Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji /Makale Koleksiyonu
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Güncel Gönderiler
Öğe A Case of Prosthetic Infection with Candida Growth in the Knee Joınt(Selçuk Üniversitesi, 2023 Nisan) Çifci, Şeyma; Demir, Nazlım Aktuğ; Sümer, Şua; Ural, Onur; Çölkesen, Fatma; Dağı, Hatice TürkIntroduction: Fungal prosthetic joint infections constitute a small part of all prosthetic infection cases, and Candida species are the causative agent in most cases. Most fungal prosthetic joint infections occur after revision arthroplasty. Case: A 77-year-old male patient underwent a total knee prosthesis operation for the right knee due to Gon arthrosis. About five months later, he was hospitalized and treated due to a bacterial prosthetic joint infection. Eight days after discharge, he reapplied with complaints of swelling, pain, temperature increase, and redness in the right knee. He was hospitalized again due to a prosthetic joint infection. Antifungal treatment was started for the patient due to the growth of Candida albicans in the knee joint. A total of 2.5 months of antifungal treatment was given. The recovered patient continues to be followed up in the outpatient clinic. Discussion: In this case report, we wanted to emphasize that in the presence of risk factors in prosthetic joint infection, we should not forget that the factor may also be fungus. During the operation, a culture should be taken, and antifungal treatment should be given for effective and long-term fungal-related prosthetic joint infections.Öğe Kronik Hepatit B’de Fibrotest ve Actitest Karaciğer Biyopsisine Alternatif Olabilir Mi?(Selçuk Üniversitesi, 2016 Eylül) Sümer, Şua; Demir, Nazlım Aktuğ; Kölgelier, Servet; Demir, Lütfi Saltuk; Ural, OnurAmaç: Bu çalışmada kronik hepatit B (KHB)’de karaciğer biyopsisinde saptanan fibrozis ve inflamasyon derecesi referans alınarak fibrotestin (FT) fibrozisi ve actitestin (AT) nekroinflamatuar aktiviteyi belirlemedeki duyarlılığının araştırılması amaçlandı. Gereç ve Yöntem: Bu prospektif çalışmaya 2013 yılı içerisinde takip edilen 53 KHB hastası dahil edildi. Biyopsiler modifiye Knodell skorlama sistemine gore değerlendirildi. Karaciğer biyopsisi yapıldığı gün hastalardan FT ve AT için kan örneği alındı. Bulgular: Çalışmaya alınan hastaların 22’si kadın, 31’i erkekti. KHB hastalarında karaciğer biyopsisi ve FT karşılaştırılmasında ciddi fibrozisi tespit etmek için FT’nin duyarlılığı %93.5, seçiciliği ise %54.5 olarak tespit edildi. FT’nin pozitif prediktif değeri (PPD) %74.3, negatif prediktif değeri (NPD) ise %85.7 olarak hesaplandı. FT için ROC analizi sonucu eğri altında kalan alan %75.1’ti (p=0.003). KHB hastalarında karaciğer biyopsisi ve AT karşılaştırılmasında ise ciddi nekroinflamasyonun tespiti için AT’nin duyarlılığı %89.2, seçiciliği %64’tü. PPD %73.5 ve NPD ise %84.2 olarak hesaplandı. AT için ROC analizi sonucu eğri altında kalan alan % 65’ti (p=0.001). Sonuç: KHB’de FT ve AT’nin ciddi fibrozis ve nekroinflamasyonu göstermedeki duyarlılıkları yüksekti. Bununla birlikte FT ve AT biyopsi yapılmaksızın tek başına kullanılabilecek bir belirteç olarak görülmemektedir.Öğe Sitomegalovirüs Pnömonisi Saptanan Bir AIDS Olgusu(Selçuk Üniversitesi, 2019 Eylül) Sümer, Şua; Ural, Onur; Demir, Nazlım Aktuğ; Çölkesen, FatmaSitomegalovirüs (CMV), Kazanılmış İmmün Yetmezlik Virüsü Sendromu (AIDS) gibi hastalıkların bulunduğu immünsupresif kişilerde en yaygın viral fırsatçı enfeksiyon nedeni olarak bildirilmektedir. AIDS’li hastalarda görülen CMV pnömonisi gibi fırsatçı pnömoniler morbidite ve mortalitenin başlıca nedenidir. Bu yazıda öksürük ve balgam gibi pnömoni bulguları ile başvuran HIV/AIDS tanısı konulan ve beraberinde CMV pnömonisi tespit edilen bir olgu sunulmuştur.Öğe Transfusion Transmitted Virüs (Ttv) Prevalansıinaktif Hepatit B Taşıyıcılarında Hemodiyalizden Etkileniyor Mu?