Journal of Antimicrobial Chemotherapy, Mar 8, 2011
Doripenem is a new carbapenem recently introduced into Europe. The COMParative Activity of Carbap... more Doripenem is a new carbapenem recently introduced into Europe. The COMParative Activity of Carbapenem Testing (COMPACT) study compared the susceptibility of common Gram-negative bacilli causing serious infections in hospitalized patients with doripenem, imipenem and meropenem. Methods: Gram-negative isolates (4498 total: 2171 Pseudomonas species; 1910 Enterobacteriaceae; and 417 other Gram-negative bacilli) were collected from 80 centres in 16 countries in Europe, the Middle East and Africa during 2008-09. The MICs of doripenem, imipenem and meropenem were determined using Etest methodology and broth microdilution. Susceptibility was interpreted according to CLSI, EUCAST and FDA breakpoints. Results: The MIC 90 s of doripenem, imipenem and meropenem for all isolates were 8, ≥64 and 32 mg/L, respectively. Doripenem had the lowest MIC 90 for Pseudomonas species at 16 mg/L, with imipenem and meropenem values of ≥64 mg/L. Enterobacteriaceae were highly susceptible to all three carbapenems, with MIC 90 s of doripenem, imipenem and meropenem of 0.06, 0.5 and 0.12 mg/L, respectively. Other Gram-negative isolates, predominantly Acinetobacter baumannii, were resistant to all three carbapenems (MIC 90 ≥64 mg/L). Susceptibility to doripenem was observed in 14.9% of isolates resistant to imipenem and/or meropenem. Conclusions: Doripenem showed excellent activity against Gram-negative isolates; generally it was more active than imipenem and at least as good as meropenem. Against Pseudomonas species, doripenem was more active than both imipenem and meropenem, with doripenem susceptibility observed for some imipenemand/or meropenem-resistant isolates.
Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INIC... more Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during
Infection Control and Hospital Epidemiology, Jul 1, 2012
10 design. A before-after prospective surveillance study to assess the impact of a multidimension... more 10 design. A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates. setting. Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, the Philippines, and Turkey. patients. PICU inpatients. methods. We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented. results. During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UCdays in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, there rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%. conclusions. Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.
The annals of clinical and analytical medicine, 2015
Acinetobacter türleri son yıllarda hastanemiz yoğun bakım hastalarında en sık rastlanan ilk iki e... more Acinetobacter türleri son yıllarda hastanemiz yoğun bakım hastalarında en sık rastlanan ilk iki etken arasında yer almaktadır. Ülkemizde kullanıma yeni sunulan doripenem, bakteri hücre duvarı sentezini inhibe ederek etkinlik gösteren, karbapenem grubu geniş spektrumlu bir antibiyotiktir. Çalışmalarda özellikle ventilatör ilişkili pnömoni etkeni olarak izole edilen Acinetobacter baumannii suşlarında doripenemin duyarlılıkları araştırılmıştır. Çalışmamızda nozokomiyal infeksiyonlarda etken olarak izole edilen Acinetobacter baumannii suşlarının doripenem duyarlılıklarının saptanmasında disk diffüzyon ve E-test yöntemlerinin karşılaştırmayı amaçladık. Gereç ve Yöntem: Akdeniz Üniversitesi Merkez Laboratuvarı'na 1 Ocak-31 Aralık 2009 tarihleri arasında yoğun bakımlardan gelen çeşitli klinik örneklerden izole edilen toplam 94 Acinetobacter baumannii suşunun disk diffüzyon ve Etest yöntemleri ile doripenem duyarlılıkları belirlenmiştir. European Committee on Antimicrobial Susceptibility Testing (EUCAST) tarafından belirlenen minimal inhibitör konsantrasyonları (MİK); duyarlı ≤1 μg/ml, orta duyarlı 2-4 μg/ml ve dirençli >4 μg/ml olarak ve 10 μg'lık disklerle inhibisyon zonu çapları, duyarlı <15mm, dirençli ≥21mm olarak kullanılmıştır. Bulgular: Disk diffüzyon yöntemiyle; 10 izolat duyarlı, 17 izolat orta duyarlı, 67 izolat ise dirençli saptanırken, E-test yöntemiyle; 12 izolat duyarlı, 12 izolat orta duyarlı, 70 izolat ise dirençli saptanmıştır. E-test yöntemi ile disk diffüzyon yöntemi arasındaki kategorik uyum (orta duyarlı izolatlar dirençli kabul edilerek), %88.3 (83/94) olarak hesaplanmıştır. Çalışmamızda büyük hata, ve küçük hata oranları sırasıyla %1.2 (1/82) ve %18.1 (17/94) olarak saptanmış, çok büyük hata saptanmamıştır. Tartışma: Sonuç olarak rutin laboratuvar pratiğinde Acinetobacter türlerine karşı doripenem duyarlılıkları saptanırken disk diffüzyon ile E-test yöntemlerinin yüksek düzeyde uyum gösterdiği tespit edilmiştir.
