Tıp Fakültesi, Enfeksiyon Hastalıkları Anabilim Dalı Koleksiyonu

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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, Funda
The 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.
An outbreak associated with multidrug-resistant pseudomonas aeruginosa contamination ofduodenoscopes and an automated endoscope reprocessor
(Allıed acad, 40 bloomsbury way, lower ground flr, london, wc1a 2se, england, 2017) Yetkin, Funda; Ersoy, Yasemin; Kuzucu, Cigdem; Otlu, Baris; Parmaksiz, Nalan; Seckin, Yuksel
Background: Duodenoscopes are semi-critical devices used for endoscopic retrograde cholangiopancreatography (ERCP). Disinfection of these instruments is usually based on high-level disinfection procedures with a manual or automated endoscope reprocessor (AER). Duodenoscopes and AER are reported very rarely as a source of infection and outbreaks. Aim: To investigate an outbreak caused by Pseudomonas aeruginosa in a Gastroenterology Department and ERCP unit in a university hospital and its underlying risk factors. Method: Three patients in the gastroenterology unit were diagnosed as infected by multidrug-resistant P. aeruginosa and a case control study was conducted for detection of the risk factors. Our infection control team commenced active epidemiological surveillance to determine the cause of these infections. Clonal relationship of the strains was investigated by pulsed field gel electrophoresis (PFGE). Results: Eight patients were affected in the gastroenterology unit during the period November 2007-February 2008. The case-control analysis confirmed that undergoing ERCP was significantly associated with isolation of P. aeruginosa (P=0.0001) in this unit. Six patients' isolates and seven environmental isolates had an indistinguishable PFGE profile, confirming cross-transmission. The healthcare worker implemented infection control measures to resolve the outbreak and no further cases occurred. Conclusions: This outbreak resulted from failure of AER and inadequate high level disinfection procedures. AERs can cause contamination of duodenoscopes and can be related P. aeruginosa outbreaks. Reuse of ancillary materials of ERCP play a critical role in outbreak development.
Pathogens of ıntensive care unit-acquired ınfections and their antimicrobial resistance: a 9-yearanalysis of data from a university hospital
(Ahvaz jundıshapur unıv med scı, po box 6357-33118, ahvaz, 00000, ıran, 2018) Yetkin, Funda; Yakupogullari, Yusuf; Kuzucu, Cigdem; Ersoy, Yasemin; Otlu, Baris; Colak, Cemil; Parmaksiz, Nalan
Background: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive actions in healthcare settings. Objectives: We investigated the causative agents of intensive care unit (ICU)-acquired infections and their antimicrobial resistance in a university hospital over a nine-year period. Methods: An active, prospective surveillance was conducted in the ICUs of a tertiary care hospital between 2007 and 2015. The changing patterns in the frequency of pathogens and their antimicrobial resistance by the time were statistically evaluated with Mann-Whitney U test. Results: A total of 3044 pathogens were isolated from 4272 healthcare-associated infections attacks in 3437 patients. The most frequently detected organisms were Acinetobacter spp. (n = 1060, 34.8%), Pseudomonas aeruginosa (n = 622, 20.4%), Escherichia coli (n = 340, 11.1%), Klebsiella pneumoniae (n = 331, 10.8%), and Candida spp. (n = 285, 9.3%). Carbapenem resistance among Acinetobacter spp., P. aeruginosa, E. coli, and K. pneumoniae was found as 82%, 30.7%, 2%, and 9.3%, respectively. The prevalence of extended-spectrum betalactamase (ESBL) among E. coli and K. pneumoniae was 49.7% and 41.3%, orderly, and methicillin resistance in Staphylococcus aureus was 81.8%. Substantial reductions occurred in the rates of E. coli (16.8% to 8.9%), S. aureus (11% to 3.2%), coagulase-negative staphylococci (7.9% to 0), and Stenotrophomonas maltophilia (4.2% to 0.3%) during the study period by the applied infection control measures while the rate of Acinetobacter spp. (9.7% to 51%) significantly increased. Furthermore, the increases in the carbapenem resistance among Acinetobacter spp. (52.5% to 91.4%), Pseudomonas spp. (25.7% to 51.6%), E. coli (0 to 12.7%), and K. pneumoniae (2.6% to 9%) and the decrease in the prevalence of ESBL-producing E. coli (57% to 27.2%) were statistically significant. Conclusions: Despite the decreases in the frequencies of staphylococci and some Gram-negative bacteria, the current infection control measures have been unable to limit the spread of carbapenem-resistant Gram-negative bacteria in our facility. Additional precautions are required to control such pathogens in the intensive care units.