(Selçuk Üniversitesi, 2018 Mart) Kölgelier, Servet; Demir, Nazlım Aktuğ; Sümer, Şua; Demir, Lütfi Saltuk; Arpacı, Abdullah; Ural, OnurAmaç: Bu çalışmada, hemodiyaliz tedavisi uygulanan ve uygulanmayan inaktif hepatit B taşıyıcılarında Transfusion Transmitted Virus (TTV) prevalansının saptanması amaçlandı. Gereç ve Yöntem: Bu çalışma, hemodiyaliz tedavisi uygulanan 50 inaktif hepatit B hastası ve renal fonksiyonları normal olan 40 inaktif hepatit B olgusu üzerinde yapıldı. Hastalardan alınan serum örneklerinden ELİSA kiti ile Anti TTV IGG çalışıldı. Veriler Ki-kare testi ile değerlendirildi. Bulgular: 50 hemodiyaliz hastasının 39’unda (%78) Anti TTV IGG pozitif saptanırken, 40 hemodiyaliz tedavisi uygulanmayan inaktif hepatit B hastasının 8’inde (%20) Anti TTV IGG pozitifliği saptandı. Bu fark istatistiki olarak anlamlı idi (p=0.001). Sonuç: Hemodiyaliz tedavisi uygulanan hastalarda TTV seropozitifliğinin yüksek olması nedeniyle, hepatit virüslerinin bulaşının önlenmesi için bu ünitelerde temizlik, dezenfeksiyon ve enfeksiyon kontrolüne yönelik standart önlemlerin daha dikkatli uygulanması gerektiğini düşünüyoruz.Öğe Selçuk Üniversitesi Tıp Fakültesi Hastanesi’nde Çalışan Hemşire ve Personellerin Sağlık Hizmeti İlişkili Enfeksiyonları Önlemeye İlişkin Eğitim Öncesi ve Eğitim Sonrası Bilgi Düzeylerinin Ölçülmesi(Selçuk Üniversitesi, 2020 Haziran) Ural, Onur; Sümer, Şua; Demir, Nazlım Aktuğ; Abukan, Perihan; Benlioğlu, Özgül Özay; Özcan, NazanAmaç: Günümüzde sağlık hizmeti ilişkili enfeksiyonların önlemesi ve kontrolünün temelini temizlik, dezenfeksiyon, sterilizasyon, el hijyeni, sürveyans, epidemiyolojik yöntemler ve izolasyon önlemleri oluşturmaktadır. Bu uygulamaların en önemli basamağı ise eğitimdir. Bu çalışmada; sağlık hizmeti ilişkili enfeksiyonların önlenmesine yönelik verilen eğitimlerin etkinliğinin belirlenmesi amaçlandı. Gereç ve Yöntem: Fakültemizde çalışan 189 hemşire ve 182 personel olmak üzere 371 kişiye eğitim verildi.Eğitimin etkinliğini ölçmek için eğitim öncesi ve sonrası anketler uygulandı. Bulgular: Eğitim öncesi ve sonrası anketler değerlendirildiğinde hemşire grubunda 1,2,4,5 ve 9. soruda, personel grubunda 1,2,5 ve 9. sorularda eğitim sonrası bilgi düzeyinde istatistiki anlamda artış olduğu gözlendi. Sonuç: Hastane çalışanları için sağlık hizmeti ilişkili enfeksiyonlarınönemi ve enfeksiyonun ortaya çıkmasını engellemek amacıyla uygun tedbirler almak önemlidir. Bu durum konu ile ilgili hizmet içi eğitim programlarının düzenlenmesi ve eğitimin sürekliliği ile sağlanabilirÖğe Surveillance of penicillin resistance of Neisseria meningitidis strains from invasive infections between 2013 and 2018 in Turkey(TAYLOR & FRANCIS LTD, 2020) Öncel, Eda Karadağ; Ceyhan, Mehmet; Başaranoğlu, Sevgen Tanır; Gürbüz, Venhar; Aycan, Ahmet Emre; Özsürekci, Yasemin; Kurugöl, Zafer; Emiroğlu, Melike Keser; Devrim, İlker; Karbuz, Adem; Akışoğlu, Havva Özlem Altay; Gürler, NezahatNeisseria meningitidis (N. meningitidis) is regarded as the leading cause of bacterial meningitis in many regions of the world. The empiric antimicrobial treatment is mainly based on antimicrobial resistance and patient characteristics. We aimed to analyze susceptibility patterns of N. meningitidis strains isolated in Turkey. Invasive meningococci collected in a multicenter, hospital-based, epidemiological surveillance study of pediatric (0-18 years of age) bacterial meningitis cases between 2013 and 2018 were studied. Five isolates (8.7%) displayed resistance to penicillin-G, while 13 isolates (22.8%) had intermediate susceptibility. All isolates were cefotaxime and rifampin susceptible. The data shows appropriateness of third-generation cephalosporins in empirical use for meningococcal infections in children. Since Turkey is located in a transition zone geographically, surveillance reports are very crucial.