Immunopharmacology and Immunotoxicology, Jul 3, 2020
Abstract Context Monoclonal antibody therapies have revolutionized the treatment of autoinflammat... more Abstract Context Monoclonal antibody therapies have revolutionized the treatment of autoinflammatory-immune/genetic disease including spondylarthritis, asthma and rheumatoid arthritis. Behcet’s disease (BD) is a multi-systemic vasculitis, which is generally recurrent aphthous lesions (RAL) as well as ocular and skin lesions. Today, the immunohistopathogenesis of BD is mostly unknown. Method Omalizumab (Anti-IgE humanized monoclonal antibody) therapy is given for severe persistent allergic asthma, and unintentionally it had effect on RAL. Our patient has received omalizumab treatment for 3 years. The steroid treatment was completely discontinued a month later and the systemic-steroid dependent diabetes mellitus was healed. The IL-1 β, IL-6, IL-8, IL-33, IL-25, IL-10, IL-23, and IL-17A levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Results After a long-term omalizumab treatment administered, the levels of WBC, d-dimer, IL-33, IL-6, IL-25 and IL-1 β decreased. The patient’s hsCRP decreased from 3 to 0.1 and Eosinophil Cationic Protein (ECP) levels decreased from 78 to 21. A significant improvement was noticed in the RAL, the asthma symptoms (cough, shortness of breath), the number of emergency admissions, and the average length of stay of the patient within the days following the initiation of the omalizumab treatment. Conclusions Here, for the first time, we introduce omalizumab treatment of a patient diagnosed with BD and the examination of the treatment for the clinical manifestations and the cytokines/coagulant protein levels. A significant improvement is observed in the patient's RAL following the initiation of omalizumab. There is strong evidence that the serum proinflammatory cytokines/coagulant factors could also play an important role in the relationship between RAL and IgE-dependent vascular autoinflammation.
Objective: Rare disease Background: Toxic epidermal necrolysis (TEN) is characterized by widespre... more Objective: Rare disease Background: Toxic epidermal necrolysis (TEN) is characterized by widespread erythematous and bullous lesions on the skin. Nowadays, considerable progress has been made in the understanding of its pathogenesis. Immunologically it is similar to graft-versus-host disease. Therefore, we may propose that TEN is a disorder of cell-mediated immunity. Case Report: Our patient was a 74-year-old white female who had pneumonia and was positive for hepatitis C virus (HCV), and who had been on levofloxacin therapy. After the first levofloxacin dose, erythematous dusky red macules occurred on her extremities and trunk, and on the following day, confluent purpuric lesions tended to run together over 85% of her body. Her biopsy results indicated TEN. Laboratory testing for serum ECP (eosinophil cationic peptide) and serum immunoglobulin (Ig) levels were performed, and blister fluid was investigated. The patient responded positively to omalizumab treatment and after treatment laboratory tests revealed decreased high sensitive CRP, ECP, IgG1, IgG2, IgG3, IgG4, IgA, and IgM levels. Conclusions: To the best of our knowledge, this is the first case of a patient with HCV who developed cutaneous adverse drug reaction on levofloxacin medication and recovered with omalizumab treatment. This is the first documentation of omalizumab treatment of a TEN patient.
