Browsing by Author "Tünger, Ö"

Now showing 1 - 13 of 13
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    Maternal carriage and antimicrobial resistance profile of group B Streptococcus
    Arisoy, AS; Altinisik, B; Tünger, Ö; Kurutepe, S; Ispahi, Ç
    Background: The aim of this study was to determine the prevalence of group B Streptococcus (GBS) colonization and to evaluate the antimicrobial resistance profile in women in the third trimester of pregnancy. Materials and Methods: A total of 310 pregnant women, referred in weeks 35 to 37 of gestation, were screened for GBS colonization during a 10-month period. Samples were collected from the vagina and the rectum. Results: The colonization rate was 10.6% and 22 women (66.7%) had both positive vaginal and rectal cultures. Rates of GBS colonization were significantly Lower in patients aged 24 years or older and in those with a third or Later pregnancy. None of the isolates were resistant to penicillin and ampicillin, whereas 21.2% and 9.1% showed resistance to erythromycin and clindamycin, respectively. Conclusion: Screening and antimicrobial susceptibility testing of GBS during pregnancy are important to guide appropiate therapy.
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    Colistin efficacy in the treatment of multidrug-resistant and extremely drug-resistant gram-negative bacterial infections
    Çetin, ÇB; Özer Türk, D; Senol, S; Dinç Horasan, G; Tünger, Ö
    Background/aim: Colistin is used as a salvage therapy for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections. Our aim was to evaluate colistin efficiency and toxicity in the treatment of these resistant gram-negative bacterial infections. Materials and methods: This is a retrospective study carried out in a tertiary care hospital during 2011-2013. Study data were collected from the medical records and consultations of the infectious diseases clinic. Results: The study group included 158 patients with nosocomial infections and 136 (86.1%) of them were hospitalized in the ICU. Respiratory tract infections were the most commonly observed ones (n = 103, 65.2%). The most frequently isolated microorganism was Acinetobacter baumannii (72.2%). A total of 98 (62.0%) patients had clinical cure. There was no statistically significant difference between monotherapy (n = 3/6, 50.0%) and combination therapies (n = 95/152, 62.5%) according to clinical response. Underlying ultimately fatal disease, previous renal disease, and total parenteral nutrition were independent risk factors for poor clinical response. Nephrotoxicity developed in 80 (50.6%) patients and clinical cure was statistically unrelated with nephrotoxicity. Conclusion: Colistin may be used as an effective agent for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections with close monitoring of renal functions, especially for older and critically ill patients.
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    Diagnostic and prognostic value of procalcitonin and sTREM-1 levels in sepsis
    Bayram, H; Tünger, Ö; Çivi, M; Yüceyar, MH; Ulman, C; Horasan, GD; Çetin, CB
    Background/aim: Sepsis is still a major cause of morbidity and mortality despite the improvements in diagnosis and treatment. The aim of this study was to investigate the values of procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the differential diagnosis of patients with sepsis and noninfectious systemic inflammatory response syndrome (NI-SIRS) and measure their importance in the prognosis of patients with sepsis. Materials and methods: This prospective study included 41 NI-SIRS and 33 sepsis patients hospitalized in Celal Bayar University Hospital, Manisa, Turkey. Blood samples were taken from NI-SIRS patients on days 0 and 3 and from sepsis patients on days 0, 3, 4, 7, and 14. Clinical status of the patients was determined with the SOFA scoring system. Results: The SOFA scoring system and procalcitonin and sTREM-1 measurements were significant in the differential diagnosis of sepsis and NI-SIRS patients. The SOFA scoring system was considered the most important indicator in determining the prognosis of sepsis patients. Procalcitonin and sTREM-1 levels increased progressively in nonsurvivors and decreased in survivors, but changes were statistically insignificant. Conclusion: In the differentiation of sepsis and NI-SIRS, and evaluation of the prognosis of sepsis, combined measurements of procalcitonin and sTREM-1 levels are important.
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    Investigation of synergism of meropenem and ciprofloxacin against Pseudomonas aeruginosa and acinetobacter strains isolated from intensive care unit infections
    Ermertcan, S; Hosgör, M; Tünger, Ö; Cosar, G
    The aim of this study was to determine synergistic effects of meropenem and ciprofloxacin against Pseudomonas aeruginosa and Acinetobacter strains isolated from intensive care unit (ICU) infections. A total of 18 P. aeruginosa and 17 Acinetobacter strains were tested. MICs were determined using the broth microdilution method. The synergy of meropenem and ciprofloxacin was investigated in glass tubes using time-kill methodology. The synergistic effect of meropenem and ciprofloxacin in combination was found to be 22% at 0.5 x the MIC and 61% at 1 x the MIC in P. aeruginosa strains. Two strains (11%) showed synergy at both 0.5 and 1 x the MIC. Of the 18 P. acruginosa strains, 1 strain (6%) did not show a synergistic effect at either 0.5 or I x the MIC. In Acinetobacter strains, the synergistic effect of meropenem and ciprofloxacin in combination was found to be 29% at 0.5 x the MIC and 18% at 1 x the MIC. One strain (6%) showed synergy at both 0.5 and 1 x the MIC. Of the 17 Acinetobacter strains, 8 strains (47%) did not show a synergistic effect at either 0.5 or 1 X the MIC. According to the results of this study, the combination of meropenem and ciprofloxacin is more effective than either antibiotic alone in ICU infections due to P. acruginosa strains.
