Browsing by Author "Oguz, VA"

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    THE RATE OF INDUCIBLE CLINDAMYCIN RESISTANCE AND SUSCEPTIBILITIES TO OTHER ANTIMICROBIAL AGENTS IN STAPHYLOCOCCI
    Oguz, VA; Yapar, N; Sezak, N; Çavus, SA; Kurutepe, S; Peksel, H; Çakir, N; Yüce, A
    Staphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics used by oral route such as erythromycin, clindamycin, trimethoprim-sulphamethoxazole (TMP-SMX) and quinolones are of value especially in the treatment of community acquired infections and resistance to those antibiotics may lead to therapeutic failure. Therefore in this study, susceptibility of staphylococci to TMP-SMX, rifampin, tetracycline, gentamicin, ciprofloxacin and vancomycin and the presence of inducible clindamycin resistance were investigated in two distinct university hospitals in Turkey. A total of 286 staphylococcus strains [184 Staphylococcus aureus, 102 coagulase negative staphylococci (CoNS)] were studied. Of the 90 hospital-acquired S.aureus, 44.6% were methicillin-resistant while all of the community acquired strains were methicillin-susceptible. All of the CoNS strains were isolated from nosocomial infections and 71.6% of them were resistant to methicillin. Inducible clindamycin resistance rate of CoNS strains (34.3%) was higher than that of S.aureus strains (7.1%) and the difference was statistically significant (p = 0.00001). Positive D-test among CoNS were significantly higher in S.hominis strains (p = 0.00001). Susceptibilities of S.aureus strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 56%, 59%, 56%, 56% and 99%, respectively. Susceptibilities of CoNS strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 73%, 72%, 39%, 40% and 46%, respectively. None of these strains were vancomycin resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive and negative S.aureus strains were found statistically significant. Although among CoNS isolates, no. statistically significant difference was found between the resistance rates, D-test positive strains were determined to be more resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive S.aureus and CoNS strains were found statistically significant. It can be concluded that inducible clindamycin resistance should be tested for staphylococci during routine antibiotic susceptibility testing. According to the presented data, clindamycin still can be used empirically in methicillin-susceptible S.aureus infections in our region, however, the routine use of rapid, easy, reproducible and economic D-test for the determination of inducible clindamycin resistance in erythromycin resistant strains should be considered in clinical microbiology laboratories. Inducible clindamycin resistance must be anticipated carefully while considering therapeutic options especially for CoNS infections.
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    A comparison of two different fluorochrome stains for the detection of acid-fast bacilli in sputum specimens
    Oguz, VA; Sezak, N; Öztop, A; Yapar, N; Sürücüoglu, S; Yüce, A
    Aim: The early diagnosis of active tuberculosis still depends on the presence of acid-fast bacilli (AFB) in stained sputum smears. In this study, our aim was to investigate the efficiency and cost-effectiveness of two different fluorochrome stains. Materials and methods: A total of 1013 sputum specimens were collected from 642 patients. Three smears and cultures were prepared from each specimen. Double-blind and prospective laboratory procedures were performed. Slides were stained with a commercial auramine/acridine orange kit (Stain 1), an in-house preparation of auramine- rhodamine/KMnO4 (Stain 2) and a Ziehl-Neelsen stain (EZN). Results: Of the 1013 specimens, 101 were culture positive. Among these, AFB was detected in 60 specimens by EZN, in 53 by Stain 1, in 81 by Stain 2. By cultures, the sensitivities and specificities of Stain 2 were 80.1% and 83.8%, respectively, and for Stain 1, 52.4% and 94.6% respectively. There is no significant difference between the costs of these methods. Conclusion: Stain 1 was easy to apply and inexpensive but the sensitivity of Stain 1 was lower than that of Stain 2. However, Stain 2 required longer preparation time, more work, and had a higher risk of exposure to carcinogens. In order to increase the sensitivity of Stain I, it is suggested that the contents of the prepared Stain 1 kit could be rearranged. In tuberculosis diagnosis, this revised kit may provide practicality in use.