Amaç: Son yıllarda, özellikle yoğun bakım ünitelerinde nonfermentatif Gram-negatif çomak infeksiy... more Amaç: Son yıllarda, özellikle yoğun bakım ünitelerinde nonfermentatif Gram-negatif çomak infeksiyonları artma eğilimindedir. Bu çalışmada hastanemizin Anesteziyoloji Yoğun Bakım Ünitesinde izlenen hastaların çeşitli klinik örneklerinden izole edilen Pseudomonas aeruginosa suşlarının antibiyotiklere duyarlılık oranlarını belirlenmesi amaçlanmıştır. Yöntemler: Yoğun Bakım Ünitesinde kafa travması nedeniyle izlenen 113 olgu çalışmaya alındı. Alınan kültürlerden izole edilen P. aeruginosa suşlarının antibiyotik duyarlılıkları Clinical and Laboratory Standards Institute (CLSI) kriterlerine göre disk difüzyon testi kullanılarak çalışıldı. Bulgular: 113 olgudan 14 (%12.4)'ünün kültürlerinde P. aeruginosa izole edildi. Bu 14 P. aeruginosa suşundan 6 (%42.8)'sı seftazidime, 6 (%42.8)'sı siprofloksasine, 5 (%35.7)'i sefoperazon-sulbaktama, 4 (% 28.6)'ü amikasine, 3 (%21.4)'ü piperasilintazobaktama ve 2 (%14.3)'si imipeneme dirençli olarak saptandı. Sonuçlar: Antibiyotik direncini önlemek için antibiyotik duyarlılıkları belirlenerek doğru antibiyotik kullanım politikaları geliştirilmelidir.
Annals of Clinical Microbiology and Antimicrobials, Nov 18, 2014
Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient sa... more Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI).
Immunopharmacology and Immunotoxicology, Apr 28, 2016
The term &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more The term &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD. The patients (N = 10) were presented to our clinic with low lung function, limited reversibility of airway obstruction, hyperinflation, abnormal body composition, dyspnea and episodic wheezing. Based on the clinical and laboratory findings, the patients were diagnosed with ACOS. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; serum IL-2 (sIL-2), sIL-4 sIL-6, sIL-10, sIL-17, sTNF-α and sIFN-γ levels were investigated as an apoptotic marker and a marker for inflammation. Having undergone omalizumab treatment and a long-term (12 months) later, patients had a decreased IgE, fractional exhaled nitric oxide concentrations (FENO), eosinophil, neutrophils, macrophages, eosinophil cationic peptide (ECP) and sIL-4 levels. To our knowledge, this is the first documentation of omalizumab use in ACOS. We demonstrated decreased IL-4, allergic pulmonary symptoms (dyspnea, wheezing, bronchial hyper responsiveness) and migraine attacks in the patients.
Background: Infections with multidrug-resistant Gram-negative bacteria such as Acinetobacter baum... more Background: Infections with multidrug-resistant Gram-negative bacteria such as Acinetobacter baumannii are major cause of morbidity and mortality. Colistin is used commonly to treat these infections. In this study, we evaluated the efficacy of different colistin combinations in a A. baumannii infection mouse model. Materials &amp;amp; methods: An A. baumannii mouse infection model was developed in 150 experimental animals. Treatment groups were as follows: colistin, colistin + rifampicin, colistin + trimethoprim/sulfamethoxazole, colistin + teicoplanin and a control group. The outcome was bacterial burden in the lung and liver tissues. The treatment groups were subdivided into 24-, 48- and 72-h groups. Results: Colistin and combinations reduce the A. baumannii burden significantly in lung and liver tissues compared with the control group. Compared with colistin alone colistin + rifampicin and colistin + TMP-SMX provided significantly better reduction in the bacterial burden. Conclusion: These results may suggest that rifampicin and TMP-SMX combination with colistin may have a potential role in the treatment of A. baumannii infections.
