Browsing by Author "Yapar, N"
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Item THE RATE OF INDUCIBLE CLINDAMYCIN RESISTANCE AND SUSCEPTIBILITIES TO OTHER ANTIMICROBIAL AGENTS IN STAPHYLOCOCCIOguz, VA; Yapar, N; Sezak, N; Çavus, SA; Kurutepe, S; Peksel, H; Çakir, N; Yüce, AStaphylococci 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.Item A comparison of two different fluorochrome stains for the detection of acid-fast bacilli in sputum specimensOguz, VA; Sezak, N; Öztop, A; Yapar, N; Sürücüoglu, S; Yüce, AAim: 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.Item Evaluation of species distribution and risk factors of candidemia: A multicenter case-control studyYapar, N; Pullukcu, H; Avkan-Oguz, V; Sayin-Kutlu, S; Ertugrul, B; Sacar, S; Cetin, B; Kaya, OThis study was planned to determine the risk factors of candidemia, and the most common Candida species causing bloodstream infections. A case-control study which included adult patients was conducted over a 1-year period at tertiary-care educational hospitals in Turkey. A total of 83 candidemia episodes were identified during the study period. Candida albicans was the most common species recovered (45.8%) followed by Candida tropicalis (24.1%) Candida parapsilosis (14.5%) and Candida glabrata which was isolated from only four (4.8%) patients. Presence of a urethral catheter (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.09-5.19; P = 0.02), previous use of antibiotics (OR 2.61; 95% CI 1.05-6.46; P = 0.03), RBC transfusions (OR 2.14; 95% CI 1.16-3.94; P = 0.01) and parenteral nutrition (OR 4.44; 95% CI 2.43-8.11; P < 0.01) were found as independent risk factors for candidemia. TPN (Total Parenteral Nutrition) was an independent risk factor for both C. albicans and non-Candida albicans Candida species (P < 0.001). Most of the risk factors were invasive procedures and former medications. We conclude that a great number of candidemia cases are preventable by means of reduction of unnecessary invasive procedures and the use of antimicrobials.Item Evaluation of species distribution and risk factors of candidemia: a multicenter case-control studyYapar, N; Pullukcu, H; Avkan-Oguz, V; Sayin-Kutlu, S; Ertugrul, B; Sacar, S; Cetin, B; Kaya, OItem Antifungal Prophylaxis in Solid Organ Transplant RecipientsSenol, 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, NSolid 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.Item Multicenter Analysis of Anidulafungin Use in Invasive Candida InfectionsIsikgoz 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, NIntroduction: 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.Item The evaluation of antifungal consumption: a point-prevalence surveySenol, 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, VItem Evaluation of patients with zygomycosisKaya, 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, NAim: 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.Item Effectiveness and safety of anidulafungin: A real-life multicenter data in TurkeyMeltem, T; Kutsoylu, OE; Pullukcu, H; Sayin-Kutlu, S; Ozturk, B; Kaya, O; Turhan, O; Senol, S; Alp-Cavus, S; Kutlu, M; Mermut, G; Metin, D; Baysan-Ozhak, B; Ergin, C; Cetin, C; Ertugrul, MB; Avkan-Oguz, V; Yapar, NItem Mortality-associated factors of candidemia: a multi-center prospective cohort in TurkeyKutlu, M; Sayin-Kutlu, S; Alp-Cavus, S; Öztürk, SB; Tasbakan, M; Özhak, B; Kaya, O; Kutsoylu, OE; Senol-Akar, S; Turhan, Ö; Mermut, G; Ertugrul, B; Pullukcu, H; Çetin, ÇB; Avkan-Oguz, V; Yapar, N; Yesim-Metin, D; Ergin, ÇCandidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30 days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154-1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752-8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634-53.744,p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079-6.761, p=0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057-6.439, p =0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147-0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia.