Browsing by Author "ENER, BEYZA"
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Publication Anidulafungin treatment for fluconazole-resistant Candida albicans vaginitis with cross-resistance to azoles: A case report(Taylor & Francis, 2020-04-16) Akdağ, Damla; Pullukçu, Hüsnü; Yamazhan, Tansu; Metin, Dilek Yeşim; Sipahi, Oğuz Resat; Isıkgöz Taşbakan, Meltem; Ener, Beyza; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0002-4803-8206; AAG-8523-2021Publication Aspergillus infections in intensive care units: Before and after the COVID-19 pandemic(Bilimsel Tıp Yayınevi, 2022-01-01) Tüzemen, Nazmiye Ülkü; Önal, Uğur; Akalın, Emin Halis; Kazak, Esra; Heper, Yasemin; İşçimen, Remzi; Kelebek Girgin, Nermin; Yılmaz, Emel; Özakın, Cüneyt; Şöhret Kahveci, Ferda; Ener, Beyza; TÜZEMEN, NAZMİYE ÜLKÜ; ÖNAL, UĞUR; AKALIN, EMİN HALİS; KAZAK, ESRA; HEPER, YASEMİN; İŞÇİMEN, REMZİ; KELEBEK GİRGİN, NERMİN; YILMAZ, EMEL; ÖZAKIN, CÜNEYT; KAHVECİ, FERDA ŞÖHRET; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-3544-3509; 0000-0001-6194-3254; 0000-0001-7530-1279; 0000-0002-5882-1632; 0000-0002-3894-1231; ACQ-7832-2022; AAU-8952-2020; JCO-3678-2023; A-4290-2018; CTY-9474-2022; DWL-9897-2022; GBC-7197-2022; HJZ-6992-2023; JKC-3728-2023; IMY-6211-2023; CNK-0895-2022Introduction: Aspergillus species have begun to cause invasive pulmonary aspergillosis (IPA) with increasing frequency in patients with known risk factors in intensive care units (ICU). An international multicenter cohort study (AspICU) established criteria for diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care units. In our study, patients with Aspergillus spp. growth in deep tracheal aspirate (DTA) samples in ICU were evaluated according to AspICU criteria.Materials and Methods: This study is a retrospective study. DTA samples were collected from the Pandemic and Reanimation ICU and performed in the Medical Microbiology Laboratory by separated two periods; pre-pandemic (1 March 2019-31 December 2019) and post-pandemic (1 March 2020-31 December 2020). Cases with Aspergillus spp. growth in the DTA samples in the Pandemic ICU were evaluated as COVID 19 associated pulmonary aspergillosis (CAPA) according to AspICU criteria.Results: While Aspergillus spp. was grown in the DTA of three patients in 2019 and five patients in 2020 in the Reanimation ICU, and 11 patients in the Pandemic ICU. Growths belonging to one patient from both Reanimation (2019) and Pandemic ICUs were considered as colonization. Other growths were interpreted as IPA according to AspICU criteria. When the incidence rates according to 10000 patient days were compared, the incidence rate increased significantly in 2020 (19.1) (p< 0.001) compared to 2019 (3.4); In 2020, it was determined that it increased significantly in the Pandemic ICU (40.4) (p< 0.001) compared to Reanimation ICU (9.2).Conclusion: It should not be forgotten that intensive care patients are also at risk for IPA, especially after viral infections (such as COVID-19, Influenza). Although the incidence of IPA was not very high, it was observed that it tended to increase according to our study. The diagnosis of IPA is problematic, therefore it is necessary to increase awareness and sample diversity and to use biomarkers more widely other than hematology patients.Publication Comparison of clinical laboratory standards institute (CLSI) microdilution method and vitek 2 automated antifungal susceptibility system for the determination of antifungal susceptibility of candida species(Springernature, 2021-12-06) Cilo, Burcu Dalyan; Ener, Beyza; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/ Mikrobiyoloji Anabilim Dalı; 0000-0002-4803-8206; AAG-8523-2021IntroductionChanges in the epidemiology of Candida infections, increasing resistance, and advances in treatment have increased the need to perform antifungal susceptibility testing in clinical laboratories. Standardized reference, the microbroth dilution method, and various commercial antifungal susceptibility test systems are used to determine antifungal susceptibility. This study aims to determine and compare the antifungal susceptibility of various Candida species isolated from blood cultures in our laboratory with the CLSI M27 microdilution reference method and VITEK 2 automated system (bioMerieux, Marcy-l'Etoile, France).MethodsThe