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    Evaluation of rational antibiotic use
    Tünger, Ö; Dinç, G; Özbakkaloglu, B; Atman, ÜC; Algün, Ü
    The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n = 937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n = 156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P < 0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization. (C) 2000 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.
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    Secondary brucellar psoas abscess
    Tünger, Ö; Arysoy, AS; Öbakkaloglu, B; Temiz, C; Borand, H
    Psoas abscesses are rarely seen and usually misdiagnosed infections of the musculoskeletal system. A case of secondary psoas abscess due to Brucella spp. that was successfully treated with percutaneous computed tomography-guided aspiration and antimicrobial therapy is presented. The reported cases, diagnostic and therapeutic recommendations are also reviewed.
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    In vitro susceptibility of Staphylococcus aureus and coagulase-negative Staphylococcus strains to fusidic acid
    Tünger, Ö; Arisoy, A; Kurutepe, S; Akçali, S; Özbakkaloglu, B
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    Community-Acquired Pneumonia: Importance of Molecular Methods for Etiological Diagnosis and Clinical Features
    Özer-Türk, D; Tünger, Ö; Sakar-Coskun, A; Gazi, H; Sanlidag, T; Kurhan, F; Çetin, CB; Senol, S
    Objective: This study aims to make an early identification for the diagnosis of community-acquired pneumonia (CAP), to increase the rate of etiological diagnosis and to distinguish bacterial and viral pathogens with the use of multiplex polymerase chain reaction (PCR) in addition to conventional methods, and to compare cases in the light of clinical and laboratory results. Methods: Ninety two CAP patients who were hospitalized and followed at our hospital between January-November 2013 were included in this study. Conventional culture and multiplex PCR were used to identify the causative microorganisms in the respiratory tract samples of the patients. Demographic data, risk factors, clinical, radiological and laboratory results, treatment and follow-up results of the cases were recorded. Statistical Package for the Social Sciences (SPSS) for Windows. Version 15.0 (SPSS Inc., Chicago, IL, USA) program was used in the analysis of the data. Results: CURB-65 score was determined in >= 2 in 80.4% of the cases and 14.1% was followed in the intensive care unit. Of the patients, 42 (45.7%) were found to have bacterial and 20 (21.7%) were found to have viral agents while in 30 (32.6%) patients an agent could not be demostrated. Bacterial etiology was detected with conventional culture methods in 15 (16.3%) and with multiplex PCR in 42 (45.6%) cases. The difference between them was found to be statistically significant (p<0.001). It was found out that mostly bacterial factors were responsible for the CAP cases which were seen in fall or winter, and the etiology of the cases which were seen in spring and summer could not be determined in general (p<0.05). Variables such as sputum production, sore throat, auscultation findings and corticosteroid use were found to be statistically significant among bacterial, viral and unidentified etiology groups. Conclusions: It was demonstrated that molecular methods are beneficial for the early diagnosis of CAP. It was also thought that early diagnosis of viral etiology can prevent the unnecessary use of antibiotics as well as contributing to the patient management.
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    Comparison of Liver Extract Medium With Novy-MacNeal-Nicolle Medium and the Molecular Method for the Diagnosis of Leishmaniasis
    Özbilgin, A; Tünger, Ö; Inanir, I; Çavus, I; Perk, NE; Özel, Y
    Objective: Diagnosis of Leishmaniasis is based on culture, microscopic examination, serological tests, molecular methods. Novy-MacNeal-Nicolle (NNN) medium is mostly used for culture all over the world. The use of molecular methods for diagnostic purposes led to the questioning of the sensitivity of NNN medium. In this study, it is aimed to compare the performance of a new culture medium with those of NNN medium and the molecular method. Methods: Samples of 22 patients with suspected cutaneous leishmaniasis (CL) and 4 patients with suspected visceral leishmaniasis (VL) were sent to Manisa Celal Bayar University Faculty of Medicine Department of Medical Parasitology for diagnosis or confirmation from Kilis, Osmaniye, Bitlis, Gaziantep and Manisa provinces. Pre-prepared media were sent to the health centers in these provinces and inoculation of these media with clinical samples was requested. Needle aspiration fluid for CL and bone marrow samples for VL were cultured simultaneously on NNN medium and newly developed liver extracted medium (LEM), and were sent to our institution with their smears. Smears were examined by staining with Giemsa method. In addition, parasite DNA was identified with real-time polymerase chain reaction method in these materials. Results: Leishmania amastigotes were detected in 14 of 26 samples. Promastigote proliferation was observed in 8 and 24 of the samples cultured in NNN and LEM respectively. No proliferation was detected by either method in samples of 2 patients with suspected CL. L. tropica, L. major and L. infantum/donovani were detected among isolates showing dermotropic location, and L. tropica and L. infantum/donovani were detected among isolates with viscerotropic location by genotyping. Conclusions: NNN medium, which is widely used in leishmaniasis diagnosis, is not sensitive enough for the diagnosis of some Leishmania strains in Turkey. Therefore, an enrichment medium such as liver extract medium which we have presented in this study should be used for diagnosis. However our results should be confirmed with more studies.