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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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    The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
    Kokturk, N; Babayigit, C; Kul, S; Cetinkaya, PD; Nayci, SA; Baris, SA; Karcioglu, O; Aysert, P; Irmak, I; Yuksel, AA; Sekibag, Y; Toprak, OB; Azak, E; Mulamahmutoglu, S; Cuhadaroglu, C; Demirel, A; Kerget, B; Ketencioglu, BB; Ozger, HS; Ozkan, G; Yuce, ZT; Ergan, B; Oguz, VA; Kilinc, O; Ercelik, M; Ciftci, TU; Alici, O; Temel, EN; Ataoglu, O; Aydin, A; Bahcetepe, DC; Gullu, YT; Fakili, F; Deveci, F; Kose, N; Tor, MM; Gunluoglu, G; Altin, S; Turgut, T; Tuna, T; Ozturk, O; Dikensoy, O; Gulhan, PY; Basyigit, I; Boyaci, H; Oguzulgen, IK; Borekci, S; Gemicioglu, B; Bayraktar, F; Elbek, O; Hanta, I; Okur, HK; Sagcan, G; Uzun, O; Akgun, M; Altinisik, G; Dursun, B; Edis, EC; Gulhan, E; Eyuboglu, FO; Gultekin, O; Havlucu, Y; Ozkan, M; Sakar, A; Sayiner, A; Kalyoncu, AF; Itil, O; Bayram, H
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    The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
    Kokturk, N; Babayigit, C; Kul, S; Cetinkaya, PD; Nayci, SA; Baris, SA; Karcioglu, O; Aysert, P; Irmak, I; Yuksel, AA; Sekibag, Y; Toprak, OB; Azak, E; Mulamahmutoglu, S; Cuhadaroglu, C; Demirel, A; Kerget, B; Ketencioglu, BB; Ozger, HS; Ozkan, G; Ture, Z; Ergan, B; Oguz, VA; Kilinc, O; Ercelik, M; Ciftci, TU; Alici, O; Temel, EN; Ataoglu, O; Aydin, A; Bahcetepe, DC; Gullu, YT; Fakili, F; Deveci, F; Kose, N; Tor, MM; Gunluoglu, G; Altin, S; Turgut, T; Tuna, T; Ozturk, O; Dikensoy, O; Gulhan, PY; Basyigit, I; Boyaci, H; Oguzulgen, IK; Borekci, S; Gemicioglu, B; Bayraktar, F; Elbek, O; Hanta, I; Okur, HK; Sagcan, G; Uzun, O; Akgun, M; Altinisik, G; Dursun, B; Edis, EC; Gulhan, E; Eyuboglu, FO; Gultekin, O; Havlucu, Y; Ozkan, M; Coskun, AS; Sayiner, A; Kalyoncu, AF; Itil, O; Bayram, H
    The COVID-19-related death rate varies between countries and is affected by various risk factors. This multi-center registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age >= 65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6-23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.
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    The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort
    Babayigit, C; Kokturk, N; Kul, S; Cetinkaya, PD; Nayci, SA; Baris, SA; Karcioglu, O; Aysert, P; Irmak, I; Yuksel, AA; Sekibag, Y; Toprak, OB; Azak, E; Mulamahmutoglu, S; Cuhadaroglu, C; Demirel, A; Kerget, B; Ketencioglu, BB; Ozger, HS; Ozkan, G; Ture, Z; Ergan, B; Oguz, VA; Kilinc, O; Ercelik, M; Ciftci, TU; Alici, O; Temel, EN; Ataoglu, O; Aydin, A; Bahcetepe, DC; Gullu, YT; Fakili, F; Deveci, F; Kose, N; Tor, MM; Gunluoglu, G; Altin, S; Turgut, T; Tuna, T; Ozturk, O; Dikensoy, O; Gulhan, PY; Basyigit, I; Boyaci, H; Oguzulgen, IK; Borekci, S; Gemicioglu, B; Bayraktar, F; Elbek, O; Hanta, I; Okur, HK; Sagcan, G; Uzun, O; Akgun, M; Altinisik, G; Dursun, B; Edis, EC; Gulhan, E; Eyuboglu, FO; Gultekin, O; Havlucu, Y; Ozkan, M; Coskun, A; Sayiner, A; Kalyoncu, AF; Itil, O; Bayram, H
    Background and objectivesAlthough several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. MethodsPatients admitted to 26 different hospitals located in 16 different provinces between March 11-July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. ResultsWe retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 +/- 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5-12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (beta [95% CI]: 4.71 [2.31-7.11]; p = 0.001), favipiravir (beta [95% CI]: 3.55 [2.56-4.55]; p = 0.001) and HCQ (beta [95% CI]: 0.84 [0.02-1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70-5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28-6.75]; p = 0.011). ConclusionOur findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.