antifungal susceptibility of a total of 140 Candida strains to fluconazole, voriconazole, and amphotericin B, and a total of 92 strains to anidulafungin was tested with the CLSI M27 method and the VITEK 2 automated system. For fluconazole, voriconazole, and amphotericin B, essential and categorical agreement percentages were calculated between the two methods. Because there is no anidulafungin in the VITEK 2 system, anidulafungin results obtained with CLSI were compared with micafungin only in terms of categorical agreement. In the category comparison, CLSI clinical breakpoints were used; the epidemiological cut-off values were used when they were not available. Very major error, major error, and minor error rates were calculated.ResultsIn general, the minimum inhibitory concentration (MIC) values obtained with VITEK 2 for azole group drugs were found to be one-fold higher than the CLSI MICs read at the 24th hour. While the essential agreement between the two methods was >90% for amphotericin B and voriconazole, it remained at 85% for fluconazole. Overall, the best categorical agreement was obtained with amphotericin B (99.3%), and the least categorical agreement was obtained with voriconazole (85.7%). A very major error was seen with amphotericin B (0.7%) and fluconazole (0.7%) in one C. parapsilosis strain each. No resistance was detected with VITEK 2 in one C. glabrata strain found to be resistant to fluconazole by the reference method. Major and minor error rates were higher for azole drugs than amphotericin B and anidulafungin/micafungin.ConclusionThe VITEK 2 system is a fast and highly applicable system, and with these features, it is advantageous for routine laboratories. In this study, although the error rate was not very high, one fluconazole-resistant C. parapsilosis and C. glabrata strain could not be detected with VITEK 2. The increase in data on the antifungal performance of the VITEK 2 system, which is available in many routine laboratories due to its ability to be used for bacteria identification and sensitivity, will contribute to the usability of the system for this purpose. In this study, data that will support the literature information in terms of the antifungal performance of the VITEK 2 system are presented.Publication Conventional amphotericin b associated nephrotoxicity in patients with hematologic malignancies(Cureus, 2021-07-17) Gürsoy, Vildan; Özkalemkaş, Fahir; Özkocaman, Vildan; Yeğen, Zafer Serenli; Pınar, İbrahim Ethem; Ener, Beyza; Akalın, Halis; Kazak, Esra; Ali, Rıdvan; Ersoy, Alparslan; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; PINAR, İBRAHİM ETHEM; ENER, BEYZA; AKALIN, EMİN HALİS; ALİ, RIDVAN; ERSOY, ALPARSLAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.; 0000-0001-9907-1498 ; 0000-0002-4803-8206; DLR-8474-2022 ; JIR-6730-2023 ; JGM-6601-2023 ; AAG-8523-2021 ; AAU-8952-2020; AAG-8459-2021; GXD-8209-2022; CPX-5894-2022Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection.Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively.Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m(2) days 1-7, Idarubicin 12 mg/m(2) days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process.Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.Publication Development of a real-time polymerase chain reaction method for the identification of Candida species(Ankara Microbiology, 2015-01-01) Ağca, Harun; Cilo, Burcu Dalyan; Özmerdiven, Gülşah Ece; Sağlam, Sezcan; Ener, Beyza; AĞCA, HARUN; Cilo, Burcu Dalyan; Özmerdiven, Gülşah Ece; Sağlam, Sezcan; ENER, BEYZA; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0002-2651-2034; AAG-8523-2021; AAH-4027-2021; IVV-5845-2023; ISU-9626-2023; KLD-2582-2024Candida species are one of the major causes of nosocomial infections and are the fourth most common agent involved in bloodstream infections. The impact of non-albicans Candida species is increasing, however C.albicans is still the most common species. Since the antifungal susceptibility pattern among Candida spp. may be different, rapid diagnosis and identification of non-albicans Candida spp. are important for the determination of antifungal agents that will be used for treatment. The aim of the study was to describe a real-time polymerase chain reaction (Rt-PCR) assay that rapidly detects, identifies and