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Öğe Boric Acid Irrigation as an Adjunct to Mechanical Periodontal Therapy in Patients With Chronic Periodontitis: A Randomized Clinical Trial(WILEY, 2013) Saglam, Mehmet; Arslan, Ugur; Bozkurt, Serife Buket; Hakki, Sema S.Background: The purpose of this single-masked, randomized, controlled clinical trial was to evaluate the effects of boric acid irrigation as an adjunct to scaling and root planing (SRP) on clinical and microbiologic parameters and compare this method with chlorhexidine irrigation and SRP alone in patients with chronic periodontitis (CP). Methods: Forty-five systemically healthy patients with CP are included in this study. They were divided into three groups: 1) SRP + saline irrigation (C); 2) SRP + chlorhexidine irrigation (CHX); and 3) SRP + boric acid irrigation (B). To determine an ideal concentration of boric acid, a preclinical analysis was conducted. At baseline, 1 month, and 3 months after treatment, clinical measurements, including plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), were performed, and subgingival plaque samples were taken. Quantitative analysis of Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Treponema denticola (Td) was performed using real-time polymerase chain reaction (PCR) procedures. Results: The concentration of boric acid is 0.75% in this study. All clinical parameters showed statistically significant reduction at all time points compared to baseline in all groups (P <0.001). Whole-mouth PD and CAL reduction was similar in all groups at all time points after treatment (P >0.05). The PD and CAL reductions for moderately deep pockets (PD >= 5 and <7) were greater in the B group compared to other groups between baseline and 1 month (P <0.05). For deep pockets (PD >= 7), reductions were similar in the B and CHX groups (P >0.05). BOP (percentage) was significantly lower in the B group compared with the CHX and C groups in the first month after treatment (P <0.001). GI and PI scores were significantly lower in the B and CHX groups compared with the C group at all time points after treatment (P <0.05). The amounts of Pg, Tf, and Td were significantly reduced in all treatment groups after 1 month (P <0.05). No statistically significant differences were detected among the groups for microbiologic parameters at any time points after treatment (P >0.05). Conclusions: The results of this study suggest that boric acid could be an alternative to chlorhexidine, and it might be more favorable because boric acid was superior in whole-mouth BOP as well as PD and CAL reduction for moderate pockets in early time periods.Öğe CHARACTERIZATION OF ESCHERICHIA COLI STRAINS ISOLATED FROM WELL WATERS: MOLECULAR TYPING BY PULSED-FIELD GEL ELECTROPHORESIS, ANTIBIOTIC RESISTANCE PATTERNS AND PLASMID PROFILES(PARLAR SCIENTIFIC PUBLICATIONS (P S P), 2013) Uysal, Ahmet; Durak, Yusuf; Arslan, UgurA number of previous studies have shown that characterization and determination of genetic relationships of the microorganisms in case of possible outbreak are of vital importance. In this study, the genetic relations and genetic diversities, susceptibility to antibiotics and plasmid profiles of 43 Escherichia coli isolates recovered from well water samples were investigated.. The pulsed-field gel electrophoresis (PFGE) method was used to identify the genetic relations and diversities of E. coli isolates. PFGE revealed 30 pulsotypes represented by 6 subtypes among the strains according to evaluation of restriction profiles. Antibiotic susceptibility tests were conducted against 15 antibiotics by using a disc diffusion method. The isolates exhibited four different types of resistance profiles. The strains showed the greatest resistance to ampicillin (97.67%), followed by ticarcillin-clavulanic acid (9.3%) and cefuroxime and ceftazidime (6.97%). Plasmid isolation studies of the strains conducted by the method of alkaline lysis revealed that 19 (44.18%) of 40 E. coli strains contain 19 different plasmid bands ranging between 78.2 and 2.6 kb. Based on the results obtained from tests, PFGE analysis revealed very high genetic diversity among the strains. Antibiotic resistance ratios increased in E. coli isolates when compared with data obtained from previous studies. Plasmids of E. coli strains demonstrated random distribution, and any significant correlation between antibiotic resistance patterns and plasmids has not been found. E. coli strains leaked to the well water sources were not closely related. Studies and surveillances should be conducted periodically to see resistance of environmental strains.