Browsing by Author "Kazak, Esra"
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Item 2005-2022 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesinde izlenen sifiliz olgularının retrospektif irdelenmesi(Bursa Uludağ Üniversitesi, 2024) Sertkaya, Hatice; Kazak, Esra; Bursa Uludağ Üniversitesi / Tıp Fakültesi / Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim DalıBu çalışmada; merkezimizde takip edilen sifiliz olgularının epidemiyolojik özellikleri, tedavi yanıtı ve seroreversiyonu etkileyen faktörler incelendi. HIV ile enfekte, nörosifilizli ve oküler sifilizli olgular ayrıca irdelendi. 2005–2022 yılları arasında sifiliz tanısı ile takip edilen 503 hasta retrospektif olarak incelendi. Olguların 371’i(%74) erkek, 132’si(%26) kadındı, ortalama yaş 40,16 ± 10,6 idi. Kadın hastaların 25(%18,9)’i gebeydi. Yıllar içinde sifiliz insidansının ve erken sifiliz oranlarının arttığı görülmüş olup, hastaların 21(%4,2)’i primer, 91(%18)’i sekonder, 18(%3,6)’i tersiyer, 10(%2)’u erken latent, 363(%72,2)’ü geç latent evredeydi. 23(%4,5) hastada SSS, 15(%3) hastada göz, 2(%0,4) hastada otik, 2(%0,4) hastada gumma, 2(%0,4) hastada kardiyak tutulum vardı. Nörosifilizli 20(%87) hastada BOS incelemesi yapılmıştı; VDRL 7(%37), Sifiliz İHA 15(%84) pozitifti. Oküler sifilizli 6(%40) hastada üveit, 9(%60) hastada retinit görüldü. 9(%60) hastaya BOS incelemesi yapılmıştı; 6(%66,6) hastada nörosifiliz de eşlik ediyordu. 134(%26) hastada HIV koenfeksiyonu vardı. Yıllar içinde HIV koenfeksiyon oranlarının arttığı görüldü. HIV ile enfekte olan grupta erkek hasta ve ESE/biseksüel oranı daha yüksek olup (p<0,001), sekonder evre ve lenfadenopati daha sık görüldü (sırasıyla p=0,003, p=0,043), medyan RPR titreleri daha yüksekti (p<0,001). Hastaların %73,6’sında tedavi yanıtı, %36’sında seroversiyon görüldü. HIV koenfeksiyonu, erken evrede olunması, RPR titresinin >1:32 olmasının tedavi yanıtını olumlu etkilediği (sırasıyla p=0,013, p<0,001 p<0,001), daha önce sifiliz tedavi öyküsünün olmasının ise olumsuz etkilediği (p=0,004) saptandı. Başlangıç RPR titresinin <1:8 olmasının seroreversiyonu artırdığı (p=0,009) saptandı. Sifiliz insidansının arttığı günümüzde erken tanı ve önleme için toplumun bilinçlendirilmesinin, riskli grupların ve gebelerin taranmasının önemi artmaktadır. Tedavi başarısını etkileyen faktörlerin net olarak bilinmesi hastaların yönetimini kolaylaştıracaktır.Publication Antibody response to hepatitis B vaccination in isolated anti-Hbc IgG positive cases(Galenos Yayıncılık, 2012-08-01) Kazak, Esra; Yılmaz, Emel; Mıstık, Reşit; Akalın, Halis; Akgöz, Semra; Göral, Güher; KAZAK, ESRA; YILMAZ, EMEL; Mıstık, Reşit; AKALIN, EMİN HALİS; Göral, Güher; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0001-7530-1279; AAU-8952-2020; AAG-8459-2021; HTL-9425-2023; DFY-3761-2022; JGX-8396-2023Objective: We aimed to investigate the antibody response secondary to 1 dose of hepatitis B vaccine and factors affecting this response in isolated cases of anti-HBc IgG positive cases.Materials and Methods: Fortyone people who were positive for isolated anti-HBc and negative for other markers of hepatitis B were recruited in the study. The level of anti-HBs was measured at the 10th and 30th day after the administration of hepatitis B vaccine to these 41 people. HBV-DNA was searched with PCR in people who did not developed a secondary antibody response to one dose of vaccination at Day 10 and 30.Results: Anti-HBs was found to be at protective levels (>= 10 IU/mL) in 27 (65.8 %) out of 41 people included in the study. The antibody response developed in 27 people with one dose of vaccination was thought to be a secondary response, and the 14 people who did not form anti-HBs and were found to be negative for HBVDNA by PCR were thought to have false anti-HBc positivity and be inactive HBs Ag carriers (HBs Ag falling below the measurable level in time and presence of antiHBe or preS, S, precor, cor mutant strain infection). There was a highly significant correlation between antibody levels at Day 10 and Day 30 (p< 0.001). In addition, when the