quantitates Candida species from blood culture samples. A total of 50 consecutive positive blood culture bottles (BACTEC, Beckton Dickinson, USA) identified at our laboratory between June-November 2013, were included in the study. Reference strains of Candida spp. (C.albicans ATCC 10231, C.glabrata ATCC 90030, C.tropicalis ATCC 1021, C.krusei ATCC 6258, C.parapsilosis ATCC 22019 and C. dubliniensis CD36) grown on Sabouraud dextrose agar were used for quality control. BACTEC bottles that were positive for Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were also studied to search the cross-reactivity. A commercial kit (Zymo Research, USA) was used for DNA extraction. Real-time PCR was performed on LightCycler 480 (Roche, Germany) with primers and probes specific for 18S rRNA of Candida species. Twenty microlitres of the reaction mix contained 2 mu l of extracted DNA, 2 mu l of LightCycler Fast Start DNA Master Probe (Roche Diagnostics, Germany), 2 mu l of MgCl2 (5 mmol), 2 mu l of 10x PCR buffer (Roche Diagnostics, Germany), 0.5 mu l of each primer (0.01 nmol/mu l) and 1 mu l of each probe (0.1 mu mol/mu l) (TibMolBiol, Germany). Amplification was performed using the following conditions; 95 degrees C for 10 mins and 50 cycles of denaturation at 95 degrees C for 10 secs, annealing at 62 degrees C for 10 secs and polymerisation at 72 degrees C for 20 secs. A melting curve was created by cooling the producs at 50 degrees C for 30 secs and then heating to 80 C at a rate of 0.1 degrees C/sec measuring of the fluorescence simultaneously. For the quantitation of fungal DNA according to the standard curve, serial dilutions of C.albicans ATCC 10231 DNA from 3 x 10(5) to 3 x 10(2) ng/mu l were used. All of the strains were also identified by conventional methods and sequence analysis in order to compare the results obtained by Rt-PCR. In our study, all patient and standard samples could be amplified, identified and quantitated by this developed Rt-PCR method. A total of 50 strains, of them 26 were C.parapsilosis, 15 were C.glabrata, 6 were C.albicans, and 3 were C.tropicalis have been detected and identified among patient samples. The results were completely concordant with the sequencing and conventional methods, so the sensitivity and specificity of this method were estimated as 100 percent. In conclusion, it was novel Rt-PCR developed and evaluated in this study is considered as a rapid, accurate, reproducible, sensitive and specific method for the detection, identification and quantitation of commonly observed Candida spp. strains.Publication Evaluation of micafungin use in children(Ankara Microbiology, 2020-01-01) Hacimustafaoglu, Mustafa; Yeşil, Edanur; YEŞİL, EDANUR; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Sezgin Evim, Melike; SEZGİN EVİM, MELİKE; Özer, Arife; Turan, Cansu; TURAN, CANSU; Timur, Demet; TİMUR, DEMET; Çakır, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Bülbül, Beyhan; BÜLBÜL, BEYHAN; Ener, Beyza; ENER, BEYZA; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Koksal, Nilgun; Özkan, Hilal; ÖZKAN, HİLAL; Sevinir, Betul; SEVİNİR, BETÜL BERRİN; Düzcan Kilimci, Duygu; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Onkoloji Anabilim Dalı.; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0001-5761-4757; 0000-0002-5720-1212; 0000-0002-3232-7652; 0000-0003-4646-660X; AAG-8523-2021; AEZ-2469-2022; GSO-3630-2022; AAH-1570-2021; HJZ-4508-2023; AAE-6201-2021; AAG-8393-2021; JCD-9679-2023Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.Publication Evaluation of serum indirect haemagglutination test results of suspected cystic echinococcosis cases from 2009-2017(Pakistan Medical Assoc, 2022-06-01) Tuzemen, Nazmiye Ulku; Alver, Oktay; Ozakin, Cuneyt; Ener, Beyza; Tuzemen, Nazmiye Ulku; TÜZEMEN, NAZMİYE ÜLKÜ; Alver, Oktay; ALVER, OKTAY; Ozakin, Cuneyt; ÖZAKIN, CÜNEYT; Ener, Beyza; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; A-4290-2018Objective: This study aims to evaluate the serological, radiological and epidemiological analysis of suspected cystic echinococcosis patients, and to assess the positivity rate in the region. Method: The retrospective study was conducted at Bursa Uludag University Hospital, Turkey and comprised data from January 2009 to December 2017 related to patients of either gender with suspected cystic echinococcosis who underwent indirect haemagglutination testing. Demographic and clinical data of patients who tested positive were analysed. Statistical analysis was done using SPSS 23. Results: Of the 3910 patients with a mean age of 41.6 +/- 19.35 years (range: 0-93 years) who underwent indirect haemagglutination testing, 692(17.7%) tested positive; 390(56.4%) females, and 302(43.6%) males. The highest seropositivity rate 107(15.5%) was observed in 2011, followed by 104(15%) in 2016. Seropositive cases were predominantly seen in those aged 40-49 years 131 (18.9%), followed by those aged 50-59 years 124 (17.9%). Conclusion: Cystic echinococcosis was found to be a public health problem in South Marmara region of Turkey.Publication Fatal cryptococcal meningitis in a patient with chronic lymphocytic leukemia(Pagepress Publ, 2012-01-01) Dizdar, Oğuzhan Sıtkı; Karakeçili, Faruk; Coşkun, Belkıs Nihan; COŞKUN, BELKIS NİHAN; Ener, Beyza; ENER, BEYZA; Ali, Rıdvan; ALİ, RIDVAN; Mistik, Reşit; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dahiliye Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hemotoloji Anabilim Dalı.; D-6213-2013; AAG-8523-2021; AAG-7155-2021Patients with chronic lymphocytic leukemia (CLL) are susceptible to infections, especially opportunistic infections. We have described a patient with CLL who had cryptococcal meningitis. Despite lack of previous immunosuppressive treatment history, the patient experienced serious and fatal fungal infection. Physicians should be alert for a diagnosis of cryptococcal meningitis in patient with CLL who developed fever and headache.Publication Impact of posaconazole prophylaxis and antifungal treatment on BAL GM performance in hematology malignancy patients with febrile neutropenia: A real life experience(Springer, 2023-10-16) Acet-Öztürk, Nilüfer Aylin; Ömer-Topcu, Dilara; Vurat Acar, Kübra; Aydın-Güçlü, Özge; Pınar, İbrahim Ethem; Demirdoğen, Ezgi; Görek-Dilektasli, Aslı; Kazak, Esra; Özkocaman, Vildan; Ursavaş, Ahmet; Özkalemkaş, Fahir; Ener, Beyza; Ali, Rıdvan; Akalın, Halis; ACET ÖZTÜRK, NİLÜFER AYLİN; ÖMER TOPÇU, DİLARA; VURAT ACAR, KÜBRA; AYDIN GÜÇLÜ, ÖZGE; PINAR, İBRAHİM ETHEM; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; KAZAK, ESRA; ÖZKOCAMAN, VİLDAN; URSAVAŞ, AHMET; ÖZKALEMKAŞ, FAHİR; ENER, BEYZA; ALİ, RIDVAN; AKALIN, EMİN HALİS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0002-6375-1472; 0000-0002-7400-9089; 0000-0001-7530-1279; AAI-3169-2021; JGM-6601-2023; Z-1424-2019; AAH-9812-2021; AAU-8952-2020; AAG-8459-2021; FRE-8778-2022; JQQ-5505-2023; GXD-8045-2022; JHW-9355-2023; FQG-8981-2022; JIW-1248-2023; CNK-0895-2022; GXD-8209-2022BackgroundDiagnostic accuracy of galactomannan measurements is highly variable depending on the study population, diagnostic procedures, and treatment procedures. We aimed to evaluate the effect of posaconazole prophylaxis and empiric antifungal treatment upon diagnostic accuracy of GM measurements in bronchoalveolar lavage (BAL), bronchial lavage (BL), and serum in hematological malignancy population.MethodsPatients hospitalized in a single tertiary care center with hematologic malignancies undergoing fiberoptic bronchoscopy (FOB) with a preliminary diagnosis of IPA were retrospectively included.ResultsIn all the study population (n = 327), AUC for BAL, BL, and serum GM were as follows: 0.731 [0.666-0.790], 0.869 [0.816-0.912], and 0.610 [0.540-0.676] with BL samples having the best diagnostic value. GM measurements in patients under posaconazole prophylaxis (n = 114) showed similar diagnostic performance. While specificity was similar between patients with and without posaconazole prophylaxis, sensitivity of GM measurements was lower in patients with prophylaxis. Analyses with patient classified according to antifungal treatment at the time of FOB procedure (n = 166) showed a decreased diagnostic accuracy in serum GM and BAL GM measurements related with the duration of treatment. However, BAL, BL, and serum GM measurements presented similar sensitivity and specificity in higher cut-off values in longer durations of antifungal treatment.ConclusionOur study shows that posaconazole prophylaxis and active short-term (3 days) antifungal treatment do not significantly affect overall diagnostic performance of GM measurements in bronchoalveolar