Patency of middle hepatic vein tributaries and right inferior hepatic vein reconstructed with differentsized ptfe vascular graft in right lobe living donor liver transplantation
(Lıppıncott wıllıams & wılkıns, two commerce sq, 2001 market st, phıladelphıa, pa 19103 usa, 2018) Yonder, H.; Akbulut, S.; Isik, B.; Yilmaz, S.
Investigation of extended spectrum beta-lactamase (esbl) genes in esbl-producing escherichia coliand klebsiella pneumoniae strains
(BILIMSEL TIP YAYINEVI, BILIMSEL TIP YAYINEVI, ANKARA, 00000, TURKEY, 2018) Otlu, Barış; Tekerekoğlu, Mehmet Sait
Introduction: Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is an important health problem all over the world. In this study, it was aimed to determine the ESBL genes in Escherichia coli and Klebsiella pneumoniae strains isolated for approximately four-year period. Materials and Methods: A total 100 ESBL-producing E. coli and 100 ESBL-producing K. pneumoniae strains which were isolated between January 2008 and October 2012 were included into this study. The strains were identified using classical bacteriologic methods and BD Phoenix (Becton Dickinson, US) automatized bacterial identification device. CTX-M, TEM, SHV, VEB, GES, PER and OXA beta-lactamase genes were analyzed with the PCR method. Results: The beta-lactamase genes detected in ESBL-positive K. pneumoniae strains were as follows: 99% for CTX-M, 91% for SHV, 71% for TEM, 10% for OXA-10 group, and 5% for OXA-2 group. In E. coli strains, the prevalence of CTX-M was 92%; TEM was 70%, SHV was 21%, and OXA-2 group was 3%. CTX-M alone was found to be positive in 25 of the 98 (25.5%) in E. coli strains; TEM alone was found to be positive in 2 of 98 (2%) and SHV alone was found in 2 of 98 (2%). CTX-M alone was found positive in 3 of 100 (3%) K. pneumoniae strains. No other resistance genes alone were found in the strains. No GES, VEB and PER-producing strains were determined in this study. Conclusion: In the study, high prevalence of CTX-M beta-lactamase was found in ESBL-producing strains. It was thought that the high potential of mobility with CTX-M genes was the most possible reason for this result. Determination of ESBL genes will be useful to understand resistance epidemiology, develop effective therapeutic strategies, and plan the appropriate preventive measurements.
Potential risk factors for ın-hospital mortality in patients with moderate-to-severe blunt multipletrauma who survive ınitial resuscitation
(Hındawı ltd, adam house, 3rd flr, 1 fıtzroy sq, london, w1t 5hf, england, 2018) Yucel, Neslihan; Demir, Tuba Ozturk; Derya, Serdar; Oguzturk, Hakan; Bicakcioglu, Murat; Yetkin, Funda
Introduction. The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) betweenMay 1, 2015, and May 31, 2016. Results. Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serumlactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.
Group 3 innate lymhoid cells are absent in dock8-defective hıes patients
(Amer assoc ımmunologısts, 9650 rockvılle pıke, bethesda, md 20814 usa, 2018) Eken, Ahmet; Okus, Fatma Zehra; Patiroglu, Turkan; Erdem, Serife
Evaluation of nosocomial ınfections after abo-compatible and ıncompatible liver transplantations
(Galenos yayıncılık, erkan mor, molla guranı cad 21-1, fındıkzade, ıstanbul 34093, turkey, 2018) Bayar, Filiz Surucu; Bayindir, Yasar; Isik, Burak; Ozgor, Dincer; Kayabas, Uner; Kuzucu, Cigdem; Yilmaz, Sezai
Introduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABO-compatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO-incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABO-incompatible patients. However, further studies are needed on this topic.
Co-Production of OXA-48 and NDM-1 Carbapenemases in Providencia rettgeri: the First Report
(ANKARA MICROBIOLOGY SOC, HACETLEPE UNIV FACULTY MEDICINE DEPT MICROBIOLOGY, 06100 ANKARA, TURKEY, 2018) Otlu, Barış; Yakupoğulları, Yusuf; Gürsoy, Nafile Canan; Duman, Yücel; Bayındır, Yaşar; Tekerekoğlu, Mehmet Sait; Ersoy, Yasemin
Our country is the epicenter of the OXA-48-like carbapenemase-producing Klebsiella and Escherichia coli; and in the recent years, the concern has been increasing due to both spreading of this resistance to other members of Enterobacteriaceae family and acquiring other carbapenemases by the OXA-48-producing strains. In this study, OXA-48 and NDM-1 co-production was presented in Providencia rettgeri. Two P.rettgeri strains that were resistant to all antimicrobials except colistin and tigecyclin, were isolated from two patients in the burn unit of our hospital, including one from the urine sample of a 68 years female in April 2017, and the other from a burn wound swab of a 35 years old male, in November 2017. Minimal inhibitory concentrations (MICs) of the isolates for imipenem and meropenem were measured as >= 32 mu g/ml; and for colistin and tigecyclin were 1 ve 0.5 mu g/ml, respectively. Multiplex PCR analysis showed that both strains were carrying bla(oxA-48 )and bla(NDM-1 )carbapenemases, and bla(TEM) extended spectrum beta-lactamase genes. By using DNA sequence analysis, the TEM gene was typed as bla(TEM-1). The Pulsed Field Gel Electrophoresis (PFGE) analysis indicated that these two strains which were consecutively isolated from two different patients in a single unit within about seven months were genetically indistinguishable. No significant data that could explain the spread of these isolates was obtained from our retrospective analysis of the medical records including the results of environmental surveillance cultures, and patients' history. Nevertheless, hospital infection control committee enforced the infection control measures in that unit, and no further isolation was observed within three months period following the last isolation, neither from environmental nor from clinical samples. With this study, it was emphasized that the co-production of OXA-48 and NDM-1 carbapenemases which was reported from only three Enterobacteriaceae species up to date was ongoing for spreading to other species by using horizontal route, and also showing a potential to be a growing problem in the hospitals, by clonal expansion (vertical route). Effectively using of the molecular epidemiological methods will provide useful data to better understand the transmission dynamics of such rare, but problematic species in hospitals.
Comparison of standard and modified standart organ procurement technique for deceased donors
(LIPPINCOTT WILLIAMS & WILKINS, TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA, 2018) Koç, C.; Akbulut, S.; Yılmaz, S.