antibody levels of people who developed secondary response at Day 10 were investigated, antibody levels of non-smokers were found to be (0-1000 IU/mL; 194.3 +/- 327.2 IU/mL) significantly higher compared to smokers (0-70 IU/mL; 12 +/- 21.8 IU/mL) (p= 0.015). No statistically significant difference was determined between the antibody responses at Day 10 and Day 30 of people with a history of diabetes mellitus (DM), malignity, chronic diseases, alcohol consumption, previous HBsAg positivity and HBV-DNA positivity, anti-HCV positivity, and hepatitis B carriers in the family (p> 0.05).Conclusion: An anamnestic response is suggested in people who give anti-HBs response to one dose of hepatitis B vaccine. However, a false anti-HBc IgG positivity or undetectable levels of HBs Ag should be considered in people who do not give antibody response. According to our results smoking affects the level of antibody response negatively. But we need further studies involving more people.Publication 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.Item Brucella abortus L7/L12 recombinant protein induces strong Th1 response in acute brucellosis patients(Shiraz Institute of Cancer Research, 2010-09) Oliveira, Sergio; Kazak, Esra; Göral, Güher; Akalın, Halis; Yılmaz, Emel; Heper, Yasemin; Oral, Haluk Barbaros; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/ Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0003-0463-6818; K-7285-2012; AAG-8459-2021; AAH-6506-2021; AAU-8952-2020; 24921238200; 6603453166; 57207553671; 22037135100; 56191003300; 7004498001Background: Because of high morbidity of the brucellosis in humans and the potential use of the microorganism as an agent of biologic warfare, protection of effective vaccines and specific diagnostic reagents become necessary to eradicate brucellosis. Objective: In this study we aimed to investigate the cytokine responses and changes in peripheral blood lymphocyte subgroups of acute brucellosis patients in response to L7/L12 and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) recombinant proteins derived from Brucella abortus. Methods: levels of IFN-gamma, IL-4 and IL-10 secreted from PBMCs of 25 acute brucellosis patients and 15 healthy controls, stimulated with Phytohemagglutinin (PHA), L7/L12 or GAPDH were measured by ELISA. Furthermore alterations in lymphocyte subgroups in response to these Brucella antigens were determined by flow cytometry. Results: Extracellular IFN-gamma levels were found to be elevated after stimulation with L7/L12 in patients with acute brucellosis, whereas no significant changes were found in IL-4 and IL-10 levels. Similar data was also obtained with GAPDH, but the stimulation of IFN-gamma production was not observed in all patients and was not as strong as that observed for L7/L12. Moreover, when the distribution of lymphocytes subgroups (CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD4(+)CD25(+), CD3(+)CD69(+) and CD3(+)CD152(+)) was evaluated, it was found that the stimulation with L7/L12 and GAPDH only led to an increase in the percentage of CD3(+)CD69(+) lymphocytes. Conclusion: These data indicate that Brucella abortus L7/L12 or GAPDH induce a Th1 type immune response in acute brucellosis patients. Additionally, these recombinant proteins, especially L7/L12, may be used in new vaccine preparations and diagnostic tests.Item Brucellosis: A retrospective evaluation of 164 cases(Singapore Medical, 2016-11) Kazak, Esra; Akalın, Halls; Ylımaz, Emel; Heper, Yasemin; Mıstık, Resit; Sınırtaş, Melda; Özakın, Cüneyt; Göral, Güher; Helvacı, Safiye; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0001-5428-3630; 0000-0002-3894-1231; AAH-6506-2021; AAU-8952-2020; AAG-8459-2021; AAG-8392-2021; 24921238200; 57207553671; 22037135100; 56191003300; 6602564624; 6505818048; 57200678942; 6603453166; 6602103491INTRODUCTION Brucellosis is a public health problem that is prevalent in several developing countries. METHODS The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. RESULTS The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. CONCLUSION Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.Item Bruseloz'da spesifik T hücre yanıtının regülasyonu(Uludağ Üniversitesi, 2006) Kazak, Esra; Oral, H. Barbaros; Uludağ Üniversitesi/Tıp Fakültesi/Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.Brucella, insanlarda endokardit, artrit, osteomiyelit, menenjite yol açan gram negatif hücre içi bakteridir. Hastalığın kronikleşme riski ve yüksek morbiditesi nedeni ile etkili aşı ve yeni tanı reaktanlarının geliştirilmesine ihtiyaç duyulmuştur. Bu amaçla Brucella antijenlerinden yeni sentetik peptitler geliştirilmiş ve hayvan modellerinde denenmiştir. Ancak bu peptidlere karşı insan immün sisteminin yanıtına ait yeterli çalışma yoktur. Çalışmamızda B. abortus’dan elde edilen L7/L12 ve GAPDH peptitlerine karşı Bruselloz’lu hastaların periferal kan lenfositlerinin profilleri ve sitokin yanıtının araştırılması amaçladık. Akut Bruselloz’lu ve sağlıklı hastaların kan lenfositlerinde bu antijenlere yanıt olarak ortaya çıkan lenfosit alt gruplarındaki değişiklikleri akım sitometrisi ile ve hücre dışı sitokin üretimini bu hücrelerin kültür süpernatantlarında ELISA yöntemi ile araştırdık. Çalışmaya 25 Akut Bruselloz hastası ve 15 sağlıklı birey alındı. Bu kişilerden elde edilen periferal mononükleer hücreler PHA, L7/L12, GAPDH ile uyarıldıktan sonra lenfosit alt grupları ve hücre dışı sitokin (IFN-γ, IL-4, IL10) miktarı ölçüldü. Uyarı sonucu Bruselloz’lu hastalarda hücre dışı IFN-γ seviyeleri yüksek tespit edildi. Gruplar arasında uyarı sonrası IL-4, IL-10 seviyeleri arasında farklılık yoktu. Çalışmada ayrıca CD3+/CD4+, CD3+/CD8+, CD4+/CD25+, CD4+/CD27-, CD3+/CD152+(CTLA4), CD3+/CD69+ lenfosit dağılımı araştırıldı. Bu peptidler ile uyarı sonucunda hastalarda CD3+/CD69+ lenfosit oranının arttığı saptandı. Ancak diğer lenfosit alt gruplarının dağılımında hasta ve sağlıklı gruplar arasında farklılık tespit edilmedi. Bu çalışmalarda elde edilen veriler ışığında Bruselloz’da koruyucu immüniteden Th1 tip immünitenin sorumlu olduğunu, GAPDH ve/veya L7/L12’nin yeni Bruselloz aşı preparasyonlarında; bu peptitler ile uyarıyı takiben IFN-γ yapımını temel alan spesifik hücresel immün yanıtı ölçen immünolojik tanı testlerinde kullanılabileceğini söyleyebiliriz. Bununla birlikte GAPDH ve L7/L12’nin kompleks immünomodülatör etkilerini açıklığa kavuşturacak yeni ve daha ileri çalışmalara gereksinim vardır.Item Central nervous system infections in the absence of cerebrospinal fluid pleocytosis(Elsevier, 2017-10-12) Kazak, Esra; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı; AAG-8459-2021; 24921238200Previous multicenter/multinational studies were evaluated to determine the frequency of the absence of cerebrospinal fluid pleocytosis in patients with central nervous system infections, as well as the clinical impact of this condition. It was found that 18% of neurosyphilis, 7.9% of herpetic meningoencephalitis, 3% of tuberculous meningitis, 1.7% of Brucella meningitis, and 0.2% of pneumococcal meningitis cases did not display cerebrospinal fluid pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had a high rate of unfavorable outcomes and thus this condition should not be underestimated.Item Comparative evaluation of galactomannan optical density indices and culture results in bronchoscopic specimens obtained from neutropenic and non-neutropenic patients(Wiley, 2013-08-10) Ağca, Harun; Ener, Beyza; Yılmaz, Emel; Ursavaş, Ahmet; Kazak, Esra; Özkocaman, Vildan; Çetinoǧlu, Ezgi Demirdöǧen; Görek Dilektaşlı, Aslı; Akalın, Halis; Özkalemkaş, Fahir; Ali, Rıdvan; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları ve Verem Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Ünitesi, İç Hastalıkları Anabilim Dalı.; 0000-0002-4803-8206; 0000-0002-2651-2034; 0000-0002-3894-1231; AAG-8523-2021; AAH-4027-2021; AAU-8952-2020; AAI-3169-2021; AAH-1854-2021; AAG-8459-2021; AAG-8495-2021; 15759379900; 15053025300; 22037135100; 8329319900; 24921238200; 6603145040; 57189524206; 36466376600; 57207553671; 6601912387; 7201813027Aspergillus infections are major causes of morbidity and mortality among immunocompromised patients. This study was designed to investigate the galactomannan assay optical density (OD) indices relative to the culture results in bronchoscopic samples obtained from neutropenic and non-neutropenic patients. Galactomannan OD indices from 1427 samples from 2005 to 2012, which were sent from 839 patients and were composed of bronchial lavage (BL=727) and bronchoalveolar lavage fluids (BAL=700), were retrospectively analysed. The recovery rates of Aspergillus species from these specimens were 9.4% from the combined patient group and 13.3% from the neutropenic group. Aspergillus fumigatus complex was the most frequently isolated species. The mean and median OD indices of the positive and negative culture samples are approximately 5 and 1, respectively, and 91% of all culture-positive samples have 1 OD index value. The receiver-operating characteristics curve analysis demonstrated that the feasibility of the Aspergillus galactomannan assay and Aspergillus galactomannan test has superior accuracy in BAL compared to BL fluids, and the test is not affected by the immune status of the patient. We suggest that the Aspergillus galactomannan test, which uses bronchoscopic material, leads to an earlier diagnosis and if the OD index is found 1, fungal growth can be expected.Item Comparison of galactomannan, beta-D-glucan, and Aspergillus DNA in sera of high-risk adult patients with hematological malignancies for the diagnosis of invasive aspergillosis(TÜBİTAK, 2015-06-28) Okuturlar, Yıldız; Keskin, Kürşad; Burgazlıoğlu, Başak; Bölük, Gülçin; Kazak, Esra; Özkalemkaş, Fahir; Ener, Beyza; Akalın, Halis; Ağca, Harun; Ali, Rıdvan; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Ünitesi.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0002-4803-8206; 0000-0002-2651-2034; AAG-8523-2021; AAG-8495-2021; AAG-8459-2021; AAU-8952-2020; AAH-4027-2021; 56196200800; 24921238200; 6601912387; 15053025300; 57207553671; 15759379900; 7201813027Bckground/aim: Invasive aspergillosis (IA) is a fatal infection that is difficult to diagnose in immunocompromised patients. In this study, Aspergillus-specific DNA was searched using real-time PCR (RT-PCR) in serum samples. Galactomannan (GM) and/or beta-D-glucan (BDG) tests were previously performed on these samples for 70 neutropenic patients with hematological malignancy. Materials and methods: The patients were categorized according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG). Among the patient serum samples, the first positive GM or BDG test sample and the median sample of GM or BDG test for negative patients were used to detect DNA levels by RT-PCR method (Light Cycler 480, Roche Molecular Biochemicals, Meylan, France) using a commercial kit (Way2Gene Fungi; Genmar, Izmir, Turkey). Results: When the proven and probable IA group were considered as real patients, sensitivity of Aspergillus-specific DNA test was 90%, specificity was 73.3%, positive predictive value was 81.8%, and negative predictive value was 84.6%. Conclusion: This study found that searching for specific DNA by RT-PCR method has a sensitivity as high as the GM test. Although specificity was rather low, it was concluded that it can be used jointly with GM and BDG tests after decreasing contamination by severe laboratory applications.Item Comparison of the E-test method with an automated bacterial identification and antimicrobial susceptibility detection system for screening extended-spectrum beta-lactamase producers(Informa Healthcare, 2003-10) Özakın, Cüneyt; Sınırtaş, Melda; Sevgican, Emine; Kazak, Esra; Gedikoğlu, Suna; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; AAĞ-8459-2021; 57200678942; 6505818048; 16246450600; 24921238200; 6603407548Some automated systems used in clinical microbiology laboratories are able to detect products responsible for antimicrobial resistance. In this study, 626 isolates (436 Escherichia coli, 134 Klebsiella pneumoniae and 56 Klebsiella oxytoca strains) were examined for the presumptive detection of extended-spectrum beta-lactamase (ESBL) production