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    Management of Brucella Endocarditis: Results of the Gulhane Study
    (ELSEVIER SCIENCE BV, 2012) Koruk, Suda Tekin; Erdem, Hakan; Koruk, İbrahim; Erbay, Ayşe; Tekce, Yasemin Tezer; Erbay, Ali Rıza; Dayan, Sami; Deveci, Özcan; İnan, Asuman; Engin, Derya Öztürk; Güner, Rahmet; Dikici, Nebahat; Kartal, Elif Doyuk; Kurtaran, Behice; Pehlivanoglu, Filiz; Sipahi, Oğuz Reşat; Yalcı, Asuman; Yemisen, Mücahit; Çavus, Sema Alp; Gencer, Serap; Güzel, Gökhan; Öncül, Oral; Parlak, Mehmet; Kazak, Esra; Tülek, Necla; Ulcay, Asim; Savaşçı, Ümit
    Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.
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    Metallobeta-Lactamase Enzymes and Antibiotic Susceptibilities in Strains of Pseudomonas Aeruginosa Isolated from Intensive Care Units in Turkey
    (Ortadoğu Ad Pres & Publ Co, 2012) Cesur, Salih; Yıldız, Eda; Irmak, Hasan; Gülay, Zeynep; Arslan, Uğur; Özen, Sepin; Bayramoğlu, Gülçin; Berktaş, Mustafa; Yalçın, Ata Nevzat; Gencer, Serap; Hoşoğlu, Salih; Demiröz, Ali Pekcan
    Objective: The aim of this study was to determine the frequency of metallobeta-lactamase (MBL) enzyme in Pseudomonas aeruginosa strains resistant to carbapenem (imipenem or/and meropenem) in seven regions of Turkey and to assess the minimal inhibitory concentration (MIC) levels of drugs used in treatment such as colistin, aztreonam, polymyxin B and rifampin. Overall 186 Pseudomonas aeruginosa (P.aeruginosa) strains resistant to carbapenem from 8 provinces (Ankara, Konya, Antalya, Istanbul, izmir, Diyarbakir, Van and Trabzon) representing 7 different geographical regions of Turkey were included in the study. Material and Methods: The presence of MBL in P.aeruginosa strains resistant to carbapenem was investigated by combined disk methods with imipenem and EDTA absorbed imipenem disk. The MBL positivity was determined in the strains. Additionally, susceptibility to aztreonam, colistin, polymyxin B, and rifampin was established by the E-test method. Results: MBL enzyme positivity was detected in 58 out of 186 strains (31.2%). There was statistically significant difference between regions in terms of MBL positivity, with the highest rates in Antalya (52%), and Istanbul (50%) and the lowest in Diyarbakir (6%). Aztreonam sensitivity was detected in 134 (72%) strains; 155 (83.3%) were sensitive to colistin and 148 (79.6%) to polymixine. No strain (0%) was sensitive to rifampin. Conclusion: In conclusion, the overall mean rate of MBL positivity was 31.2%, which is quite high. Therefore, it will be beneficial to confirm the MBL positivity of strains with molecular methods, to review regional antibiotic surveillance data at certain intervals and to share the obtained data with relevant institutions in order to prevent the regional spread of these strains. Thus, it is essential to record and monitor systematically the antibiotic surveillance data.