Öğe Hepatosteatozun entekavir ve tenofovir tedavilerinde virolojik yanıta etkisi(AVES, 2019) Korkmaz, Pınar; Demirtürk, Neşe; Batırel, Ayşe; Tülek, Necla; Özgüler, Müge; Harman, Rezan; Çınar, Güle; Toka, Onur; Yörük, Gülşen; Hatipoğlu, Çiğdem Ataman; Sarıgül, Figen; Sırmatel, Fatma; İmre, Ayfer; Özatağ, Duru Mıstanoğlu; Karakeçili, Faruk; Ural, Onur; Sümer, Şua; Demir, Nazlım Aktuğ; Kadanalı, Ayten; Çomoğlu, Şenol; Üçer, Sengül; Saltoğlu, Neşe; Günal, Özgür; Özkaya, Hacer Deniz; Yenilmez, Ercan; Çetinkaya, Rıza Aytaç; Yüksel, Esma; Hakyemez, İsmail Necati; Meriç-Koç, Meliha; Tuncer-Ertem, Günay; Dursun, Zehra Beştepe; Çelik, İlhami; Yılmaz, Emel; Evik, Güliz; Kaya, Ali; Süer, KayaObjective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment. Methods: The study was designed retrospectively. All patients receiving antiviral therapy due to CHB in the departments of Infectious Diseases and Clinical Microbiology of 29 different hospitals between January 2012 and June 2017 were searched by examining medical records. Results: A total of 1069 patients were included. Six hundred and fifty of the patients had been receiving TDF and 419 of them had been receiving ETV. The rate of virological response obtained at the 48'h week of TDF was higher in patients with steatosis (p=0.029). Virological response at the 24th week and 48th week of ETV were higher in the patients without steatosis (p=0.001). TDF and ETV therapies were compared in the patients with hepatosteatosis and it was found that the virological response at 48th week was higher in the TDF group. Conclusion: Although steatosis has an effect on virological response in the short-term results of nucleos(t)ide therapy, it does not have any effect on virological response in the long-term results.Öğe Awareness of Hepatitis B virus reactivation among physicians administering immunosuppressive treatment and related clinical practices(AVES, 2019) Korkmaz, Pınar; Demirtürk, Neşe; Aydın, Gule; Çeken, Sabahat; Aygen, Bilgehan; Toka, Onur; Gündoğdu, Kıymet; Çelikbaş, Aysel Kocagül; İnan, Dilara; Kuruüzüm, Ziya; Kutsoylu, Oya Özlem Eren; Batırel, Ayşe; Sırmatel, Fatma; Ersöz, Gülden; Hakyemez, İsmail Necati; Aşçı, Zerrin; Yeşilbağ, Zuhal; Sönmezer, Meliha Çağla; Tülek, Necla; Örmen, Bahar; Karadağ, Fatma Yılmaz; Yörük, Gülşen; Türker, Nesrin; Özkaya, Hacer Deniz; Kalkan, İrem Akdemir; Süer, Hüseyin Kaya; Tekin, Süda; Saltoğlu, Neşe; Şener, Alper; Yenilmez, Ercan; Çetinkaya, Rıza Aytaç; Özel, Selcan Arslan; Ayaz, Celal; Karagöz, Ergenekon; Aydın, Mehtap; Acar, Ali; Arslan, Eyüp; Ceylan, Mehmet Reşat; Demir, Nazlım Aktuğ; Çaylak, Selmin Dirgen; Günal, Özgür; Solay, Aslı Haykır; Öztürk, Sinan; Ural, Onur; Sümer, Şua; Kadanalı, Ayten; Altıparmak, Vuslat Ecem Güneş; Akhan, Sıla; Sayan, Murat; Köse, ŞükranObjective: This study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: The study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: A total of 430 physicians participated in the study. Their mean age was 39.87 +/- 7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p<0.05). Physicians who used the guidelines related to HBV reactivation in their specialties performed screening for the HBV infection much more often than physicians who did not use the guidelines (p=0.002). Conclusions: According to the results obtained in our study, the rates of conducting screening and awareness of HBV reactivation among physicians administering immunosuppressive treatment were higher compared with similar studies; however, their awareness that HBV DNA and anti-HBc should be utilized much more frequently among the serological tests they use for screening of HBV infection, should be increased.