Comparıson of pulmonary functıon testıng among non-smokers, hand-rolledcıgarette smokers and factory made cıgarette smokers
(Southeast asıan mınısters educ organızatıon, seameo-tropmed, 420-6 rajvıthı rd,, bangkok 10400, thaıland, 2018) Turgut, Kasim; Turtay, Muhammet Gokhan; Kilic, Talat; Oguzturk, Hakan; Gulacti, Umut; Gur, Ali; Guven, Taner; Colak, Cemil
Tobacco use causes significant health problems. The aim of this study was to compare the following factors among factory-made cigarette (FMC) smokers, hand-rolled cigarette (HRC) smokers and non-smokers (NS): demographic characteristics, pulmonary function testing (PFT) and carboxyhemoglobin (COHb) levels. PFT included checking: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, forced expiratory flow from 25-75% of the vital capacity (FEF25-75) and peak expiratory flow (PEF). We wanted to determine the impact of smoking on pulmonary function testing and to determine any differences in PFTs and COHb levels between FMC and HRC smokers. A total of 182 participants (all males) were included in the study. The subjects in the study were randomly chosen from emergency service admissions which had complaints other than respiratory system. The mean age of study subjects was 40.8 (range: 22-92) years. Mean age of starting smoking among HRC smokers was not significantly different from FMC smokers (95% CI: -0.55-2.37, p=0.220). HRC smokers had significantly lower economic and education levels than FMC smokers (95% CI: 9.0-45.2, p<0.01). NS had highest economic and educational levels (95% CI: 35.9-66.6, p<0.01) of the 3 study groups. The mean [+/- standard deviation(SD)] FEV1/FVC was 76.66 (+/- 7.45) among FMC smokers (95% CI: 74.82-78.51), 77.36 (+/- 8.14) among HRC smokers (95% CI: 75.36-79.36) and 83.13 (+/- 5.08) among NS (95% CI: 81.70-84.56, p<0.01). The mean (+/- SD) FEV1 was 84.50 (+/- 17.80) among FMC smokers (95% CI: 80.12-88.92 ), 89.4 (+/- 15.8) among HRC smokers (95% CI: 85.56-93.32) and 95.30 (+/- 13.3) among NS (95% CI: 91.59-99.07, p<0.01). The mean (+/- SD) PEF was 81.90 (+/- 19.30) among HRC smokers (95% CI: 77.19-86.69), 78.10 (+/- 18.70) among FMC smokers (95% CI: 73.47-82.74) and 86.20 (+/- 16.0) among NS (95% CI: 81.70-90.69, p=0.06). The mean FVC, FEV1, FEV1/FVC, FEF25-75%, and PEF values among NS were significantly (p<0.05) higher for each variable than the mean of these values among FMC and HRC smokers. The mean COHb level among NS was significantly (p<0.05) lower than the mean COHb levels in the two smoking groups. There were no significant differences in PFT results or COHb levels between the two smoking groups (p>0.05). Cigarette smoking cause impairment of pulmonary function equally independent of the cigarette type (FMC, HRC) smoked.
Detection of bla(oxa-48) and clonal relationship in carbapenem resistant k-pneumoniae isolatesat a tertiary care center in western turkey
(ELSEVIER SCIENCE LONDON, 84 THEOBALDS RD, LONDON WC1X 8RR, ENGLAND, 2018) Ece, Gülfem; Tunç, Emine; Otlu, Barış; Aslan, Deniz; Ece,Cem
Background: Klebsiella pneumoniae is an important nosocomial pathogen that can lead to high morbidity and mortality. ESBL and carbapenamase producing strains may cause epidemic situations. The aim of our study was to investigate the molecular epidemiology and clonal relationship between carbapenem resistant K. pneumoniae strains isolated from our hospital during a three month period. Methods: Fourteen carbapenem resistant K. pneumoniae strains isolated during April 1st-June 30th 2013 were included. The identification and the antibiotic susceptibility of the strains were studied by Vitek 2 Compact (Biomerieux, France) system. The carbapenemase production of the isolates were investigated by Modified Hodge assay. The bla(OXA) of the strains was investigated by in house PCR. The clonal relationship between the isolates were studied by pulsed-field gel electrophoresis (PFGE) and automatized repetitive extragenic palindromic PCR (Rep-PCR, DiversiLab sistemi, Biomerieux, France) methods. Results: All the K. pneumoniae isolates were carbapenem resistant; they were all susceptible to gentamycin and colistin. All of them had bla(OXA-48). The genotyping analysis revealed that eight isolates were in the same cluster both by Rep-PCR (similarity border >= 95%) and PFGE (Tennover criteriae) analysis. The other isolates did not belong to any other clusters. The strains that are in the same cluster are isolated from the Anesthesiology Intensive Care Unit during a three month period. The cluster ration by both methods was 57%. Conclusions: All K. pneumoniae strains possessed bla(OXA-48). The clonal spreading was particularly detected in Anesthesiology Intensive Care Unit. Molecular epidemiological monitorization of nosocomial pathogens may prevent the spread of these multidrug resistant pathogens. (C) 2018 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.
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, Banu

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