by 2 methods: the Sceptor system (BD, Sparks, MD, USA) and the E-test. ESBL production was detected in 26 E. coli strains (5.96%), 60 K. pneumoniae strains (44.77%) and 15 K. oxytoca strains (26.78%) by ceftazidime/ceftazidime-clavulanate E-test. Using the E-test, ESBL production was detected in 25 of 201 E. coli strains (12.43%), 55 of 75 K. pneumoniae (73.33%) and 14 of 27 K. oxytoca strains (51.85%) that were alerted as ESBL-producing strains by the Sceptor system. ESBL positivity was detected in 1 E. coli, 5 K. pneumoniae and 1 K. oxytoca strains, that were not warned as being ESBL producers by the Sceptor system. These data suggest that clinical microbiology laboratories should not only rely on these rapid automated systems but also use another method for screening ESBL producers, such as the E-test. The rates of these ESBL-producing isolates in this study were lower than those in other studies reported from other parts of Turkey, but higher than those reported from the USA and Europe.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 Evaluation of using empiric glycopeptides in accordance with the idsa guidelines in hematologic malignancy patients with febrile neutropenia(Mattioli 1885, 2022-05-01) Yalçın, Cumali; Özkalemkaş, Fahir; Özkocaman, Vildan; Ersal, Tuba; Pınar, İbrahim Ethem; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Akyol, Merve Nur; Ada, Nevriye Gül; Özakın, Cüneyt; Kazak, Esra; Akalın, Halis; Ali, Rıdvan; YALÇIN, CUMALİ; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; ERSAL, TUBA; PINAR, İBRAHİM ETHEM; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; AKYOL, MERVE NUR; ADA, NEVRİYE GÜL; ÖZAKIN, CÜNEYT; KAZAK, ESRA; AKALIN, EMİN HALİS; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0001-7530-1279; 0000-0003-3970-2344; 0000-0001-5428-3630; KIE-5102-2024; JIW-1248-2023; FQG-8981-2022; AAJ-4354-2021; JGM-6601-2023; ACW-2157-2022; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; JYC-2094-2024; GNJ-2469-2022; AAG-8392-2021; AAG-8459-2021; AAU-8952-2020; GXD-8209-2022Background: This study aimed to evaluate the effects of the appropriate use of empiric glycopeptide therapy in hematologic malignancy patients with febrile neutropenia (FN).Materials and Methods: Patients with FN who were hospitalized in our clinic and started empiric glycopeptide therapy were retrospectively analyzed. Empiric glycopeptide treatment initial indications were determined according to 7 specific criteria in the IDSA guidelines. In addition, the duration of glycopeptide use according to initial indications, causative pathogens in culture positivity, frequency of VRE infection, and the mortality rate was identified.Results: 87 patients were included. Of these, 102 episodes of FN were analyzed. Appropriate use of glycopeptides was observed in 98% of patients. The most common initial indication for glycopeptide was skin or soft-tissue infection, with 52% (n = 53). The mean duration of glycopeptide use was 11 (2-22) days. The time of glycopeptide use was longer in patients with catheter-related infections than in those with severe mucositis and hemodynamic instability (p = 0,041/p = 0,016). The duration of glycopeptide use was shorter in patients with consolidation therapy than in those without consolidation therapy. The mortality rate in culture-positive patients was significantly higher than in culture-negative patients (p = 0.041). At 72 h, glycopeptide therapy was discontinued in 8 of 79 FN episodes within culture-negative patients.Conclusion: This study showed that the mortality rate was higher in culture-positive patients. Additionally, glycopeptides should be discontinued early with no evidence of gram-positive infection.Publication Healthcare-associated stenotrophomonas maltophilia bacteraemia: Retrospective evaluation of treatment and outcome(Springernature, 2021-10-20) Tuncel, Tekin; Akalın, Halis; Payaslıoğlu, Melda; Yılmaz, Emel; Kazak, Esra; Heper, Yasemin; Özakın, Cüneyt; Tuncel, Tekin; AKALIN, EMİN HALİS; PAYASLIOĞLU, AYŞE