Öğe Role of Tumor Necrosis Factor Alpha Promoter Polymorphisms in Interferon Related Side Effects in Chronic Hepatitis B Patients Under Interferon Alpha 2b Treatment(2019) İnkaya, Ahmet Çağkan; Arıbaş, Emel Türk; Kandemir, Bahar; Acar, Hasan; Bitirgen, MehmetObjective: Interferon alpha therapy is associated with series of adverse ef-fects leading premature discontinuation of treatment. Here we aimed to de-termine the effects of Tumor necrosis alpha promoter polymorphisms on in-terferon related side effects during interferon alpha 2b treatment in chron-ic hepatitis B patients.Material and Methods: This observational study enrolled 50 chronic hepati-tis B patients, who were treated with interferon alpha 2b 10 tiw plus lamivu-dine 100mg/day at Selçuk University Meram Medical Faculty Department of Infectious Diseases and Clinical Bacteriology between 2006-2007. Patients were followed-up with complete blood count, transaminases and amylase monthly at out patient clinics of our department. All patients were asked to fill a questionnaire to evaluate the interferon related side effects at every vis-it. Tumor necrosis factor alpha -238 and -308 polymorphisms were investi-gated with PCR-Restriction fragment length polymorphisms.Results: Arthralgia was present in 93.8% of patients. Exhaustion, loss of ap-petite, mount dryness and fever are the leading complaints of the patients. Median complaint scores were 9, 9.5, 11 and 5 at 4th, 12th, 24th and 48th week visits, respectively. Thrombocytopenia and leucopenia were detected in 8 (16%) and 5 (10%) patients, respectively. One-third of the patients report-ed depressive mood however, depression was diagnosed in 5 (10%) patients. TNF alpha promoter 238GG and 308GG allele was present in 42/50 and 43/50 patients, respectively. No association was found between TNF pro-moter allele and certain patient-reported side effect, complaint score, hema-tological and psychological adverse effects. Conclusion: TNF alpha promoter polymorphisms do not contribute to oc-currence of IFN alpha treatment related side effects.Öğe Relaps ile izlenen bir sıtma olgusu(2018) Sümer, Şua; Demir, Nazlım Aktuğ; Ural, Onur; Çimen, Gizem; Yalçınkaya, EmineSıtma, anofel cinsi sivrisineklerin ısırması ile insana bulaşan hücre içi parazit olan Plasmodium’ların neden olduğu bir hastalıktır. Bu hastalıkinsanlık tarihi kadar eski olup geçmişte büyük salgınlar yapmış, aynı zamanda sosyal ve ekonomik gelişimi engellemiştir. Ülkemizde DoğuAkdeniz ve Güneydoğu Anadolu bölgelerinde endemiktir. Ülkemizde en sık görülen Plasmodium türü Plasmodium vivax’dır. P.vivax enfeksiyonlarındarelapslara neden olan hipnozoit formunu eradike etmek için tedaviye primakin eklenmelidir. Bu sunumda relaps ile seyredenP.vivax olgusu sunulmuş olup tedavide primakin dozunun önemi vurgulanmak istenmiştir.Öğe Bir üniversite hastanesi öğrencileri, araştırma görevlileri ve öğretim üyelerinin el hijyeni hakkındaki bilgi düzeyleri(2018) Demir, Nazlım Aktuğ; Sümer, Şua; Demir, Lütfi Saltuk; Ural, OnurAmaç: Bu çalışmanın amacı bir üniversite hastanesi öğrencilerinin,araştırma görevlilerinin ve öğretim üyelerinin el hijyenihakkında farkındalığı ve bilgi düzeyinin değerlendirilmesidir.Yöntemler: Bu çalışma bir üniversite hastanesinde okuyan 892öğrenci, fakültemizde çalışan 243 araştırma görevlisi ve 131öğretim üyesi olmak üzere toplam 1266 kişi üzerinde yapıldı.Literatür taraması sonrasında hazırlanan anketler katılımcılarayüz yüze uygulandı.Bulgular: Çalışmaya katılan 1266 kişinin 657 (%51.9)’si erkek,609 (%48.1)’u kadındı. Çalışmaya katılan öğrencilerin %91’inin,araştırma görevlilerinin %73.2’sinin son 5 yıl içerisinde el hijyenieğitimi aldığı saptandı. Araştırma görevlilerinin %23.1’inin,öğrencilerin %38.7’sinin son bir yıl içerisinde eğitim aldığı tespitedildi. Öğretim üyelerinin hiçbirinin son 5 yıl içerisinde el hijyenieğitimi almadığı saptandı. Çalışmamızda son bir yıl içerisindeeğitim alanlarda bilgi düzeyi en yüksek bulundu (p0.001).