Journal of health sciences and medicine, Sep 24, 2021
Objective: This study aimed to evaluate to prognosis of patients admitted to the COVID-19 isolati... more Objective: This study aimed to evaluate to prognosis of patients admitted to the COVID-19 isolation unit of the emergency department and present epidemiological data by examining their demographic, clinical, laboratory and lung tomography findings. Material and Method: A total of 504 patients presenting with COVID-19 symptoms were randomly and retrospectively evaluated based on electronic records obtained from the hospital archive. Results: Of the patients, 216 (42.9%) were female and 288 (57%) were male. The RT-PCR test was positive in 291 (57.7%) patients, and fever was the most common symptom in 280 (55.5%). A total of 133 patients (26.4%) were admitted to the inpatient ward. The WBC, Troponin-t, CRP, AST, ALT, LDH, D-dimer and ferritin levels were high and lymphocyte count was low in patients who were hospitalized. Sixty-one percent of the patients had a comorbid condition; 19% of had diabetes and 18.8% had hypertension as the most common underlying condition. Totally, 312 (61.9%) had favipiravir, 106 (21%) were favipiravir + hydroxychloroquine, 60 (11.9%) used hydroxychloroquine alone, 26 (5.2%) were followed up without treatment and to 147 of them, antibiotics were prescribed in addition to the medicine; 38.5% of the patients followed up in the intensive care unit were diabetic; 26 patients (5.2%) were followed up in the intensive care unit. The mortality rate was found to be 1.9%. At least one comorbid condition was present in all who were hospitalized and died in the intensive care unit. Conclusion: The importance of a healthy diet and regular physical activity for metabolic conditions such as diabetes and hypertension as well as for fighting infections is well known. We consider that the mortality and morbidity rates due to the COVID-19 pandemic can be reduced by developing reliable and safe antiviral treatment options and implementing effective and fair vaccination policies.
Journal of Antimicrobial Chemotherapy, Mar 8, 2011
Doripenem is a new carbapenem recently introduced into Europe. The COMParative Activity of Carbap... more Doripenem is a new carbapenem recently introduced into Europe. The COMParative Activity of Carbapenem Testing (COMPACT) study compared the susceptibility of common Gram-negative bacilli causing serious infections in hospitalized patients with doripenem, imipenem and meropenem. Methods: Gram-negative isolates (4498 total: 2171 Pseudomonas species; 1910 Enterobacteriaceae; and 417 other Gram-negative bacilli) were collected from 80 centres in 16 countries in Europe, the Middle East and Africa during 2008-09. The MICs of doripenem, imipenem and meropenem were determined using Etest methodology and broth microdilution. Susceptibility was interpreted according to CLSI, EUCAST and FDA breakpoints. Results: The MIC 90 s of doripenem, imipenem and meropenem for all isolates were 8, ≥64 and 32 mg/L, respectively. Doripenem had the lowest MIC 90 for Pseudomonas species at 16 mg/L, with imipenem and meropenem values of ≥64 mg/L. Enterobacteriaceae were highly susceptible to all three carbapenems, with MIC 90 s of doripenem, imipenem and meropenem of 0.06, 0.5 and 0.12 mg/L, respectively. Other Gram-negative isolates, predominantly Acinetobacter baumannii, were resistant to all three carbapenems (MIC 90 ≥64 mg/L). Susceptibility to doripenem was observed in 14.9% of isolates resistant to imipenem and/or meropenem. Conclusions: Doripenem showed excellent activity against Gram-negative isolates; generally it was more active than imipenem and at least as good as meropenem. Against Pseudomonas species, doripenem was more active than both imipenem and meropenem, with doripenem susceptibility observed for some imipenemand/or meropenem-resistant isolates.
Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INIC... more Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during
Infection Control and Hospital Epidemiology, Jul 1, 2012
10 design. A before-after prospective surveillance study to assess the impact of a multidimension... more 10 design. A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates. setting. Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, the Philippines, and Turkey. patients. PICU inpatients. methods. We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented. results. During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UCdays in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, there rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%. conclusions. Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.
