Browsing by Author "Metin, DY"

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    Antifungal Prophylaxis in Solid Organ Transplant Recipients
    Senol, S; Kutsoylu, OE; Kaya, O; Avci, M; Tasbakan, MI; Oguz, VA; Baysan, BÖ; Çavus, SA; Çetin, CB; Ergin, C; Ertugrul, B; Kutlu, SS; Kutlu, M; Mermut, G; Metin, DY; Öztürk, B; Pullukçu, H; Turhan, Ö; Yapar, N
    Solid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed.
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    Molecular Typing of Adenoviruses Isolated from Clinical Specimens by PCR and DNA Sequencing Methods
    Çiçek, C; Sanlidag, T; Akçali, S; Sayan, M; Yalaz, M; Metin, DY
    Adenoviruses are responsible for a broad spectrum of diseases, including upper and lower respiratory tract infections (URTIs and LRTIs, respectively), conjunctivitis, gastroenteritis, and hemorrhagic cystitis. The aim of this study was to determine the adenovirus (AdV) types isolated from clinical specimens by polymerase chain reaction (PCR) and DNA sequencing methods. A total of 22 AdV strains isolated between January 1st 2011 to May 31th 2011, from various samples (295 nasopharyngeal swabs, 42 conjunctival swabs, 13 stool) sent to our routine virology laboratory were included in the study. Of the 22 patients whose samples yielded adenovirus positivity, 8 were adult (4 were male; median age: 32.5 years) and 14 (7 were male; median age: 1 year) were children. Those specimens (14 nasopharyngeal swabs, 7 conjunctival swabs, 1 stool) were obtained from patients with URTIs (n= 6), LRTIs (n= 8), conjunctivitis (n= 7) and gastroenteritis (n= 1). For the isolation and identification of adenoviruses, rapid (shell vial) cell culture and direct immunofluorescence antibody methods were used, respectively. Molecular typing of adenoviruses were performed by PCR and sequencing of a partial region (hipervariable region 1-6) of the hexon gene. PCR primers (Adhex F1, Adhex R1) used for DNA amplification were from those described by Lu and Erdman, previously. If insufficient DNA was amplified from the first reaction for sequencing, a nested PCR was performed using Adhex F2 and Adhex R2 primers. Sequencing was performed using the amplification primers and Sequence Reagent Mix-DYEnamic ET Terminator Cycle Sequencing Kit (Amersham Pharmacia Biotech Inc, USA) on ABI PRISM 310 Genetic Analyzer (Applied Biosystems, USA). Obtained adenovirus sequences were typed by BLAST analysis and three AdV types namely type 3, 4, and 8 were identified. In our study, AdV type 3 was detected in a gastroenteritis case and six cases with URTIs and LRTIs (n= 7, 31.8%). AdV type 8 was identified as the cause of conjunctivitis in seven patients and of URTIs and LRTIs in five patients (n= 12, 54.5%). AdV type 4 was found to be associated with URTI in one, and LRTIs in two patients (n= 3; 13.7%). Our data indicated that AdV type 8 was the most prevalent type in patients with conjunctivitis and URTIs, while AdV type 3 was the most prevalent type in patients with LRTI. BLAST analysis was thought to be useful for the molecular typing of adenoviruses. In conclusion, advanced studies with large number of specimens are necessary to achive a reliable, detailed national adenovirus database.