Öğrencilerin bilgi düzeyi, araştırma görevlisi ve öğretim üyelerindenyüksek olarak tespit edildi (p0.01). Çalışmaya katılanların%54.2’si el hijyenine uyum oranını orta, %23.1’i iyi, %32.7’sikötü olarak değerlendirdi. Katılımcılar tarafından en çok doğrubilinen bilgi “her hastada eldiven değiştirilmelidir”iken en çokyanlış bilinen bilgi “eldiven giymek el hijyeni yerine geçer” olaraksaptandı. Katılımcılar arasında el hijyenine uyumsuzluğunen önemli nedeni iş yoğunluğu olarak belirtildi.Sonuçlar: Hastanemizde el hijyenine uyumun artırılmasına yönelikolarak yapılan çalışmaların sürekliliğinin sağlanmasının ne kadarönemli olduğu ve ayrıca eğitimlerin hastanede çalışan tüm personele(özellikle de doktorlara) ulaştırılmasının gerekliliği gözlendi.Öğe Nedeni bilinmeyen ateş etyolojisi araştırılırken saptanan üç tiroidit olgusu(2018) Demir, Nazlım Aktuğ; Sümer, Şua; Ural, Onur; Torun, AyşeAteş pek çok hastalığın ortak bulgusudur. En sık infeksiyonlarda görülmekle beraber infeksiyon hastalıkları dışında da karşımıza çıkabilir.Tiroiditler nedeni bilinmeyen ateş etyolojisi araştırılırken saptanan nadir nedenlerdendir. Ayırıcı tanıda düşünülürse tanısı kolaylıklakonulabilmektedir. Bu makalede kliniğimizde nedeni bilinmeyen ateş etyolojisi araştırılırken saptanan üç tiroidit olgusu irdelenmiştir.Hepsinin ortak şikayetleri ateş, boğaz ağrısı ve kilo kaybıdır. Fizik muayenelerinde bütün olgularda tiroid bezi hassas olarak saptanmıştır.Laboratuvar tetkiklerinde eritrosit sedimentasyon hızı yüksekliği, lökositoz ve tiroid stimüle edici hormon baskılanması tespit edilmiştir.Öğe Diz ekleminde gelişen tüberküloz septik artrit olgusu(2018) Ural, Onur; Sümer, Şua; Demir, Nazlım Aktuğ; Çiftci, ŞeymaSeptik artrit, eklemlerdeki sinovyal zar ve sinovyal sıvının bakteriyel, viral ya da fungal etkenlerle oluşan iltihabıdır. Tüm yaş ve riskgruplarında görülen en sık etken Staphylococcus aureus’tur. Kronik septik artrit söz konusu ise Mycobacterium türleri etken olabilir.Osteoartiküler tüberküloz, birçok kemik eklem patolojisini taklit edebilir. Tedavi edilmeyen olgularda destrüktif osteoartiküler sonuçlaraneden olabileceği için hızlı tanı ve tedavi önemlidir. Bu yazıda tekrarlayan septik artrit atakları ile başvuran ve tüberküloz artrit tanısıalan bir olgu sunulmuştur.Öğe Impaired thiol-disulfide balance in acute brucellosis(National Institute of Health, 2017) Kölgelier, Servet; Ergin, Merve; Demir, Lütfi Saltuk; İnkaya, Ahmet Cağkan; Demir, Nazlım Aktuğ; Alışık, Murat; Erel, ÖzcanThe objective of this study was to examine a novel profile: thiol-disulfide homeostasis in acute brucellosis. The study included 90 patients with acute brucellosis, and 27 healthy controls. Thiol-disulfide profile tests were analyzed by a recently developed method, and ceruloplasmin levels were determined. Native thiol levels were 256.72 ± 48.20 µmol/L in the acute brucellosis group and 461.13 ± 45.37 µmol/L in the healthy group, and total thiol levels were 298.58 ± 51.78 µmol/L in the acute brucellosis group and 504.83 ± 51.05 µmol/L in the healthy group (p < 0.001, for both). The disulfide/na-tive thiol ratios and disulfide/total thiol ratios were significantly higher, and native thiol/total thiol ratios were significantly lower in patients with acute brucellosis than in the healthy controls (p < 0.001, for all ratios). There were either positive or negative relationships between ceruloplasmin levels and thiol-disulfide parameters. The thiol-disulfide homeostasis was impaired in acute brucellosis. The strong associations between thiol-disulfide parameters and a positive acute-phase reactant reflected the disruption of the balance between the antioxidant and oxidant systems. Since thiol groups act as anti-inflammatory mediators, the alteration in the thiol-disulfide homeostasis may be involved in brucellosis. © 2017, National Institute of Health. All rights reserved.