MELDA; YILMAZ, EMEL; KAZAK, ESRA; HEPER, YASEMİN; ÖZAKIN, CÜNEYT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0001-7530-1279; 0000-0003-1785-3539; AAU-8952-2020; EBR-5383-2022; FQO-1207-2022; GDP-0005-2022; AAG-8459-2021; CTY-9474-2022; JNH-9929-2023IntroductionStenotrophomonas maltophilia (SM) is one of the common gram-negative pathogens that cause nosocomial infections. The aim of the present study is to evaluate the treatment and outcome of SM bacteraemia.Materials and MethodsWe retrospectively evaluated antimicrobial treatment in adult patients with nosocomial SM bacteraemia, with the 14th and 30th-day mortality as the outcome.ResultsIn total, 140 adult patients with SM bacteraemia who were diagnosed between January 1, 2002, and December 31, 2016 were enrolled in the present study. Seventy-one (50.7%) patients were in the intensive care unit (ICU). The 14th and the 30th-day mortality rates were 32.9% (n=46) and 45.7% (n=64), respectively. Female sex (OR, 7.47; 95% CI 1.61-34.47, p<0.01), steroid use within the last month (OR, 10.2; 95% CI 1.27-82.27, p=0.029), Pittsburgh bacteraemia score (PBS) >= 4 (OR, 39.9; 95% CI 4.96-321.32, p<0.001) and solid organ malignancy (OR, 9.6; 95% CI 1.73-53.72, p<0.01) were independent risk factors for 14th day mortality. Removal of the catheter was an independent protective factor for both 14th (OR, 0.05; 95% CI 0.22-0.010, p<0.001) and 30th day (OR, 0.039;95% CI 0.164-0.009, p<0.001) mortality. We did not detect any difference between treatment regimens including trimethoprim-sulfamethoxazole (TMP/SMX) or levofloxacin in terms of mortality. We found that TMP/SMX and levofloxacin combination did not significantly improve patient prognosis.ConclusionDue to the high mortality rates associated with nosocomial SM bacteraemia, adequate antibiotic therapy should be initiated immediately in the suspicion of infection, and prompt removal of any indwelling central venous catheter is important.Item İmmünsüprese bir hastada salmonella enteritidis’in etken olduğu gluteal apse(Uludağ Üniversitesi, 2014-07-22) Özvatan, Tülay Şener; Ceylan, Serkan; Kırdak, Türkay; Kazak, Esra; Cilo, Burcu Dalyan; Yılmaz, Emel; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.In this study it was aimed to investigate interrelationships between complaints, diagnoses, and psychotropic drug usage of children and adolescents applied to a child and adolescent psychiatric outpatient clinic. Medical files of the patients who had been examined for the first time between July 2012, and December 2012 in Outpatient Clinics of Child and Adolescent Psychiatry of Uludag University Hospitals of Medical Faculty were evaluated. The total number of cases evaluated was 953, the age range was 1-17 and the mean age was 9, 5 ± 4, 6. The most frequently encountered presenting complaints were determined as naughtiness, and disobedience (188-19.7 %) and the most frequently detected diagnoses were attention deficit hyperactivity disorder (ADHD) (180-18.8%). Mostly selective serotonin reuptake inhibitors 208 (21.8 %), atypical antipsychotic 143 (14.8%), and psycho stimulants 79 (8.3 %) were recommended in decreasing order of frequency. Recognition of frequently detected complaints, and diagnoses, determination of differences in diagnoses according to gender, and age groups of patients, evaluation of the drugs used, and their relationship with relevant diagnoses will contribute favourably to the improvement and standardization of health care services provided in the outpatient clinics of child and adolescent psychiatry and identifying areas of sociodemographic characteristics.Salmonelloz dünyada yaygın olarak görülen bir halk sağlığı sorunudur. Çok sayıda türü olan Salmonella, farklı klinik tablolara sebep olmaktadır. Ülkemizde zaman zaman küçük çaplı salgınlara yol açması ve bazı bölgelerde hala endemik olması etkene yönelik gıda endüstrisi ve hayvancılıkta çeşitli önlemlerin alınmasına sebep olmaktadır. Son yıllarda tüm ülkelerde nontifoidal salmonelloz olguları artmaktadır. Bu olguların çoğunda kendi kendini sınırlayan enfeksiyonlara sebep olurken immünsüprese hastalarda önemli morbidite ve mortaliteye yol açan değişik yer ve lokalizasyonlarda enfeksiyonlara neden olur. Sunulan hasta uzun süre immünsüpresif tedavi aldıktan sonra yaptırdığı intramusküler (İM) enjeksiyon bölgesinde apse gelişmesi nedeniyle merkezimize başvurmuştur. Gluteal apse materyalinde Salmonella Enteritidis üremesi oldu. Olgu farklı bulaş yolu olması nedeniyle ve nontifoidal salmonellozun etiyoloji ile klinik önemini tartışmak üzere sunuldu.