Browsing by Author "Kilimci, DD"

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    Biallelic variant at 5' UTR DMRT1: A novel 46,XY DSD syndrome?
    Solmaz, AE; Ersoy, B; Özen, S; Kilimci, DD; Kizilay, DÖ; Akin, H
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    EPISODE OF ACUTE HEMOLYSIS DUE TO UNDIAGNOSED GLUCOSE-6-PHOSPHATE DEHIDROGENASE DEFICIENCY IN AN ADOLESCENT WITH NEWLY DIAGNOSED TYPE 1 DIABETES MELLITUS: CASE REPORT AND REVIEW OF LITERATURE
    Goren, TA; Kilimci, DD; Yigit, Y; Yildirim, AT; Gulen, H; Ersoy, B
    Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency is common in the community. The most important clinical manifestation of G6PD deficiency is acute hemolytic anemia due to oxidative stressors. Diabetes Mellitus (DM) can precipitate hemolysis in patients with G6PD deficiency. Here, we described a 15-year-old male with newly diagnosed type 1 DM (T1DM) and unknown G6PD deficiency who suffered from hemolytic anemia during normalization of blood glucose. On admission, the patient did not have ketoacidosis. After the patient's blood sugars were regulated with insulin therapy, he presented five days later with hemolytic anemia. The cause of hemolytic anemia was G6PD deficiency. The patient had no previous episodes of hemolysis and had no relevant family history. Hypoglycemia did not occur during blood glucose regulation. The return of blood sugar to normal after a long period of hyperglycemia was thought to be the possible cause of hemolysis. In conclusion, G6PD deficiency should be considered when there is an episode of hemolysis in newly diagnosed children and adolescents with T1DM, especially in the absence of ketoacidosis and hypoglycemia.
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    Evaluation of Children with Stenotrophomonas maltophilia Bacteremia
    Yesil, E; Çelebi, S; Özaslan, Z; Özer, A; Kilimci, DD; Hacimustafaoglu, M
    Introduction: Stenotrophomonas maltophilia (S. maltophilia) is a resistant gramnegative rod that can often cause serious infections, especially in patients with long hospital stays and using broad-spectrum antibiotics. In this study, clinical data, and mortality-related risk factors of patients with S. maltophilia bacteremia were evaluated. Materials and Methods: Patients with S. maltophilia bacteremia included in this study and evaluated retrospectively, when hospitalized between 2013 and 2018 in our pediatric wards and intensive care units. Results: A total of 67 patients had 100 S. maltophilia bacteremia in 70 different episodes. Sixty percent (n=40) of the cases were male and their median age were 9 months. Sixty-nine percent (n=46) of the cases were admitted in intensive care units. The most common comorbidity was malignancy. All bacteremias were healthcare associated, and 55% (n=55) were catheter-related. In the total of 70 episodes; 57% (n=37) of the patients had central venous catheters, 47% (n=33) were entubated. Fourty-seven percent (n=33) of the patients had broad spectrum antibiotic use over 14 days. In the blood cultures, 98% of S. maltophilia-producing strains were sensitive to trimethoprim-sulfamethoxazole. Ciprofloxacin and trimethoprim-sulfamethoxazole combination therapy had used for treatment. The mortality rate in the first 30 days was 16% (n=11). Mechanical ventilation was found to be significant (p<0.05) as a predisposing factor related to mortality. Conclusion: Stenotrophomonas maltophilia is the causative pathogen in healthcare associated bloodstream infections especially in intensive care unit. In our study, 69% of the cases were admitted in the intensive care unit and mechanical ventilation status increased mortality.
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    Evaluation of Children with Ralstonia pickkettii Bacteraemia
    Yesil, E; Hacimustafaoglu, M; Çelebi, S; Özer, A; Kilimci, DD; Eren, H; Özakin, C
    Objective: Ralstonia pickettii is an opportunistic pathogen that is often considered to be contaminant. It can cause infection due to colonisation in infusion solutions and disinfectants. Although rare, it can lead to nosocomial outbreaks, so this agent should not be ignored. In this study, it was aimed to evaluate the growth of R. pickettii in blood cultures taken in the pediatric wards of our hospital, to analyze the outbreaks by R. pickettii and to discuss the precautions to prevent the outbreaks.Material and Methods: Patients with Ralstonia picketti in blood cultures, who were admitted in the pediatric intensive care unit (PICU; n= 46, 81%), neonatal intensive care unit (n= 7, 12%) and other pediatric wards (n= 4, 7%) between February 2014 and December 2017 were included into the study. Patient's data, the relation between the outbreaks and culture growths, and the sources and the prevention of potential outbreaks were evaluated. Recurrent growths were defined as a single episode.Results: Ralstonia pickettii detected in 57 different specimens in 38 different episodes in a total of 35 patients. Of the fifty-seven blood samples, 67% (n= 38) were peripheral blood cultures, 33% (n= 19) were catheter blood cultures and 74% of the samples lead to infection. Of the 38 ep-isodes, 63% (n= 24) were considered as infection and 37% (n= 14) was contamination. Median age of the patients were seven (0-180) months, and the major underlying comorbidity was congenital heart disease. Of 57 specimens with Raltstonia pickettii growth, 16 (28%) had only R. pickettii growth, and the remaining 41 (71%) cultured growths were poly -microbial. Among these, the most common accompanying microorganisms were Stenotrophomonas maltophilia and Burkholderia species. Of 38 episodes, 58% (n= 22) had a central venous catheter (CVC), of which 64% (n= 14) developed catheter-related bloodstream infection due to R. pickettii. Eighty-one percent of the specimens were detected in the pediatric in-tensive care unit, and the outbreak situation was examined. Twenty-three (61%) of a total of 57 growths were associated with an outbreak of health-care-associated infection in three separate periods. Ralstonia pickettii was not detected in environment scans. Antibiogram features of the growths were similar and they were thought to be of the same isolate, no molecular study was applied. Three patients died within the first 30 days after the growth.Conclusion: Our study has the largest case series reported in a pediatric population in Turkiye and the world. The mortality rate due to R. pickettii was low. Eighty-one percent of the specimens were in the pediatric inten-sive care unit and 61% was associated with the outbreak. The importance of hospital infection control measures in preventing R. pickettii and similar outbreaks were emphasized. A limited number of studies have been conducted on this subject in Turkiye, and we believe that our study will contribute to the literature.