lavage and bronchial lavage samples. However, using different cut-off values for patients receiving active treatment might be suggested to increase sensitivity.Publication Impact of revised EORTC/MSGERC 2020 criteria on diagnosis and prognosis of invasive pulmonary aspergillosis in patients with hematological malignancies undergoing bronchoscopy(Masson Editeur, 2022-06-14) Acet-Öztürk, N. A.; Ömer-Topcu, D.; Vurat-Acar, K.; Aydın-Güçlü, O.; Pınar, I. E.; Demirdoğen, E.; Görek-Dilektaşli, A.; Kazak, E.; Özkocaman, V; Ursavaş, A.; Akalın, H.; Özkalemkas, F.; Ener, B.; Ali, R.; ACET ÖZTÜRK, NİLÜFER AYLİN; ÖMER TOPÇU, DİLARA; VURAT ACAR, KÜBRA; AYDIN GÜÇLÜ, ÖZGE; PINAR, İBRAHİM ETHEM; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; KAZAK, ESRA; ÖZKOCAMAN, VİLDAN; URSAVAŞ, AHMET; AKALIN, EMİN HALİS; ÖZKALEMKAŞ, FAHİR; ENER, BEYZA; ALİ, RIDVAN; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0001-9907-1498; 0000-0002-7380-2501; JII-3270-2023; FRE-8778-2022; GXC-7806-2022; GXD-8045-2022; JGM-6601-2023; JIA-5197-2023; CRM-4095-2022; CZK-6380-2022; JIR-6730-2023; AAI-3169-2021; EJJ-6847-2022; JIW-1248-2023; CNK-0895-2022; GXD-8209-2022Introduction: The first consensus definitions for invasive fungal diseases (IFD) were published in 2002. Advan-ces in diagnostic tests and a clear need for improvement in certain areas led to a revision of these definitions in 2008. However, growing data on Aspergillus galactomannan (GM) thresholds and the introduction of new polymerase chain reaction-based diagnostic tests resulted in a further update by EORTC and Mycoses Study Group Education and Research Consortium (MSGERC) in 2020. Compared to the 2008 version, the 2020 EORTC/MSGERC criteria have stricter definitions, especially regarding GM levels, which should lead to improved specificity. Thus, our study aimed to evaluate diagnostic changes, based on GM levels, resulting from these new definitions and ascertain the impact of the new classification on mortality rates. Method: Patients hospitalized in a single tertiary care center with hematologic malignancies and undergoing bronchoscopy for suspected IPA between April 2004 and December 2019 were included in this retrospective study. Results: The study population consisted of 327 patients with 31 patients (nine patients with proven IPA and 22 patients with no IPA) excluded from the study. 194 patients were classified as probable IPA cases according to 2008 EORTC/MSG criteria. However, 53 (27.3%) of these patients were re-classified as possible IPA according to 2020 EORTC/MSGERC criteria, due to novel galactomannan cut-off levels. Compared to re-classified possible IPA patients, those remaining in the probable IPA category experienced a higher incidence of septic shock (34.0% vs 16.9%, p=0.02), and required more non-invasive (12.0% vs 0.0%, p=0.004) and invasive (44.6 vs 24.5%, p=0.01) mechanical ventilation. There was a higher in-hospital mortality rate in probable IPA patients than in the re-clas-sified possible IPA group (42.5% vs 22.6%, p=0.01). Patients reassigned to possible IPA had similar underlying dis-eases, radiological features and prognosis to patients already classified as possible IPA. Independent risk factors for mortality were classification as probable IPA according to 2020 EORTC/MSGERC criteria, lack of remission from hematologic malignancy, and number of nodules in Thorax CT. Conclusion: The use of 2020 EORTC/MSGERC criteria resulted in a 27.3% significant reduction in probable IPA diagnoses and created a more homogeneous category of patients with respect to treatment response, prog-nosis and mortality. Therefore, 2020 EORTC/MSGERC criteria afford more reliable mortality prediction than 2008 EORTC/MSG criteria.(c) 2022 SFMM. Published by Elsevier Masson SAS. All rights reserved.Publication Impact of the revised EORTC/MSGERC 2020 criteria upon prognosis in patients with hematologic malignancies undergoing bronchoscopy(European Respiratory Soc Journals, 2021-09-05) Topcu, Dilara Omer; Acer, Kubra Vurat; Guclu, Ozge Aydin; Pinar, Ibrahim Ethem; Demirdogen, Ezgi; Dilektasli, Asli Gorek; Kazak, Esra; Ozkocaman, Vildan; Ursavas, Ahmet; Akalin, Halis; Ozkalemtas, Fahir; Ener, Beyza; Ali, Ridvan; Ozturk, Nilufer Aylin Acet; ACET ÖZTÜRK, NİLÜFER AYLİN; ÖMER TOPÇU, DİLARA; VURAT ACAR, KÜBRA; AYDIN GÜÇLÜ, ÖZGE; PINAR, İBRAHİM ETHEM; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; KAZAK, ESRA; ÖZKOCAMAN, VİLDAN; URSAVAŞ, AHMET; AKALIN, EMİN HALİS; Ozkalemtas, Fahir; ENER, BEYZA; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0002-6375-1472; 0000-0003-1005-3205; 0000-0002-7400-9089; 0000-0001-7530-1279; 0000-0002-6375-1472; 0000-0003-1005-3205; 0000-0002-4803-8206; JGM-6601-2023; KHE-5423-2024; AAU-8952-2020; JPK-7012-2023; JWP-2738-2024; AAI-3169-2021; Z-1424-2019; JIF-7772-2023; CBS-8892-2022; AAG-9930-2019; CNP-1063-2022; AAG-8459-2021; FQG-8981-2022; FQJ-3657-2022; AAG-8523-2021; GXD-8209-2022Publication Invasive fungal infections in renal transplant recipients: Epidemiology and risk factors(Oxford Univ Press, 2015-05-01) Şahin, Sezin Zorlu; Akalın, Halis; YILDIZ, ABDULMECİT; KAZAK, ESRA; AKALIN, EMİN HALİS; Ersoy, Alparslan; ERSOY, ALPARSLAN; OCAKOĞLU, GÖKHAN; Ocakoğlu, Gökhan; Dizdar, Oğuzhan; Kazak, Esra; ENER, BEYZA; Ener, Beyza; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0001-7530-1279; 0000-0002-1114-6051; HLG-6346-2023; AAH-5180-2021; AAG-8459-2021; AAU-8952-2020; AAH-5054-2021; AAG-8523-2021; D-6213-2013Publication Invasive fusariosis in patients with hematologic malignancies at a university hospital(Amer Soc Hematology, 2015-12-03) Özkocaman, Vildan; Özkalemkaş, Fahir; Cilo, Burcu Dalyan; Alp, Tuğcan; Ersal, Tuba; Gözden, Erdem; Yeğen, Zafer Serenli; Rıdvan, Ali; Ener, Beyza; ÖZKOCAMAN, VİLDAN; ÖZKALEMKAŞ, FAHİR; Cilo, Burcu Dalyan; Alp, Tuğcan; ERSAL, TUBA; Gözden, Erdem; Yeğen, Zafer Serenli; ALİ, RIDVAN; ENER, BEYZA; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0002-1361-6213; 0000-0002-4803-8206; AAJ-4354-2021; AAG-8523-2021; AAI-5246-2020; AAG-8495-2021; IVV-5845-2023; AAH-1854-2021; HMD-4249-2023; EWL-5375-2022; EFO-5712-2022; DMU-2091-2022Publication Investigation of parasitic infection rate in stool samples submitted to uludag university parasitology laboratory between 2011-2015(Bilimsel Tip Yayinevi, 2017-01-01) Tüzemen, Nazmiye Ülkü; TÜZEMEN, NAZMİYE ÜLKÜ; Alver, Oktay; Ener, Beyza; ENER, BEYZA; ALVER, OKTAY; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0003-3544-3509; AAA-5241-2021; A-4290-2018; AAG-8523-2021Introduction: Intestinal parasitic infections are among the most significant causes of morbidity and mortality in undeveloped countries, particularly in children. These infections may cause loss in physical and mental progress of children in particular, and loss of work and labour force in adults.Materials and Methods: In this study, patients who applied with various gastrointestinal complaints to the clinics of the Uludag University Medical Faculty, were thoroughly investigated for the presence of intestinal parasites. A total of 8981 stool and 854 cellophane tape samples were parasitologically evaluated. All stool samples were prepared using formal-ethyl acetate concentration method for helminth ova and protozoan cysts, and examined in lugol preparations microscopically with 10x and 40x magnifications. Preparations were examined by using oil-immersion objectives (100x) following trichrome and modified Erlich-Ziehl-Nielsen staining for the diagnosis of intestinal and coccidian protozoa, respectively. For the detection of Entamoeba histolytica adezin antigen in stools, commercial ELISA kit (Wampole (R) E. histolytica II Test Kit; TechLab, USA) was used.Results: In this study, one or more parasites were found in 327 (3.6%) of the 8981 stool samples (including nonpathogenic protozoa). Enterobius vermicularis eggs were detected in 29 (3.4%) out of 854 samples by using the cellophane tape method. Of the parasite detected cases, 165 (50.5%) were female and 162 (49.5%) were male. Giardia intestinalis (0.9%) and E. vermicularis (3.4%) were the most frequently detected protozoon and helmint parasites, respectively. The parasites were detected mostly in summer months (26.3%).Conclusion: Although the prevalence rates of intestinal parasites were lower than those in the previous studies carried out in the city, it is seen that the presence of intestinal parasites is still a serious public health problem in our region.Publication Investigation of the defective growth pattern and multidrug resistance in a clinical isolate of Candida glabrata using whole-genome sequencing and computational biology applications(Amer Soc