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 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-8209-2022Item Invasive fungal infections in renal transplant recipients: Epidemiology and risk factors(Springer, 2015-08) Şahin, Sezin Zorlu; Akalın, Halis; Ersoy, Alparslan; Yıldız, Abdulmecit; Ocakoğlu, Gökhan; Çetinoğlu, Ezgi Demirdöven; Dizdar, Oğuzhan Sıtkı; Kazak, Esra; Ener, Beyza; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; 0000-0002-4803-8206; 0000-0002-0710-0923; AAG-8459-2021; AAG-8523-2021; AAH-5180-2021; AAH-5054-2021; AAU-8952-2020; 56537830100; 57207553671; 35612977100; 56256977500; 15832295800; 57189524206; 55202193000; 24921238200; 15053025300Invasive fungal infections are a major cause of morbidity and mortality among renal transplant recipients. The aim of this study was to investigate the frequency and risk factors for fungal infections in renal transplant recipients. We retrospectively evaluated all kidney transplant recipients at our center from December 1988 to June 2010 for the epidemiology, spectrum, risk factors, and mortality of invasive fungal infections. In 32 patients (10.30 %), at least one fungal infection developed after the transplantation. The most common pathogens causing fungal infections in our patients were Candida spp. and Aspergillus spp. The independent risk factors associated with invasive fungal infection episodes were antibiotic treatment within the last 3 months (OR 15.88, 95 % CI 3.90-64.73, p < 0.001), cytomegalovirus infection (OR 18.54, 95 % CI 9.01-38.17, p < 0.001), and the presence of diabetes mellitus (OR 6.01, 95 % CI 2.95-12.25, p < 0.001). Mortality was significantly higher among patients with fungal infections than among other patients (53.10 and 17.80 %, respectively; p < 0.001). It is difficult to diagnose and treat fungal infections early, and it can be useful to determine independent risk factors in order to identify and treat high-risk patients.Publication 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-6213-2013Item An investigation of Candida species isolated from blood cultures during 17 years in a university hospital(Wiley, 2014-10) Özkan, Ö.; Gürcüoğlu, Emel; Kazak, Esra; Akın, Hicran; Ener, Beyza; Sığırlı, Deniz; Yılmaz, Emel; Çelebi, Solmaz; Akçağlar, Sevim; Akalın, Halis; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0002-4803-8206; 0000-0002-4759-9634; AAG-8459-2021; AAA-7472-2021; AAG-8523-2021; AAU-8952-2020; 24921238200; 54782139900; 15053025300; 24482063400; 22037135100; 7006095295; 6506194958; 57207553671Candidemia is the most frequent manifestation observed with invasive candidiasis. The aim of this study was to analyse the trends of candidemia in a large tertiary-care hospital to determine the overall incidence during January 1996-December 2012, as well as to determine the susceptibility of 453 isolates according to the revised Clinical and Laboratory Standards Institute (CLSI) breakpoints. Candidemia episodes in adult and paediatric patients were retrospectively analysed from the laboratory data of Uluda University Healthcare and Research Hospital. The 17-year period studied was divided into three periods (1996-2001, 2002-2007 and 2008-2012) for better comparison, and candidemia incidence was determined by the ratio of total number of patients with candidemia per 1000 patients admitted to the hospital and per 10000 patient days in these three periods. Redefined CLSI M27-A3 breakpoints were used for interpretation of antifungal susceptibility results. Candidemia incidence was determined as 2.2, 1.7 and 1.5 per 1000 admitted patients during 1996-2001, 2002-2007 and 2008-2012 respectively. A