Öğe Distribution and evaluation of Vancomycin resistant Enterococci seen in Selcuk University Medical Faculty Hospital between 2012 and 2015(BILIMSEL TIP YAYINEVI, 2017) Torun, Ayşe; Sümer, Şua; Ural, Onur; Demir, Nazlım AktuğIntroduction: Prevailing at increasing rates as a cause of hospital infections in recent years, vancomycin resistant enterococcus (VRE) infections pose a serious problem in our country and across the world. This study aims at providing an overview of the VRE problem in our hospital. Materials and Methods: The data of 112 patients monitored in the clinics and intensive care units of Selcuk University Medical School Hospital between 1 January 2012 and 31 December 2015 and who had growth of VRE in their various cultures were reviewed retrospectively by going through patient files. Results: Looking at the distribution of VRE cases by years, it was seen that there were 13 cases in 2013 (11.6%), 23 cases in 2014 (20.5%) and 76 cases in 2015 (67.9%). Of these cases, 71 (63.4%) were colonized, 15 (13.4%) infected and 26 (23.2%) were both colonized and infected. The rate of infected cases was observed to be more in 2013, which was statistically significant (p< 0.001). From the 112 cases involving VRE, 36 (32.1%) were monitored in the clinics and 76 (67.9%) in the intensive care units. Thirty (83.3%) of the patients hospitalized in clinics were followed in the internal medicine clinics and 6 (16.7%) in surgical departments. The rate of colonization in patients treated in the intensive care units was higher than in those treated in clinics, which was statistically significant (p= 0.015). There was one or more underlying diseases in 109 (97.3%) of the 112 patients found to have VRE, a history of antibiotic use in 102 of them (91.1%), presence of urinary catheter in 102 (91.1%), and a history of hospitalization in 86 (76.7%). Therefore, history of hospitalization, history of underlying disease, history of antibiotic use, and presence of a urinary catheter were considered statistically significant risk factors for VRE infections (p values 0.01, 0.02, 0.01 and 0.01, respectively). E. faecium was found in 137 of the 141 isolates with VRE. Their susceptibility to antibiotics was 95.5% for linezolid and 99.2% for tigecycline. Their resistance to ampicillin and ciprofloxacin were 100%, to teicoplanin 95.7%, to trimethoprim sulfamethoxazole 89.2%, to high levels of gentamicin 87.5% and of tetracycline 80.4%. Conclusion: As a result of our study, risk factors for VRE infections were identified, which had become a growing problem in years in our hospital. It is to our belief that it would be useful, as a precaution, to take routine stool cultures from patients found to carry these risk factors.Öğe Selçuk Üniversitesi Tıp Fakültesi Hastanesinde 2012-2015 yılları arasında görülen Vankomisine dirençli Enterokokların dağılımı ve irdelenmesi(2017) Torun, Ayşe; Sümer, Şua; Ural, Onur; Demir, Nazlım AktuğGiriş: Son yıllarda hastane infeksiyonu etkeni olarak giderek artan oranda görülen vankomisine dirençli enterokok (VRE) infeksiyonları ülkemizde ve tüm dünyada ciddi bir sorun olarak karşımıza çıkmaktadır. Bu çalışmada hastanemizdeki VRE sorununun gözden geçirilmesi amaçlandı.Materyal ve Metod: Bu çalışmada, 01 Ocak 2012-31 Aralık 2015 tarihleri arasında Selçuk Üniversitesi Tıp Fakültesi Hastanesi servis ve yoğun bakımlarında takip edilen, çeşitli kültürlerinde VRE üreyen 112 olgunun verileri retrospektif olarak hasta dosyaları taranarak değerlendirildi.Bulgular: Yıllara göre VRE olgularının dağılımına bakıldığında; 2013 yılında 13 (%11.6) olgu, 2014 yılında 23 (%20.5) olgu, 2015 yılında ise 76 (%67.9) olgu saptandı. Olguların 71 (%63.4)'i kolonize, 15 (%13.4)'i infekte, 26 (%23.2)'sı ise hem kolonize hem de infekte olarak belirlendi. 