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Öğe Case of Periprosthetic Joint Infection Associated with Streptococcus dysgalactiae subsp. dysgalactiae(Galenos Publ House, 2026) Salduz, Ekrem; Toplu, Sibel Altuniik; Yilmaz, Zeynep BurcinPeriprosthetic joint infection (PJI) is a serious complication following joint prosthesis implantation. Although Streptococcus dysgalactiae subsp. equisimilis is increasingly recognized as an emerging human pathogen, Streptococcus dysgalactiae subsp. dysgalactiae (SDSD) is traditionally considered an animal-associated organism. However, recent reports indicate that SDSD can infrequently cause invasive human infections. SDSD has been linked to PJIs, endocarditis, and cellulitis of the upper and lower extremities. To date, only two cases of SDSD-related PJI have been described in the literature. Here, we present a rare case of late-onset PJI caused by SDSD following knee arthroplasty.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 Factors Associated with Candidemia After Living Donor Liver Transplantation: A Case-Control Study(Mdpi, 2025) Durmus, Mefkure; Karahan, Sena Guzel; Akbulut, Sami; Yilmaz, Zeynep Burcin; Karabulut, ErtugrulBackground: Liver transplant recipients are highly susceptible to invasive fungal infections, particularly candidemia, due to intensive immunosuppressive therapy and postoperative complications. However, few studies have comprehensively examined postoperative antimicrobial and immunosuppressive factors in this context. Aim: This study aimed to identify perioperative and postoperative factors associated with the development of candidemia in living donor liver transplant (LDLT) recipients, with a particular focus on antimicrobial and immunosuppressive regimens during initial hospitalization. Methods: A retrospective case-control analysis was conducted involving 36 LDLT recipients who developed candidemia (candidemia group) and 72 matched controls without candidemia (non-candidemia group) between January 2019 and November 2023. Demographic and clinical variables were compared using univariate and multivariate logistic regression analyses to identify independent associations. A post hoc power analysis demonstrated a high statistical power (97.3%) to detect large effect sizes. Results: Univariate analysis revealed significant associations with prolonged intubation (p < 0.001), bile leaks (p < 0.001), relaparotomy (p < 0.001), chronic renal disease (p = 0.011), hepatocellular carcinoma (p = 0.011), and the use of antimicrobials including meropenem (p = 0.048), linezolid (p = 0.005), tigecycline (p = 0.045), third-generation cephalosporins (p = 0.003), anidulafungin (p < 0.001), fluconazole (p = 0.006), mycophenolate (p = 0.011), and total parenteral nutrition (TPN) (p = 0.049). CMV prophylaxis (p < 0.001) and CMV-PCR positivity (p = 0.015) were also significantly associated with candidemia. Multivariate logistic regression analysis identified prolonged intubation (OR = 1.07; p = 0.019), bile leaks (OR = 10.9; p = 0.002), anidulafungin use (OR = 4.70; p = 0.032), fluconazole use (OR = 35.8; p = 0.005), and absence of CMV prophylaxis (OR = 11.7; p = 0.021) as independent factors associated with increased odds of candidemia. Conclusions: Prolonged intubation, bile leaks, antifungal exposure, and lack of CMV prophylaxis are independently associated with higher odds of candidemia after LDLT. Targeted prophylaxis, prudent antimicrobial stewardship, and timely biliary intervention may reduce fungal morbidity and mortality in post-transplant patients.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 Meropenem-Associated Acute Hepatocellular Liver Injury: A Rare Case Report(Bilimsel Tip Yayinevi, 2026) Salduz, Ekrem; Avcu, Atakan; Kose, Adem; Yilmaz, Zeynep BurcinDrug-induced liver injury (DILI) is a serious and commonly encountered clinical complication, the diagnosis of which is usually established by exclusion. Antibiotics, particularly beta-lactam agents, are among the leading causes of DILI. Meropenem is a widely used broad-spectrum carbapenem antibiotic. This report presents a case of acute hepatocellular liver injury that developed within 24 hours after initiation of meropenem for the treatment of pneumonia in an 85-year-old patient. Viral hepatitis, autoimmune diseases, and other potential causes of liver injury were comprehensively excluded. In the presence of marked elevations in liver enzymes, meropenem was discontinued, after which the biochemical abnormalities were observed to resolve spontaneously without any specific treatment. Reports of meropenem-induced liver injury are rare in the literature; the rapid onset and reversibility observed in this case underscore the importance of drug discontinuation in management. In clinical practice, awareness of the risk of hepatotoxicity associated with meropenem use and adoption of a multidisciplinary approach in similar cases are of great importance.Öğe Outbreak of adenovirus type-8 conjunctivitis among healthcare workers in the ophthalmology clinic of a tertiary hospital: Management and infection control measures(Elsevier Inc., 2025) Memişoğlu, Funda; Yilmaz, Zeynep Burcin; Yakupoğulları, Yusuf; Toplu, Sibel Altunışık; Tanrıverdi, Elif Seren; Cumurcu, Tongabay; Otlu, BarışBackground This study documents an outbreak of Human adenovirus (HAdV) keratoconjunctivitis originating in the ophthalmology department of a tertiary hospital and spreading to the neonatal intensive care unit. Methods Following ORION guidelines, the Hospital Infection Control Committee launched an investigation after clusters of keratoconjunctivitis in healthcare workers reported over 4-week. Patient records were reviewed, environmental and patient samples collected, and PCR analyses performed. Infection control measures were implemented, and their effectiveness was assessed through follow-up testing. The institutional burden of the outbreak was analyzed. Results Twelve healthcare workers were affected (8 ophthalmology, 4 neonatal intensive care unit). PCR confirmed HAdV in conjunctival swabs from 11 tested individuals, including cases infected more than 3 weeks earlier. Viral contamination was detected on 10/16 environmental surfaces in the ophthalmology clinic. Genotyping identified HAdV type-8. The outbreak imposed major operational burdens, especially workforce loss. Chlorine solution achieved rapid surface disinfection, while 0.36% hydrogen peroxide required repeated applications for chlorine-sensitive devices. Following enhanced disinfection protocols and temporary clinic closure during a holiday, no new cases occurred. Discussion This outbreak, which continued until the Infection Control Committee intervened, underlines the high environmental contamination of HAdV and the critical importance of a swift, evidence-based, and multidisciplinary response. Conclusions This study demonstrates that targeted disinfection and strict Infection control measures are essential for containing such outbreaks and mitigating their significant operational and financial impact on healthcare institutions. Copyright © 2025. Published by Elsevier Inc.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.