Öğe Chemotherapy-induced Hepatitis B virus reactivation in HbsAg positive cancer patients: a single center experience(HUMANA PRESS INC, 2009) Eren, Orhan Onder; Artac, Mehmet; Boruban, Melih Cem; Yavas, Ozlem; Arslan, Ugur; Basaranoglu, MetinHepatitis B reactivation due to chemotherapy is a cause of serious morbidity and mortality in some of the patients with cancer. In this study, we retrospectively assessed the prevalence of hepatitis B reactivation among the patients undergoing cytotoxic chemotherapy. We investigated efficacy of lamivudine prophylaxis against hepatitis B reactivation as well.Öğe COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AND GENOTYPES AMONG UNIVERSITY STUDENTS IN TURKEY(SOUTHEAST ASIAN MINISTERS EDUC ORGANIZATION, 2014) Demirel, Gamze; Findik, Duygu; Dagi, Hatice Turk; Arslan, Ugur; Lan, ArsNasal carriage of Staphylococcus aureus is an important risk factor for nosocomial and community-acquired staphylococcal infections. We investigate the prevalence of community-acquired methicillin-sensitive (CA-MSSA) and -resistant (CA-MRSA), including inducible dormant (ID)-MRSA S. aureus, and genotypes of MRSA strains of nasal cultures from 1,108 university students attending Selcuk University, Turkey. Risk factors were based on replies to a questionnaire. S. aureus was identified using conventional culture methods and a Stapyloslide (R) latex test. Antibiotic susceptibility and methicillin resistance were determined by a disk diffusion method, and vancomycin susceptibility was performed using an E-test. Identification of mecA and SCCmec types were conducted by PCR and genotypes by pulse field gel-electrophoresis (PFGE). Prevalence of S. aureus was 17%, with 9% being MRSA. Two isolates were SCCmec type III, 11 were SCCmec variant IIIA and one SCCmec type IV. No ID-MRSA was detected. The majority of the isolates were resistant to penicillin and no strain was resistant to vancomycin. Two MRSA strains were PFGE pulsotype A, 9 pulsotype B, 2 pulsotype C,1 pulsotype D and 3 pulsotype E. Presence of permanent catheter and use of antibiotics in the previous month were risk factors for MSSA colonization and association with medical facilities were risk factors for MRSA carriers. There is a need for multicenter studies in Turkey to investigate CA- and ID-MRSA prevalence and nosocomial infections.Öğe Determination of Hemolytic Activity and In Vitro Antifungal Susceptibility of Trichophyton rubrum Clinical Strains(ANKARA MICROBIOLOGY SOC, 2011) Solgun, Gulkan; Findik, Duygu; Dagi, Hatice Turk; Arslan, UgurTrichophyton spp. which are among the agents of dermatophytosis with high morbidity, produce many virulence factors including hemolysins that exhibit toxic activity on immune system cells. Since relapses and chronicity are common problems related to dermatophytosis, prompt and appropriate treatment is of crucial importance. However, treatment is getting difficult due to the choice of inappropriate antifungals and increasing rates of cross-resistance among antifungal agents. The aims of this study were to investigate the hemolytic activities of Trichophyton rubrum strains isolated from patients with dermatophytosis and to detect the in vitro susceptibilities of those strains to ketoconazole, itraconazole, sulconazole, econazole and terbinaphine. Hair, skin and nail samples of patients were examined with direct microscopy using potassium hydroxide and cultivated on mycobiotic agar and Sabouraud dextrose agar. To determine hemolytic activities of T.rubrum strains, they were subcultured in Columbia Agar with 5% sheep blood and incubated for 7-14 days at 25 degrees C in aerobic conditions. Media which displayed hemolysis were further incubated for 1-5 days at 37 degrees C to increase hemolytic activity. Antifungal susceptibility testing was done with broth microdilution method guided by Clinical and Laboratory Standards Institute (CLSI) M38-A document. A total of 79 T.rubrum strains which exhibited negative urease and hair perforation tests, yielded pigmentation in potato-dextrose agar, were evaluated in the study. Hemolytic activity was detected in 71 strains (89.9%). Fifty strains showed incomplete (alpha) hemolysis and 21 strains showed complete (beta) hemolysis, whereas hemolysis was absent in eight of the isolates. Larger colonies created a larger zone of hemolysis and the smaller ones created a smaller zone. However, alpha-hemolysis did not turn to beta-hemolysis following further enlargement of the colony. According to antifungal susceptibility testing, the minimum inhibitory concentration (MIC) ranges, MIC50 and MIC90 values were found 0.0125-4 mu g/ml, 0.5 and 2 mu g/ml for ketoconazole; 0.0625-2 mu g/ml, 0.5 and 1 mu g/ml for itraconazole; 0.0313-4 mu g/ml, 0.25 and 1 mu g/ml for sulconazole; 0.0313-0.125 mu g/ml, 0.0313 and 0.0625 mu g/ml for econazole; 0.0313-0.0313 mu g/ml, 0.0313 and 0.0313 mu g/ml for terbinaphine, respectively. When the MIC values of hemolytic and non-hemolytic T.rubrum strains were compared, it was detected that hemolytic activity had no effect on MIC values. Our data have indicated that terbinaphine was the most effective antifungal agent against T.rubrum, while MIC values for itraconazole which is in common clinical use, were higher than expected and MIC values for econazole were lower than expected.