significantly decreased candidemia incidence was obtained in the third period. C. albicans (43.8%) was the most common candidemia agent, followed by C.parapsilosis (26.5%) in all three periods. According to the revised CLSI breakpoints, there was fluconazole resistance in C. albicans, C.parapsilosis, C.tropicalis and C.glabrata species (1.4%, 18.2%, 2.6% and 14.3% respectively). Almost all Candida species were found susceptible to voriconazole except one C.glabrata (7.1%) isolate. Candidemia is an important health problem. Local epidemiological data are determinative in the choice of appropriate antifungal treatment agents.Item Kan kültürlerinden izole edilen flukonazol dirençli candida parapsilosis suşlarındaklonal ve klinik ilişki(Bursa Uludağ Üniversitesi, 2021) Semet, Cihan; Kazak, Esra; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.Nozokomiyal kan dolaşımı enfeksiyonlarında kandidemiler 4. sırada yer almakta ve bunların %50’den fazlasında etken olarak C. albicans saptanmıştır. Ancak son yıllarda albicans dışı Candida’lar da artmaktadır. Özellikle yenidoğan ve cerrahi yoğun bakım birimlerinde C. parapsilosis’in ve C.glabrata’nın artan sıklıkla izole edildiği bildirilmektedir. Bu durum ampirik vekanıtlanmış antifungal seçimini etkilemektedir. Son çalışmalar, C. parapsilosis kandidemi insidansının %7-24 oranında arttığını göstermiştir. Özellikle invazif girişimlerin artışı, port ve benzeri kalıcı kataterlerin kullanımının yaygınlaşması, uzun yatış süreleri, antibiyotik kullanımının artması, total parenteral nutrisyon (TPN) desteklerinin çoğalması bu insidans artışı nedenleri arasında sayılmaktadır. C. parapsilosis’e bağlı kandidemilerde mortalite diğer kandidemilere göre düşük olsa da etken hastanede salgın yapabilir, yatış süresinin uzamasına, katater değişimine neden olabilir, en kısa sürede uygun ve etkili antifungal tedavi başlanmasını gerektirir. Kandidemilerde uygun, ampirik tedavinin bir an önce başlanmasının mortalite ve yatış süresini etkilediği bilinmektedir. Bu nedenle hastalarda kandidemi riskini, mortaliteyi etkileyen faktörleri belirlemek, etkenlerin tür tayini, duyarlılık profillerinin bilinmesi yararlıdır. Hastalarda uygun ve etkili tedaviye hızla başlanması için hastane veya bölümde epidemiyolojinin bilinmesi önemlidir. Ayrıca antifungal tedavilerin giderek yaygın kullanılması, dirençli etkenlerin ortaya çıkabilmesi, hasta profillerindeki değişim bu konularda yeni çalışmalara ihtiyaç doğurmaktadır. Bu çalışmanın amacı laboratuvarımızda, kan kültürlerinden izole edilen flukonazol dirençli C. parapsilosis tür kompleksi suşları arasında genotipik ilişki ve belirlenmesi ve bu suşlarla enfekte hastaların özellikleri ve klinik seyrinin incelenmesidir. Çalışmada 1997-2019 yılları arasında, flukonazol dirençli 88 C. parapsilosis kandidemisi tanılı hasta değerlendirildi. 30. gün mortalitesi %21.5 (n=19) olarak bulundu. Risk faktörlerine bakıldığında kemoterapi almanın iii mortaliyeti arttığı görüldü. İstatistiksel olarak santral venöz kateterin (SVK) çekilmesinin ve antifungal tedavi seçiminin mortalite üzerinde etkisi anlamlı bulunmadı. 88 suştan, izole edilebilen 47 suş genotipik olarak mikrosatellit yöntemi ile analiz edildi. Bu suşlar içinde, altı farklı genotip tespit edilmiş olup, en küçük ağaç yolu çizimi ve dendogram değerlendirilmesi neticesinde esas olarak iki farklı grup halinde kümelendikleri gösterilmiştir. Aynı dönemde, aynı klinikte yatan hastalarda aynı genotipe sahip etkenler tespit edilmiş ve etkenin endojen kaynaklı olmasından ziyade, çevre kaynaklı yayıldığı düşünülmüştür. Bu sonuçlar ile C. parapsilosis’e bağlı kandidemi görülen, genel durumu kötü ve altta yatan hastalıkları fazla olan hasta grubunda kataterlerin çekilmesinin bir süre ertelenebileceği, in vitro dirençli olmasına karşın flukonazol veya ekinokandin seçeneklerinin tedavide tercih edilebileceği, C. parapsilosis salgınlarından şüphelenildiği durumlarda salgın analizinde mikrosatellit analiz yönteminin uygun bir seçenek olarak düşünülebileceği gösterilmiştir.
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