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    Multicenter Analysis of Anidulafungin Use in Invasive Candida Infections
    Isikgoz Tasbakan, M; Eren Kutsoylu, O; Pullukçu, H; Sayin Kutlu, S; Öztürk, B; Kaya, O; Turhan, Ö; Senol Akat, S; Alp Çavus, S; Kutlu, M; Mermut, G; Metin, DY; Özhak, B; Ergin, C; Çetin, CB; Ertugrul, MB; Avkan Oguz, V; Yapar, N
    Introduction: Fungal infections are vital problems worldwide and their incidence have increased along with changing patient profile. Particularly candida species is still the most commonfungal agent, and the significance of non-albicans candida species have gained importance in recent years. In the present study, it was aimed to evaluate retrospectively the risk factors and distribution of candida species in patients with invasive candida infections, who were treated with anidulafungin. Materials and Methods: In the first three years (1 January 2012 to 31 December 2014) when anidulafungin came out in our country, we retrospectively evaluated the data of the patients with invasive candida infections who were treated by anidulafungin for more than 48 hours in seven university hospitals. Data were recorded to the case report forms. Results: Two hundreds and fifty-seven patients were included into the study. Fifty-six percent of the patients were male and mean age was 58.57 +/- 19.5 years. Two hundreds and three patients (79%) were hospitalized in intensive care units, 37 (14.3%) in internal medicine services, and 17 (0.07%) in surgery services. As previously described, we detected antibiotic usage in the last month (%96.9), presence of urinary catheter (90.3%) and presence of central venous catheter (82.1%) as risk factors for invasive candida infections. More than half of the patients (57.1%) with central venous catheter had candidemia. Sixty-six (47.7%) of the blood isolates were Candida albicans, 33 (23.7%) were Candida parapsilosis, 17 (12.2%) were Candida tropicalis and 13 (9.4%) were Candida glabrata. During follow up, 64.5% of 124 patients whose catheters couldn't be taken off and 47.6% of 86 patients whose catheters could be taken off died. During anidulafungin treatment, one anaphylaxis, one skin eruption and one thrombocytopenia were seen as side effects. Conclusion: In our study, we found that removal of central venous catheter of the patients with candidemia was a positive effect on mortality. We suggest that patients with candidemia, insisting on catheter removal besides antifungal treatment is necessary. We observed that anidulafungin is an effective and safe choice in invasive candida infections.
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    The evaluation of antifungal consumption: a point-prevalence survey
    Senol, S; Eren-Kutsoylu, OO; Turhan, O; Alp-Cavus, S; Tasbakan, M; Ozturk, B; Sayin-Kutlu, S; Cetin, CB; Kaya, O; Ozhak, B; Pullukcu, H; Ertugrul, B; Kutlu, M; Mermut, G; Ergin, C; Metin, DY; Yapar, N; Avkan-Oguz, V
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    Evaluation of patients with zygomycosis
    Kaya, O; Alp Çavus, S; Turhan, O; Isikgöz Tasbakan, M; Pullukcu, H; Ertugrul, MB; Senol, S; Çetin, CB; Özhak Baysan, B; Sayin Kutlu, S; Metin, DY; Avci, M; Mermut, G; Avkan Oguz, V; Yapar, N
    Aim: Zygomycosis is a severe angioinvasive infection caused by Zygomycetes. We retrospectively investigated 16 cases of zygomycosis. Materials and methods: The data of patients, who had been followed between 2004 and 2010 in 8 tertiary-care teaching hospitals, were reviewed. Demographic characteristics, underlying diseases, and clinical signs and symptoms of the patients, as well as diagnostic methods, data obtained by radiological imaging methods, and the therapies, were recorded. Therapeutic approaches, antifungal agents and duration of use, and the characteristics of the cases were identified. Results: The study included 11 female and 5 male subjects. The most common symptoms and clinical signs were fever (n = 9) and retro-orbital pain (n = 7). Rhinocerebral zygomycosis was the most common form. The mean time elapsed for diagnosis was 14.26 +/- 13.96 (range: 2-52) days. Antifungal therapy was given to 15 patients (94%). In addition to antifungal therapy, 12 patients underwent surgical intervention 1 to 4 times. The mean duration of receiving antifungal therapy was 61.4 +/- 58.02 (range: 1-180) days. The median duration of treatment was 62.5 (range: 42-180) days in survivors. Conclusion: Zygomycosis is an infectious disease with high mortality despite antifungal therapy and surgical interventions.