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    Community Acquired Lower Urinary Tract Infections in Primary Care: Causative Agents and Antimicrobial Susceptibility
    Arman, D; Agalar, C; Dizbay, M; Tunçcan, ÖG; Keten, DT; Aygün, G; Tünger, Ö; Demirtürk, N; Inan, D; Özakin, C; Bayindir, Y; Akbulut, A; Bakir, M; Köksal, I; Özinel, MA; Oztoprak, N; Aktas, E; Alpay, Y
    Introduction: The aim of this study was to determine the causative agents of community-acquired lower urinary tract infections (CALUTIs) in primary care. We also aimed to evaluate the antimicrobial susceptibility rates of urinary Escherichia coli isolates to various oral antibiotics and to assist primary care physicians with antibiotic selection. Materials and Methods: The study was performed in 55 primary care centers in 13 cities between May and July 2009. Adult patients with at least two of dysuria, pollakiuria, nocturia, suprapubic tenderness, or blurred urine symptoms, but not fever, were included in the study. Urinary samples were obtained and patient data were recorded at the primary care centers. Results: Totally, 400 patients were enrolled. In 175 (43.8%) patients, urine cultures yielded a urinary pathogen. The most frequently encountered pathogen was E. coli (62.8%). Among E. coli isolates, the lowest resistance rates were detected for nitrofurantoin (0.9%) and fosfomycin (3.6%) and the highest for trimethoprim/sulfamethoxazole (43.6%) and amoxicillin/clavulanate (41%). Resistance rates to quinolones were 23.6% for ciprofloxacin and 21% for levofloxacin. Minimum inhibitory concentration (MIC)(50) and MIC90 values for ciprofloxacin and levofloxacin were 0.015 and 32 mu g/mL and 0.06 and 16 mu g/mL, respectively. Quinolone resistance was significantly higher in patients who received an antimicrobial treatment within the last three months (p< 0.001). Extended spectrum beta-lactamase (ESBL) positivity was detected in 15 of 110 (13.6%) E. coli isolates. Quinolone resistance was significantly higher among ESBL positive than ESBL negative strains (53.3% vs. 15.8%, p= 0.002). Conclusion: In conclusion, the most frequent causative agent in CALUTIs was E. coli. The lowest resistance rates among E. coli isolates were detected for nitrofurantoin and fosfomycin. Resistance rates to quinolones were over 20% in our study. Our study provides important data about the causative agents and their antibiotic susceptibilities and also contains valuable data for rational antibiotic usage in the treatment of CALUTI in Turkey.
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    First Presentation of the Complete Infection Cycle of Visceralizing Leishmania infantum/ donovani Hybrid Strain in Turkey: The Host, Reservoir and Vector
    Özbilgin, A; Arserim, SK; Tünger, Ö; Çavus, I; Yildirim, A; Tunali, V; Gündüz, C
    Objective: Visceral Leishmaniasis (VL) is a widespread infectious disease of the reticuloendothelial system which is mostly caused by Leishmania infantum and L.donovani. VL is a zoonotic infection and dogs act as the main reservoirs of the disease while the vectors are the female Phlebotomus, that is to say, sandflies. Although Leishmania spp. are attributed to reproduce asexually, the genetic exchange between different strains has recently been demonstrated and causes interspecific hybrids. We aimed to present the complete infection cycle of a hybrid strain of Leishmania infantum/donovani with the host, reservoir, and vector.Materials and Methods: A patient presenting with VL proved to have a dog with canine leishmaniasis. Bone marrow aspirate from the patient and lymph node aspirates from the dog were inspected for Leishmania spp. amastigotes under light microscopy. Samples were cultured in enriched NNN medium. Serological examinations were made using IFAT for the patient serum and rK39 test for both human and dog samples. Light traps were placed to collect Phlebotomus. Leishmania molecular identification was executed by primers and probes specific to ITS-1 and cytochrome B gene region of Leishmania parasites.Results: Leishmania spp. amastigotes were detected in the slides while promastigotes were present in the enriched NNN medium. For patient serum, IFAT IgG was 1/256 positive, and rK39 was positive for both dog and human samples. Fifty-two Phlebotomus were caught (24 male, 28 female): 35 of them were P. similis, ten were P. neglectus/synacus, six were P .papatasi, and one was P. tobbi. Molecular analysis showed that the Leishmania spp. isolates from the patient, dog, and P.tobbi were identical. Gel image revealed two bands in all three samples, thus leading to the conclusion that the infecting strain was a hybrid of L. infantum and L. donovani. Conclusion: We found identical isolates that are putative hybrids of L. donovani and L. infantum in human, dog reservoir and sandfly..