and clonal relationship among the extended spectrum beta lactamase producing nosocomial escherichia coli isolates(Mikrobiyoloji Bulteni, 2015) Görgeç, Sündüz; Kuzucu, Çiğdem; Otlu, Barış; Yetkin, Funda; Ersoy, YaseminGenişlemiş spektrumlu beta-laktamaz (GSBL) üreten mikroorganizmalar günümüzde önemli bir sorun oluşturmaktadır. Özellikle CTX-M beta-laktamazı üreten Escherichia coli, tüm dünyada yayılarak hem nozokomiyal hem de toplumsal kaynaklı enfeksiyonlara neden olmaktadır. Bu çalışmanın amacı, GSBL üreten hastane kökenli E.coli izolatlarında beta-laktamaz gen prevalansı, antibiyotik duyarlılıkları ve klonal ilişkilerinin araştırılmasıdır. Çalışmaya, Haziran 2010-Haziran 2011 tarihleri arasında hastanede yatan hastaların idrar (n= 26), kan (n= 25) ve yara (n= 25) örneklerinden izole edilen ve CDC kriterlerine göre hastane enfeksiyonu etkeni olarak tanımlanan toplam 76 GSBL pozitif E.coli suşu dahil edilmiştir. İzolatların antibiyotik duyarlılıkları, CLSI önerilerine göre Kirby-Bauer disk difüzyon yöntemiyle araştırılmıştır. GSBL varlığı çift disk sinerji testi ile saptanmış, şüpheli olgularda sefotaksim/sefotaksim klavulanik asit E-test şeriti (AB Biodisk, İsveç) kullanılmıştır. TEM, SHV, CTX-M, PER, VEB, GES, OXA-2 grup ve OXA-10 grup beta-laktamaz genlerinin varlığı bu bölgelere özgül primerler kullanılarak polimeraz zincir reaksiyonu (PCR) ile araştırılmıştır. Suşlar arasındaki klonal ilişkilerin tespiti için PFGE (pulsed-field gel electrophoresis) yöntemi kullanılmıştır. GSBL üreten E.coli suşlarının en sık yoğun bakım (%35), dahiliye (%16) ve genel cerrahi (%13) bölümlerinden gönderilen örneklerden izole edildiği belirlenmiştir. Suşların tamamı imipenem, meropenem ve amikasine duyarlı olarak saptanmış; tüm izolatların sefotaksim ve seftriaksona dirençli olduğu izlenmiştir. Sefoksitin, ertapenem, sefoperazon/sulbaktam, piperasilin/tazobaktam, gentamisin, siprofloksasin, sefepim, amoksisilin/klavulanik asit, aztreonam ve seftazidime duyarlılık oranları ise sırasıyla; %96, %83, %63, %61, %50, %41, %25, %21, %20 ve %18’dir. Çalışmaya alınan E.coli suşlarında CTX-M, TEM, OXA-2 grup, PER, SHV ve OXA-10 grup beta-laktamaz gen pozitifliği sırasıyla; %89.5, %59.2, %15.8, %14.5, %11.8 ve %3.9 olarak bulunmuş; izolatların hiçbirinde GES ve VEB betalaktamaz genine rastlanmamış; 1 (%1.3) izolatta ise araştırılan genlerden hiçbirisi saptanmamıştır. PCR analizi sonucu, 25 izolatta TEM ve CTX-M genlerinin birlikte bulunduğu belirlenmiş; 20 izolatta yalnız CTX-M ve iki izolatta yalnız TEM geninin varlığı tespit edilmiştir. SHV geni hiçbir izolatta tek başına saptanmamıştır. PFGE yöntemi ile GSBL üreten izolatlar arasında belirgin bir klonal ilişki gözlenmemiştir. Sonuç olarak bu çalışmada, hastanemizde nozokomiyal GSBL üreten E.coli suşları arasında CTX-M tipi enzimin yüksek sıklıkta olduğu gösterilmiş; GSBL pozitif suşların poliklonal olarak yayıldığı belirlenmiş ve baskın olan bir epidemik suş tanımlanamamıştır. Bununla birlikte, epidemik klonlar ile plazmidler arasındaki ilişkiyi açıklayacak plazmid analizi ve multilokus dizi tiplendirme yöntemleri ile daha ileri çalışmalara gereksinim olduğu düşünülmüştür.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.