Öğe Determination of hepatitis B virus DNA incidence, viral load, and mutations in blood donors with HBsAg and anti-HBs-negative serology and antibodies to hepatitis B core antigen(ELSEVIER, 2007) Findik, Duygu; Arslan, Ugur; Baykan, MahmutBackground: The aim of the present study was to determine hepatitis B virus DNA incidence, viral load, and mutations in blood donors with HBsAG and anti-HBs negative serology and antibodies to hepatitis B core antigen. Methods: Blood samples were collected from 1000 blood donors with HBsAg-negative test results. Anti-HBc total screening was performed using the ELISA method. HBsAg-negative/anti-HBc total-positive samples were tested for anti-HBs, anti-HBc IgM, HBeAg, and anti-HBc. Samples with isolated anti-HBc were determined for viral load of HBV DNA using real-time PCR. Results: Anti-HBc total was established as positive in 200 (20%) of the 1000 blood donors. While anti-HBs was negative in 59 (29.5%) of the 200anti-HBc-positive samples, it was found to be positive in 141 (70.5%) of them. All of the other hepatitis B markers were negative in all of the anti-HBs-negative samples. HBV DNA was not detected in the sera of the isolated anti-HBc-positive blood donors with real-time PCR. Conclusion: Although we could not detect HBV DNA in the sera of the isolated anti-HBc-positive blood donors, findings in the literature suggest that anti-HBc testing should be used in combination with HBsAg for the screening of blood donors to reduce risk. After that, the most appropriate algorithm to follow can be HBV DNA screening of donors. (c) 2007 European Federation of Internal Medicine. Published by Elsevier B.V All rights reserved.Öğe Distribution of emm Genotypes and Antibiotic Susceptibility of Streptococcus pyogenes Strains: Analogy with the Vaccine in Development(ANKARA MICROBIOLOGY SOC, 2013) Arslan, Ugur; Oryasin, Erman; Eskin, Zeynep; Turk Dagi, Hatice; Findik, Duygu; Tuncer, Inci; Bozdogan, BulentStreptococcus pyogenes is the most common bacterial pathogen causing pharyngotonsillitis, and also can lead to diseases such as otitis media, impetigo, necrotizing fasciitis, bacteremia, sepsis and toxic shock-like syndrome. M protein encoded by emm gene is an important virulence factor of S.pyogenes and it is used for genotyping in epidemiological studies. The aims of this study were to determine the M protein types of group A streptococci (GAS) by using emm gene sequence analysis method, to compare the M types in terms of analogy with the vaccine in development and to determine the antibiotic susceptibilities of the isolates. A total of 35 GAS strains isolated from various clinical specimens in our laboratory were included in the study. Strains growing in blood culture were considered as invasive, strains growing in throat and abscess cultures were considered as non-invasive. The isolates have been identified by conventional methods and 16S rRNA sequence analysis at species level. emm genotyping of strains identified as S.pyogenes, was performed by PCR method as proposed by the CDC. Amplicons were obtained and sequenced in 23 out of 35 isolates. The results were compared with CDC emm sequence database. Antibiotic susceptibility of the isolates was performed by agar dilution method and evaluated as recommended by CLSI. Twenty-three out of 35 isolates could be typed and 15 different emm genotypes were detected. The most common emm types were emm1 (22%), emm89 (13%), emm18 (9%) and emm19 (9%). The detection rate of other emm types (emm5, 12, 14, 17, 26, 29, 37, 74, 78, 92, 99) was 47%. Types emm1, 12, 19, 74, 89 and 99 were observed in strains isolated from blood cultures. It was detected that nine of the 15 (60%) emm types are within the contents of 26 valent vaccine (emm 1, 5, 12, 14, 18, 19, 29, 89, 92). It was also observed that 17 (74%) of the 23 cases were infected by vaccine types and the four emm types (emm1, 12, 19, 89) identified in blood samples were among the vaccine types. All of the strains were found susceptible to penicillin, ampicillin, erythromycin, lincomycin, gentamicin, chloramphenicol, vancomycin and linezolid, however six isolates were resistant to levofloxacin (MIC=4 and 16 mu g/ml) and one isolate was resistant to tetracycline (MIC= 16 mu g/ml). In conclusion, this preliminary local study with limited number of invasive and non-invasive S.pyogenes isolates, emphasized the need for larger scale multi-center studies to determine the analogy and efficacy of the vaccine in development.