2013 yılındaki infekte olguların oranının daha fazla olduğu ve bu durumun istatistiksel olarak anlamlı olduğu gözlendi (p 0.001). VRE saptanan 112 olgunun 36 (%32.1)'sı kliniklerde, 76 (%67.9)'sı yoğun bakımlarda izlendi. Kliniklerde yatan olguların 30 (%83.3)'u dahili, 6 (%16.7)'sı cerrahi bölümlerde takip edildi. Yoğun bakım ünitelerinde takip edilen olgularda kolonizasyon oranı serviste takip edilen olgulara göre daha fazla tespit edildi. Bu durum istatistiksel olarak anlamlıydı (p 0.015). VRE saptanan 112 olgunun 109 (%97.3)'unda altta yatan bir veya daha fazla hastalık, 102 (%91.1)'sinde antibiyotik kullanım öyküsü, 102 (%91.1)'sinde üriner kateter varlığı, 86 (%76.7)'sında hastanede yatış öyküsü vardı. Buna göre; hastanede yatış öyküsü varlığı, altta yatan hastalık varlığı, antibiyotik kullanım öyküsü olması ve üriner kateter varlığı VRE infeksiyonu açısından istatistiksel olarak anlamlı saptanan risk faktörleri olarak belirlendi (p değerleri sırasıyla 0.01, 0.02, 0.01, 0.01). VRE tespit edilen 141 izolatın 137'sinde Enterococcus faecium saptandı. Antibiyotik duyarlılıklarına bakıldığında linezolid duyarlılığı %95.5, tigesiklin duyarlılığı %99.2 olarak tespit edildi. Ampisilin ve siprofloksasin direnci %100, teikoplanin direnci %95.7, trimetoprim-sülfametoksazol direnci %89.2, yüksek düzey gentamisin direnci %87.5 ve tetrasiklin direnci %80.4 olarak saptandı.Sonuç: Yaptığımız çalışma sonucunda hastanemizde yıllar içinde gittikçe büyüyen bir problem haline gelen VRE infeksiyonlarına yönelik olarak risk faktörlerimiz belirlendi. Önlem olarak risk faktörleri saptanan hastalardan rutin dışkı kültürü alınmasının yararlı olacağı düşünülmektedir.Öğe Evaluation of dual therapy in real life setting in treatment-naive turkish patients with hcv infection: A multicenter, retrospective study(GALENOS YAYINCILIK, 2016) Gürbüz, Yunus; Tülek, Necla Eren; Tütüncü, Emin Ediz; Koruk, Süda Tekin; Aygen, Bilgehan; Demirtürk, Neşe; Kınıklı, Sami; Kaya, Ali; Yıldırmak, Taner; Süer, Kaya; Korkmaz, Fatime; Ural, Onur; Akhan, Sıla; Günal, Özgür; Tuna, Nazan; Köse, Şükran; Gönen, İbak; Örmen, Bahar; Türker, Nesrin; Saltoğlu, Neşe; Batırel, Ayşe; Tuncer, Günay; Bulut, Cemal; Sırmatel, Fatma; Ulçay, Asım; Karagöz, Ergenekon; Tosun, Derviş; Şener, Alper; Aynıoğlu, Aynur; Altunok, Elif SargınBackground: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naive. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naive-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (+/- 0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naive Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.Öğe Retreatment of chronic hepatitis c infection with telaprevir: Preliminary results in Turkey(GALENOS YAYINCILIK, 2015) Aygen, Bilgehan; Yıldız, Orhan; Akhan, Sıla; Çelen, Mustafa Kemal; Ural, Onur; Koruk, Süda Tekin; Köse, Şukran; Korkmaz, Fatime; Kuruüzüm, Ziya; Tuna, Nazan; Taheri, Serpil; Sayan, Murat; Demir, Nazlım Aktuğ; Sümer, Şua; Altınok, Elif SargınBackground: The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. Aims: To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. Study Design: Multi-center, retrospective, cross-sectional study. Methods: The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. Results: The mean age of the patients was 56.02 +/- 9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p<0.001). eRVR rates were 83.8% in prior relapsers, 48% in prior null responders, and 50% in prior partial responders (<0.001). The virological response at the 24th week of treatment was found to be the highest in prior relapsers (88.8%); it was 56% in prior null responders and 66.7% in prior partial responders (p<0.001). Common side effects were fatigue, headache, anorexia, malaise, anemia, pruritus, dry skin, rash, dyspepsia, nausea, pyrexia, stomachache, and anorectal discomfort. All treatments were discontinued due to side effects in 9.9% of patients. Conclusion: High virological response rates were obtained with TVR/PegIFN/RBV treatment. Although side effects were frequently observed, the discontinuation rate of combination therapy was low.