Microbiology, 2022-07-18) Merdan, Osman; Şişman, Ayşe Sena; Aksoy, Seçil Ak; Kızıl, Samet; Tüzemen, Nazmiye Ülkü; Yılmaz, Emel; Ener, Beyza; MERDAN, OSMAN; ŞİŞMAN, AYŞE SENA; Aksoy, Seçil Ak; Kızıl, Samet; TÜZEMEN, NAZMİYE ÜLKÜ; YILMAZ, EMEL; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Klinik Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/İnegöl Meslek Yüksekokulu.; 0000-0001-9824-6073; 0000-0003-3544-3509; 0000-0002-3894-1231; JCN-8933-2023; ADM-8457-2022; A-4290-2018; JCN-9142-2023; GOI-2416-2022; GOI-0092-2022; HJZ-6992-2023; CNK-0895-2022Candida glabrata is increasingly isolated from blood cultures, and multidrug-resistant isolates have important implications for therapy. This study describes a cholesterol-dependent clinical C. glabrata isolate (ML72254) that did not grow without blood (containing cholesterol) on routine mycological media and that showed azole and amphotericin B (AmB) resistance. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) and whole-genome sequencing (WGS) were used for species identification. A modified Etest method (Mueller-Hinton agar supplemented with 5% sheep blood) was used for antifungal susceptibility testing. WGS data were processed via the Galaxy platform, and the genomic variations of ML72254 were retrieved. A computational biology workflow utilizing web-based applications (PROVEAN, AlphaFold Colab, and Missense3D) was constructed to predict possible deleterious effects of these missense variations on protein functions. The predictive ability of this workflow was tested with previously reported missense variations in ergosterol synthesis genes of C. glabrata. ML72254 was identified as C. glabrata sensu stricto with MALDI-TOF, and WGS confirmed this identification. The MICs of fluconazole, voriconazole, and amphotericin B were.256,.32, and.32 mg/ mL, respectively. A novel frameshift mutation in the ERG1 gene (Pro314fs) and many missense variations were detected in the ergosterol synthesis genes. None of the missense variations in the ML72254 ergosterol synthesis genes were deleterious, and the Pro314fs mutation was identified as the causative molecular change for a cholesterol-dependent and multidrug-resistant phenotype. This study verified that web-based computational biology solutions can be powerful tools for examining the possible impacts of missense mutations in C. glabrata.IMPORTANCE In this study, a cholesterol-dependent C. glabrata clinical isolate that confers azole and AmB resistance was investigated using artificial intelligence (AI) technologies and cloud computing applications. This is the first of the known cholesterol-dependent C. glabrata isolate to be found in Turkey. Cholesterol-dependent C. glabrata isolates are rarely isolated in clinical samples; they can easily be overlooked during routine laboratory procedures. Microbiologists therefore need to be alert when discrepancies occur between microscopic examination and growth on routine media. In addition, because these isolates confer antifungal resistance, patient management requires extra care.Publication Is the extraction by Whatman FTA filter matrix technology and sequencing of large ribosomal subunit D1-D2 region sufficient for identification of clinical fungi?(Wiley, 2015-10-01) Kiraz, Nuri; Öz, Yasemin; Aslan, Hüseyin; Erturan, Zayre; Ener, Beyza; Akdağlı, Sevtap Arıkan; Müslümanoğlu, Hamza; Çetinkaya, Zafer; ENER, BEYZA; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı; 0000-0002-4803-8206; AAG-8523-2021Although conventional identification of pathogenic fungi is based on the combination of tests evaluating their morphological and biochemical characteristics, they can fail to identify the less common species or the differentiation of closely related species. In addition these tests are time consuming, labour-intensive and require experienced personnel. We evaluated the feasibility and sufficiency of DNA extraction by Whatman FTA filter matrix technology and DNA sequencing of D1-D2 region of the large ribosomal subunit gene for identification of clinical isolates of 21 yeast and 160 moulds in our clinical mycology laboratory. While the yeast isolates were identified at species level with 100% homology, 102 (63.75%) clinically important mould isolates were identified at species level, 56 (35%) isolates at genus level against