Öğe Effects of 2 bracket and ligation types on plaque retention: A quantitative microbiologic analysis with real-time polymerase chain reaction(MOSBY-ELSEVIER, 2013) Baka, Zeliha Muge; Basciftci, Faruk Ayhan; Arslan, UgurIntroduction: The aim of this study was to evaluate the effects of self-ligating brackets and conventional brackets ligated with stainless steel ligatures on dental plaque retention and microbial flora. Methods: Twenty boys (mean age, 14.2 +/- 1.5 years) underwent bonding with self-ligating bracket systems and conventional standard edgewise bracket systems ligated with stainless steel ligatures with a split-mouth design. Clinical measurements, including plaque index, probing pocket depth, and bleeding on probing, were obtained before bonding, 1 week after bonding, and 3 months after bonding. Supragingival plaque samples were obtained at baseline and 3 months after bonding for the detection of bacteria. A quantitative analysis for Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, and Lactobacillus acidophilus was performed using real-time polymerase chain reaction. The Mann-Whitney U test and the Hotelling T-2 multivariate test were used for statistical comparisons of the groups. Results: The numbers of S mutans, S sobrinus, L casei, and L acidophilus were not statistically different between self-ligating brackets and conventional brackets ligated with stainless steel ligatures (P>0.05). The 2 archwire ligation techniques showed no statistically significant differences in plaque index, bleeding on probing, and probing pocket depth values of the bonded teeth (P>0.05). All clinical parameters and the numbers of all microorganisms showed statistically significant increases from baseline to 3 months after bonding in both groups (P<0.001). Conclusions: Self-ligating brackets and conventional brackets ligated with stainless steel ligatures do not differ with regard to dental plaque retention.Öğe Evaluation of Antibiotic Susceptibilities and VISA-VRSA Rates Among MRSA Strains Isolated from Hospitalized Patients in Intensive Care Units of Hospitals in Seven Provinces of Turkey(ANKARA MICROBIOLOGY SOC, 2012) Cesur, Salih; Irmak, Hasan; Simsek, Husniye; Coplu, Nilay; Kilic, Hasan; Arslan, Ugur; Bayramoglu, GulcinThe aim of this study was to determine whether vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin intermediate susceptible S.aureus (VISA) strains were present among methicillin-resistant S.aureus (MRSA) strains isolated from patients hospitalised at intensive care units (ICU) of hospitals located at different regions of Turkey and to determine the minimum inhibitory concentration (MIC) values of teicoplanin, linezolid, tigecycline, quinupristin-dalfopristin and daptomycin, which are alternative drugs for the treatment of MRSA infections. A total of 260 MRSA clinical strains (isolated from 113 lower respiratory tract, 90 blood, 24 wound, 17 catheter, 13 nasal swabs, two urine and one CSF sample) were collected from nine health-care centers in eight provinces [Ankara (n=52), Konya (n=49), Antalya (n=40), Istanbul (n=7), Izmir (37), Diyarbakir (n=15), Van (n=12), Trabzon (n=48)] selected as representatives of the seven different geographical regions of Turkey. Methicillin resistance was determined by cefoxitin disk diffusion in the hospitals where the strains were isolated and confirmed by oxacillin salt agar screening at the Refik Saydam National Public Health Agency. Screening for VISA and VRSA was conducted using the agar screening test and E-test. Susceptibility of the MRSA strains to other antibiotics was also determined by E-test method. None of the 260 MRSA strains were determined to be VRSA or VISA. All were susceptible to teicoplanin and linezolid, and susceptibility rates to daptomycin, tigecycline and quinupristin-dalfopristin were 99.6%, 96.9%, and 95%, respectively. Absence of VISA and VRSA among the MRSA strains surveyed currently seemed hopeful, however, continuous surveillance is necessary. In order to prevent the development of VISA and VRSA strains the use of linezolid, tigecycline, quinupristin-dalfopristin and daptomycin should be encouraged as alternative agents of treatment of MRSA infections.