Öğe Gözden kaçabilen bir enfeksiyon: Abdominal tüberküloz(2014) Demir, Nazlım Aktuğ; Sümer, Şua; Yiğit, Özge; Ural, OnurMycobacterium tuberculosis, en sık pulmoner tutulumla seyreden ve halen dünyada yaygın olarak görülmeye devam eden bir en- feksiyon hastalığıdır. Ekstrapulmoner tüberküloz tüm tüberküloz vakalarının %15-20'sini oluştururken, abdominal tüberküloz ise ekstapulmoner tüberküloz olgularının yalnızca %3'ünü kapsar. Bu yazıda yüksek ateş, halsizlik, iştahsızlık şikayetleri ile başvuran, dirençli ateşin nedenini bulmaya yönelik yapılan araştırmalar sırasında izole karaciğer ve dalak tutulumu saptanan bir tüberküloz olgusu sunulmuşturÖğe Konya Bölgesinde Tularemi(ANKARA MICROBIOLOGY SOC, 2012) Dikici, Nebahat; Ural, Onur; Sümer, Şua; Öztürk, Kayhan; Yiğit, Özgen Albayrak; Katlanır, Eda; Keleş, BaharTularemia is a zoonotic infection caused by Francisella tularensis. In the recent years tularemia has become a reemerging infection in Turkey with epidemics and also sporadic cases. Transmission occurs most often through consumption of contaminated water and food, direct contact with animals and insect/tick bites. In this study, we evaluated clinical features and laboratory findings of 35 tularemia cases diagnosed during two outbreaks that occurred in two different villages during two different periods in Konya (located in Central Anatolia), Turkey and five sporadic cases. In both outbreaks, first (index) cases were admitted to our outpatient clinic with the complaints of cervical lympadenopathy. After diagnosis of tularemia, an organized team visited the villages to search if more cases existed. For microbiological diagnosis, blood, throat and tonsil swabs and lymph node aspirate specimens were collected from the suspected cases. Diagnostic tests (culture, serology, molecular methods) for tularemia were performed in reference center, Refik Saydam National Public Health Agency. Drinking and potable water samples from those villages were also collected by provincial health authorities. The cases (n= 14) that belonged to the first epidemics were detected in February 2010 and cases (n= 21) of the second epidemics in NovemberDecember 2010; five cases were followed as sporadic. The mean age of the 40 patients (25 females, 15 males) was 37.6 (age range: 5-80 years; five of them were pediatric group) years. The most common complaints of patients were cervical mass (90%), sore throat (63%), chills (60%) and fever (58%). The most frequently detected clinical findings were enlarged lymph nodes (n= 34, 85%), followed by tonsillitis (20%), skin lesions (15%) and conjunctivitis (8%). Most of the patients (82.5%) had been misdignosed as acute tonsillitis, suppurative lymphadenitis, tuberculous lymphadenitis and brucellosis, before their admission to our hospital and treated with beta-lactam antibiotics. Demographic analysis of the cases revealed that 68% of them lived in the rural area, 75% had rodents at home, 46% used natural water supplies, 53% fed animals, 15% had contact with game animals and 5% had contact with ticks. Clinical samples from the patients were found culture negative for F.tularensis. The diagnosis of the cases was based on the presence of specific F.tularensis antibodies between 1/160-1/1280 titers obtained by microagglutination test. Additionally F.tularensis DNA was demonstrated in three lymph node aspirate samples by polymerase chain reaction (PCR). Water samples were found negative both by culture and PCR assays. However, it was detected that there were problems in the chlorination of water supplies in the two villages where epidemics were seen. All the patients were treated with streptomycin (2 x 1 g, intramuscular, 10 days), and surgical intervention was performed for the patients (n= 12) with extremely large lymph nodes and suppuration. Erythema nodosum developed in two patients following the end of treatment. Death or serious complications such as pneumonia or meningitis were not detected. In conclusion, tularemia should be considered in patients presenting with cervical lymphadenopathy, sore throat, fever and unresponsive to previous treatment with beta-lactam antibiotics. For the management of the disease, healthcare personnel and the community should be educated concerning the risk factors and precautions for tularemia.