fungal sequences existing in DNA databases and two (1.25%) isolates could not be identified. Consequently, Whatman FTA filter matrix technology was a useful method for extraction of fungal DNA; extremely rapid, practical and successful. Sequence analysis strategy of D1-D2 region of the large ribosomal subunit gene was found considerably sufficient in identification to genus level for the most clinical fungi. However, the identification to species level and especially discrimination of closely related species may require additional analysis.Publication Trends of bloodstream infections in a university hospital during 12 years(Polskie Towarzystwo Mikrobiologow-polish Society Of Microbiologists, 2022-09-24) Tuzemen, Nazmiye Ulku; Payaslioglu, Melda; Özakin, Cuneyt; Ener, Beyza; Akalin, Halis; Tuzemen, Nazmiye Ulku; TÜZEMEN, NAZMİYE ÜLKÜ; Payaslioglu, Melda; PAYASLIOĞLU, AYŞE MELDA; Ozakin, Cuneyt; ÖZAKIN, CÜNEYT; Ener, Beyza; ENER, BEYZA; Akalin, Halis; AKALIN, EMİN HALİS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0001-7530-1279; A-4290-2018; AAU-8952-2020This study aims to investigate trends in bloodstream infections and their antimicrobial susceptibility profiles over 12 years in our hospital. This retrospective study was carried out in the Bursa Uludag University Hospital, Turkey, during 2008-2019. Blood cultures from patients were performed using BACTEC System. Isolates were identified with Phoenix System until 2018 and "matrix-assisted laser desorption ionization time-of-flight mass spectrometry" (MALDI-TOF MS) in 2019. Antibiotic susceptibility testing was performed with Phoenix System. Patient data came from the BD EpiCenter (TM) data management system. Escherichia coli was found to be the most common Gram-negative (11.6%), and coagulase-negative staphylococci were the most common Gram-positive (10.1%) monomicrobial growth. Overall, there was a significant increase in rates of extended-spectrum beta-lactamase positive E. coli (p = 0.014) and Klebsiella pneumonia (p < 0.001), carbapenem-resistant E. coli (p < 0.001), and K. pneumoniae (p < 0.001) and colistin-resistant K. pneumoniae (p < 0.001) and Acinetobacter baumannii (p < 0.001) over 12 years. Carbapenem and colistin resistance has increased dramatically in recent years. We believe that regular monitoring of the distribution of pathogens and antibiotic susceptibility profiles, especially in intensive care units, can contribute to evidence for the increase in resistant microorganisms and help prevent their spread with antimicrobial stewardship and infection control policies.Publication Viral and atypical bacterial respiratory infections in a university teaching hospital(Natl Inst Infectious Diseases, 2019-09-01) Harun, Ağca; Beyza, Ener; AĞCA, HARUN; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı; 0000-0002-2651-2034; AAH-4027-2021; ISU-9626-2023Respiratory viral and atypical bacterial agents lead to infections in a large spectrum, from mild symptoms to respiratory failure. In the present study, we aimed to detect multiple viral and bacterial agents in the respiratory samples of inpatients by real-time polymerase chain reaction (RT-PCR). Nasopharyngeal swabs and broncho-alveolar lavage samples from inpatients with respiratory infection symptoms at the Uludag University Hospital between December 1, 2015 and March 31,2018 were investigated. DNA/RNA was extracted using the EZ1 Virus Mini Kit v2.0 (Qiagen, Belgium) with the EZ1 extraction device (Qiagen, Belgium). The R-GENE (R) RT-PCR (Biomerioux, France) kit was used to detect influenza A, influenza B, respiratory syncytial virus (RSV), human metapneumovirus, rhinovirus/enterovirus (RV/EV), adenovirus, human bocavirus (hBoV), corona virus, parainfluenza virus, Chlamydia pneumoniae/Mycoplasma pneumoniae, and Legionella pneumophila in Rotor-Gene Q (Qiagen, Belgium). Patients were aged between 0 and 90 years. Overall, 177 (56.9%) patients were men and 134 (43.1%) were women. A total of 311 samples were analyzed, of which 214 (68.8%) were positive. In total, 360 agents, including 338 viruses and 22 bacteria, were detected. The commonest agents were influenza A+B (n = 65, 18,1%), hBoV (n = 64, 17.8%), RV/EV (n = 56, 15.6%), and RSV (n = 47, 13.1%). Rapid diagnosis of viral infections by RT-PCR is important for the specific treatment of patients.