Öğe Extended-spectrum beta-lactamase production in Klebsiella pneumoniae strains isolated from blood cultures and their antibiotic susceptibilities(ANKARA MICROBIOLOGY SOC, 2008) Isik, Ferhat; Arslan, Ugur; Tuncer, InciThis study was carried out to detect the extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae strains isolated from blood cultures of hospitalized patients, and to determine their antimicrobial susceptibilities. A total of 102 K.pineumoniae strains isolated from blood samples were taken in the study, and ESBL production and susceptibilities to amikacin, gentamicin, imipenem, ciprofloxacin, amoxicillin/clavulonate (AMX/CA), ceftazidime, ceftriaxone, trimethoprim/sulphametoxazole (TMP-SMX), piperacilin-tazobactam (PIP/TAZ) and chloramphenicol were investigated by using E-test (AB Biodisk, Sweden). ESBL positivity was observed in 65 (63.7%) of the isolates, and all of the strains were found susceptible to imipenem. The resistance rates of ESBL-producing isolates were detected as 27.7% for amikacin, 41.5% for chloramphenicol, 49.2% for TMP-SMX, 55.4% for ciprofloxacin and 60% for PIP/TAZ; whereas these rates for ESBL non-producers were 2.7%, 5.4%, 5.4%, 2.7%, and 13.5%, respectively. Both the resistance rates and MIC values (MIC50 and MIC90) of the tested antimicrobial agents except imipenem, were found higher in ESBL positive strains than the ESBL negative strains (p < 0.05). The results of this study, in accordance with the previous national and international reports, indicated high rate of ESBL positive K.pneumoniae and also increased rate of antimicrobial resistance in such strains. Clinical microbiology laboratories should put ESBL detection tests into practice and each hospital should determine their antibiotic treatment policies according to their data.Öğe Familial brucellosis: A report of four patients(ELSEVIER SCI LTD, 2006) Findik, Duygu; Ural, Onur; Arslan, Ugur; Dikici, Nebahat[Abstract not Available]Öğe Familial Mediterranean fever associated with type 1 diabetes - Association or coincidence?(LIPPINCOTT WILLIAMS & WILKINS, 2006) Atabek, Mehmet Emre; Pirgon, Ozgur; Sert, Ahmet; Arslan, UgurFamilial Mediterranean fever, also known as a periodic disease or recurrent polyserositis, is an autosomal-recessive disorder characterized by recurrent attacks of fever, synovitis, peritonitis, or pleuritis. In patients presenting with typical clinical features and with an appropriate ethnic origin, the diagnosis can be made without genetic confirmation. The discovery of the MEFV gene has led to a molecular approach to diagnosis, aiming at improving the global diagnosis of the disease. Some diseases, mainly vasculitides, seem to be more common in familial Mediterranean fever. The "decreased antiinflammatory response" hypothesis and other putative mechanisms (cytokines) in familial Mediterranean fever can also take a predisposing and facilitating role in type I diabetes autoimmune pathogenicity. We describe a previously unreported association between familial Mediterranean fever and type I diabetes in a 9-year-old girl.Öğe First case report of neurobrucellosis associated with hydrocephalus(ELSEVIER SCIENCE BV, 2008) Guney, Figen; Gumus, Haluk; Ogmegul, Aysegul; Kandemir, Bahar; Emlik, Dilek; Arslan, Ugur; Tuncer, InciBrucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs. (c) 2008 Elsevier B.V. All rights reserved.Öğe Genotype distribution of extended Spectrum beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae.(ALLIED ACAD, 2015) Dagi, Hatice Turk; Al Dulaimi, Dhay Ali Azeez; Kus, Halit; Seyhan, Tuba; Findik, Duygu; Tuncer, Inci; Arslan, UgurExtended-spectrum beta-lactamase (ESBL) production is the most important cause of beta-lactam resistance in Gram-negative bacteria. Although it may also be found in other Gram-negative bacteria, ESBL is most commonly produced by Escherichia coli and Klebsiella pneumoniae strains. In this study, we aimed to investigate the distribution of beta-lactamase genes in ESBL-producing E. coli and K. pneumoniae strains. One hundred and twenty isolates of E. coli and K. pneumoniae isolated from clinical samples were used in this study. The identification and the antibiotic susceptibility tests were performed by VITEK 2 system in accordance with the manufacturer's instructions. ESBL production was determined accoring to Clinical and Laboratory Standards Institute guidelines. The DNA isolation was performed with a commercial kit following company recommendations. (TEM)-T-bla, (SHV)-S-bla and (CTX)-C-bla-M genes were amplified by multiplex PCR with specific primers. Of the 120 isolates collected, 84 isolates were of E. coli and 36 isolates were of K. pneumoniae. (TEM)-T-bla gene was the most prevalent type (85.8%) followed by (CTX)-C-bla-M (83.3%) and (SHV)-S-bla (24.2%). No blaSHV gene was detected in the E. coli strains. Among 120 ESBL-producing strains, 10.8% were susceptible to cefepime, 10.0% to ceftazidime, while 5.0% to ceftriaxone. In conclusion, (TEM)-T-bla gene was the most frequently encountered ESBL of E. coli and K. pneumonia in our hospital. Further molecular surveillance and epidemiological studies of such resistant bacteria are recommended for monitoring and controlling the spread of ESBL producing strains.Öğe Identification and antifungal susceptibility of Candida species isolated from bloodstream infections in Konya, Turkey(BMC, 2016) Dagi, Hatice Turk; Findik, Duygu; Senkeles, Cigdem; Arslan, UgurBackground: In this study, our aim was to identify Candida species isolated from bloodstream infections and to determine their susceptibilities to various antifungal agents to demonstrate the local resistance profiles and to guide empirical treatment for clinicians. Methods: Two hundred Candida isolates (95 Candida albicans, 105 non-albicans Candida strains) were included in the study. Candida species were identified by conventional, biochemical and molecular methods. Antifungal susceptibility tests for amphotericin B, fluconazole, voriconazole, posaconazole, caspofungin and anidulafungin were performed with broth microdilution method according to the Clinical and Laboratory Standards Institute M27-A3 document. Results: Of the 200 Candida strains, the most prevalent species were C. albicans (47.5 %), Candida glabrata (18.0 %) and Candida parapsilosis complex (14.0 %). All Candida species except for three (1.5 %) Candida kefyr strains were susceptible to amphotericin B. Only one (2.8 %) C. glabrata was resistant to fluconazole (MIC >= 64 mu g/ml), and the others (97.2 %) exhibited dose-dependent susceptibility. All species, but C. glabrata strains, were susceptible to fluconazole. Resistance to voriconazole, posaconazole, caspofungin and anidulafungin was not detected in any strain. Conclusion: Candida albicans were susceptible to all antifungal drugs. Three C. kefyr strains were resistant to amphotericin B. Only one C. glabrata was resistant to fluconazole. All the strains were susceptible to voriconazole, posaconazole, caspofungin and anidulafungin. In vitro antifungal susceptibility tests should be performed to select of appropriate and effective antifungal therapy, and monitor the development of resistance.Öğe THE IMPORTANCE OF SONICATION IN THE DIAGNOSIS OF PROSTHETIC JOINT INFECTIONS(NOBEL ILAC, 2017) Sumer, Sua; Erkocak, Omer Faruk; Arslan, Ugur; Findik, Duygu; Dagi, Hatice Turk; Aydin, Bahattin Kerem; Demir, Nazlim AktugObjective: The objective of this study is to investigate the efficacy of sonication method used to determine the cause in the diagnosis of prosthetic joint infections (PJI). Material and Method: This study included 30 patients who were operated due to prosthesis infection and as a control group 10 patients whose prostheses were removed due to mechanical reasons and who had no sign of infection. Cultures were prepared from these tissue samples through gram staining and conventional methods. The prostheses removed from the patients were put into the sonication device in sterile water with ringer lactate. After sonication, Gram staining, cultures and polymerase chain reaction (PCR) were made. Results: During the Gram staining done prior to the sonication, microorganisms were found in six patients (20%); after the sonication, microorganisms were seen in nine patients (30%), but this difference was not statistically significant (p>0.05). While agents were found in the cultures of 11 patients (36.7%) that were prepared using the conventional method, agents were found in 20 patients (66.7%) with the sonication method. The rate of detecting the agent in the culture prepared after sonication was statistical significantly higher than in the culture prepared with conventional methods (p=0.004). The sensitivity of PCR was found 63.3%. Conclusion: The sonication method of PJI is basically a procedure performed to increase the detectability of microorganisms. We found in the present study that the sonication method was obviously more precise than conventional methods in the microbiological diagnosis of PJI.Öğe In Vitro Synergistic Activity of Sulbactam in Combination with Imipenem, Meropenem and Cefoperazone Against Carbapenem-Resistant Acinetobacter baumannii Isolates(ANKARA MICROBIOLOGY SOC, 2014) Dagi, Hatice Turk; Kus, Halit; Arslan, Ugur; Tuncer, InciAcinetobacter baumannii which is an opportunistic pathogen leading to nosocomial epidemics, exhibit high rates of antimicrobial resistance. Treatment of Acinetobacter infections is a challenge since most of the isolates are multiple antibiotic resistant. The aim of this study was to investigate minimum inhibitory concentrations (MICs) of sulbactam, imipenem, meropenem, and cefoperazone and in vitro synergistic activity of sulbactam in combination with imipenem, meropenem and cefoperazone against A.baumannii isolates of hospitalized patients. Forty A.baumannii strains isolated from various clinical specimens and found to be resistant to carbapenems by disc diffusion method, were included in the study. The isolates were identified by conventional methods and VITEK 2 (bioMerieux, France) automated identification system. MICs of sulbactam, imipenem, meropenem, and cefoperazone were determined by the broth nnicrodilution method according to the standards of CLS1 and in vitro synergy test was performed using the checkerboard microdilution method. Synergistic, partial synergistic, additive, indifferent and antagonistic effects of drug combinations were evaluated with the fractional inhibitory concentration index (FICI). Interpretation of the FICI was as follows: 0.5 synergy; <= 0.5 to < 1 partial synergy; 1 additive; > 1 to < 4 indifference; and >= 4 antagonism. Forty A.baumannii isolates were resistant to imipenem and cefoperazone, but two were susceptible, seven were moderately susceptible and 31 were resistant to meropenem with the microdilution method. MIC values of the isolates for sulbactam were found to be 4 mu g/ml in two, 8 mu g/ml in five, 16 mu\g/ml in three, 32 mu g/ml in 13, 64 pg/ml in three, 128 pg/ml in six and > 128 pg/ml in eight isolates. According to the FICI; imipenem/sulbactam combination exhibited synergy in 18 (45%), partial synergy in 4 (10%) and indifferent effect in 2 (5%) isolates, the combination of meropenem and sulbactam showed synergy in 19 (48%), partial synergy in 3 (7.5%), and indifferent effect in 3 (7.5%) isolates, the combination of cefoperazone/sulbactam demonstrated synergy in 18 (45%), partial synergy in 2 (5%), and indifferent effect in 2 (5%) isolates. There was no antagonistic effect with the tested combinations. In conclusion, MIC values of sulbactam were generally high in carbapenem-resistant A.baumannii strains. However, synergistic effect was detected in approximately half of the strains with the sulbactam/carbapenem combinations. The data obtained in this study should be supported by further advanced in vitro and clinical studies to predict the accurate clinical efficacy of sulbactam containing combinations on A.baumannii infections.Öğe Investigation of OXA Type Beta-Lactamases and PFGE Patterns in Acinetobacter baumannii Strains Resistant to Carbapenems(ANKARA MICROBIOLOGY SOC, 2014) Keyik, Serafettin; Arslan, Ugur; Dagi, Hatice Turk; Seyhan, Tuba; Findik, DuyguAcinetobacter baumannii is an important opportunistic and multidrug-resistant pathogen leading to nosocomial infections. Over the last 10 years, a significant and threatening increase in resistance to carbapenems, mainly due to the dissemination of class D beta-lactamases, has been reported in A.baumannii worldwide. The most common types of beta-lactamases causing carbapenem resistance in A.baumannii are the OXA-23, OXA-24, OXA-40, OXA-58 and OXA-143 type serine beta-lactamases. The aim of this study was to investigate the presence of OXA type beta-lactamases in carbapenem-resistant A.baumannii strains and the clonal relationship between the strains. A total of 105 non-duplicate carbapenem-resistant A.baumannii strains isolated from various clinical samples (68 blood, 18 bronchoalveolar lavage, 13 drainage, 3 urine, 2 cerebrospinal fluid and 1 catheter samples) in the Microbiology Laboratories of Selcuk University, Meram (2009-2012) and Selcuklu (2007-2008) Medical School Hospitals, were included in the study. The isolates were identified by conventional methods and Phoenix 100 BD (BD Diagnostic, USA) and Vitek II (bioMerieux, France) automated systems. Carbapenem susceptibility test was performed by Kirby-Bauer disk diffusion method according to the CLSI standards. bla(OXA 23-like), bla(OXA 24-like), bla(OXA 58-like) and bla(OXA 51-like) genes were amplified by multiplex PCR assay and clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) using Apal enzyme. The bla(OXA 51-like) gene was determined in all carbapenem-resistant A.baumannii isolates, while the bla(OXA 23-like) and bla(OXA 58-like) genes were detected in 46.6% and 53.3% of isolates, respectively. However biG(OXA) (24-like) gene was not demonstrated in any isolates. bla(OXA 23-like) gene was determined in both Meram and Selcuklu Medical School hospitals, but bla(OXA 58-like) gene was detected only in Meram Medical School hospital. PFGE analysis of the isolates revealed 32 different groups in bla(OXA 23-like) producing A.baumannii strains and 23 different groups determined in bla(OXA 58-like) producing strains. No common epidemic isolates were detected in the two hospitals, however it was noted that some clones produced small outbreaks in Meram MS hospital. In this study it was shown that bla(OXA 23-like) and bla(OXA 58-like) genes together with bla(OXA 51-like) gene had significant roles in the carbapenem-resistance of A.baumanniistrains. Carbapenem-resistant A.baumannii strains producing bla(OXA 23-like) and bla(OXA 58-like) enzymes showed the epidemic potential of this nosocomial pathogen and the requirement of molecular typing methods to identify the epidemiologic relationship of the isolates.Öğe INVESTIGATION OF THE CLONALITY AND PANTON-VALENTINE LEUKOCIDIN TOXIN AMONG NOSOCOMIAL METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS STRAINS(ANKARA MICROBIOLOGY SOC, 2009) Kirdar, Sevin; Arslan, Ugur; Tuncer, Inci; Findik, Duygu; Bozdogan, BuelentMethicillin-resistant Stapyhlococcus aureus (MRSA) is one of the major causes of morbidity and mortality in hospitalized patients. This study was aimed to investigate the clonality of the MRSA strains isolated from patients with nosocomial infection and also to determine the presence of Panton-Valentine leukocidin (PVL) toxin in these isolates. A total of 37 samples (31 isolated from surgical wound samples, 2 them from abscess and 4 from drainage samples) obtained from patients hospitalized at surgery, internal medicine and intensive care units, were included to the study. The clonality among MRSA strains was demonstrated by pulsed-field gel electrophoresis (PFGE) and the presence of PVL by polymerase chain reaction using luk-PV-1 and luk-PV-2 primers. PFGE revealed that 31 of 37 strains were A pulsotype and subtypes, 3 strains were B pulsotype and the last 3 were C pulsotype. Pulsotype A has been isolated especially from cardiovascular surgery and other surgery departments and intensive care units, pulsotype B from orthopedic and pulsotype C from neurology and neurosurgery wards. PVL gene was not identified in any of the isolates. These results indicated the presence of a dominant clone among MRSA strains in our hospital, however, different pulsotypes may also be present in different surgery units. Continuous molecular epidemiological surveillance of nosocomial MRSA strains and their PVL positivity supply valuable clinical and epidemiological data for infection control and patient follow-up.Öğe Investigation of Various Virulence Factors of Klebsiella pneumoniae strains Isolated from Nosocomial Infections(ANKARA MICROBIOLOGY SOC, 2017) Kus, Halit; Arslan, Ugur; Turk Dagi, Hatice; Findik, DuyguKlebsiella pneumoniae is an opportunistic pathogen that commonly affects immunosuppressed patients and causes nosocomial infections. K. pneumoniae has a variety of virulence factors, especially capsule polysaccharide, hypermucoviscosity (HV), fimbriae, toxins and determinants for iron acquisition. The aim of this study was to detect the virulence factors in K. pneumoniae strains isolated from nosocomial infections in two years. Fifty three K. pneumoniae strains isolated from the samples of patients with nosocomial infections in the Medical Microbiology Laboratory of Selcuk University Faculty of Medicine Hospital between 2011 and 2013 were included in the study. Identification and antimicrobial susceptibilities of the isolates were performed by VITEK 2 automatic system. Biofilm formation, alpha-hemolysin, capsule and HV were investigated by phenotypic methods. Polymerase chain reaction (PCR) was used to detect virulence genes encoding adhesins (fimH-1, mrkD, kpn, ycfM), siderophores (entB: enterobactin, iutA: aerobactin, irp-1, irp-2, ybtS, fyuA: yersiniabactin, iroN: catechols receptor), protectines or invasins (rmpA, magA, traT) and toxins (hlyA, cnf-1). Of the 53 K. pneumoniae isolates, 12 (22.6%) were isolated from in patients of reanimation intensive care unit, 8 (15.1%) medical oncology, 7 (13.2%) newborn intensive care unit and 26 (49%) other clinics. The distribution of the isolates according to the samples was as follows: urine (n=14), blood (n=13), wound (n=8), drainage fluid (n=10), broncho-alveolar lavage (n=7), and cerebrospinal fluid (n=1). Isolates which were resistant to meropenem were 5.7% and production of extended spectrum beta-lactamase (ESBL) was 71.7%. The capsule, biofilm formation, and HV were observed in 100%, 79.2%, and 1.9% of the isolates, respectively. Production of alpha-hemolysin was not detected in any of the isolates. The genes; entB (96.2%), ycfM (86.8%), and mrkD (83.0%) showed high prevalence. The other genes were detected in different ratios: fimH-1 (64.2%), fyuA (54.7%), kpn (49.1%), ybtS (41.5%), irp-1(41.5%), irp-2 (37.7%), traT (11.3%) and iutA (5.7%). Virulence genes; iroN, rmpA, magA, hlyA and cnf-1 were not detected in any of the isolates. Enterobactin had the highest rate among siderophores, and ycfM and mrkD in adhesins. The capsule and biofilm formation were commonly found in the isolates. Hypermucoviscosity was only found in one isolate but associated genes were not detected. Alfa hemolysin production and hlyA gene were not determined. As a result, it seems that the basis of the pathogenicity of K. pneumoniae strains isolated from nosocomial infections are capsule, adhesins, enterobactin and ability of biofilm formation. There is a need for new studies for the continuous monitoring of toxin and invasion ability as well as antibiotic resistance in the control of hospital infection caused by K. pneumoniae.