The annals of clinical and analytical medicine, 2015
Acinetobacter türleri son yıllarda hastanemiz yoğun bakım hastalarında en sık rastlanan ilk iki e... more Acinetobacter türleri son yıllarda hastanemiz yoğun bakım hastalarında en sık rastlanan ilk iki etken arasında yer almaktadır. Ülkemizde kullanıma yeni sunulan doripenem, bakteri hücre duvarı sentezini inhibe ederek etkinlik gösteren, karbapenem grubu geniş spektrumlu bir antibiyotiktir. Çalışmalarda özellikle ventilatör ilişkili pnömoni etkeni olarak izole edilen Acinetobacter baumannii suşlarında doripenemin duyarlılıkları araştırılmıştır. Çalışmamızda nozokomiyal infeksiyonlarda etken olarak izole edilen Acinetobacter baumannii suşlarının doripenem duyarlılıklarının saptanmasında disk diffüzyon ve E-test yöntemlerinin karşılaştırmayı amaçladık. Gereç ve Yöntem: Akdeniz Üniversitesi Merkez Laboratuvarı'na 1 Ocak-31 Aralık 2009 tarihleri arasında yoğun bakımlardan gelen çeşitli klinik örneklerden izole edilen toplam 94 Acinetobacter baumannii suşunun disk diffüzyon ve Etest yöntemleri ile doripenem duyarlılıkları belirlenmiştir. European Committee on Antimicrobial Susceptibility Testing (EUCAST) tarafından belirlenen minimal inhibitör konsantrasyonları (MİK); duyarlı ≤1 μg/ml, orta duyarlı 2-4 μg/ml ve dirençli >4 μg/ml olarak ve 10 μg'lık disklerle inhibisyon zonu çapları, duyarlı <15mm, dirençli ≥21mm olarak kullanılmıştır. Bulgular: Disk diffüzyon yöntemiyle; 10 izolat duyarlı, 17 izolat orta duyarlı, 67 izolat ise dirençli saptanırken, E-test yöntemiyle; 12 izolat duyarlı, 12 izolat orta duyarlı, 70 izolat ise dirençli saptanmıştır. E-test yöntemi ile disk diffüzyon yöntemi arasındaki kategorik uyum (orta duyarlı izolatlar dirençli kabul edilerek), %88.3 (83/94) olarak hesaplanmıştır. Çalışmamızda büyük hata, ve küçük hata oranları sırasıyla %1.2 (1/82) ve %18.1 (17/94) olarak saptanmış, çok büyük hata saptanmamıştır. Tartışma: Sonuç olarak rutin laboratuvar pratiğinde Acinetobacter türlerine karşı doripenem duyarlılıkları saptanırken disk diffüzyon ile E-test yöntemlerinin yüksek düzeyde uyum gösterdiği tespit edilmiştir.
Immunopharmacology and Immunotoxicology, Jul 3, 2020
Abstract Context Monoclonal antibody therapies have revolutionized the treatment of autoinflammat... more Abstract Context Monoclonal antibody therapies have revolutionized the treatment of autoinflammatory-immune/genetic disease including spondylarthritis, asthma and rheumatoid arthritis. Behcet’s disease (BD) is a multi-systemic vasculitis, which is generally recurrent aphthous lesions (RAL) as well as ocular and skin lesions. Today, the immunohistopathogenesis of BD is mostly unknown. Method Omalizumab (Anti-IgE humanized monoclonal antibody) therapy is given for severe persistent allergic asthma, and unintentionally it had effect on RAL. Our patient has received omalizumab treatment for 3 years. The steroid treatment was completely discontinued a month later and the systemic-steroid dependent diabetes mellitus was healed. The IL-1 β, IL-6, IL-8, IL-33, IL-25, IL-10, IL-23, and IL-17A levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Results After a long-term omalizumab treatment administered, the levels of WBC, d-dimer, IL-33, IL-6, IL-25 and IL-1 β decreased. The patient’s hsCRP decreased from 3 to 0.1 and Eosinophil Cationic Protein (ECP) levels decreased from 78 to 21. A significant improvement was noticed in the RAL, the asthma symptoms (cough, shortness of breath), the number of emergency admissions, and the average length of stay of the patient within the days following the initiation of the omalizumab treatment. Conclusions Here, for the first time, we introduce omalizumab treatment of a patient diagnosed with BD and the examination of the treatment for the clinical manifestations and the cytokines/coagulant protein levels. A significant improvement is observed in the patient's RAL following the initiation of omalizumab. There is strong evidence that the serum proinflammatory cytokines/coagulant factors could also play an important role in the relationship between RAL and IgE-dependent vascular autoinflammation.
Objective: Rare disease Background: Toxic epidermal necrolysis (TEN) is characterized by widespre... more Objective: Rare disease Background: Toxic epidermal necrolysis (TEN) is characterized by widespread erythematous and bullous lesions on the skin. Nowadays, considerable progress has been made in the understanding of its pathogenesis. Immunologically it is similar to graft-versus-host disease. Therefore, we may propose that TEN is a disorder of cell-mediated immunity. Case Report: Our patient was a 74-year-old white female who had pneumonia and was positive for hepatitis C virus (HCV), and who had been on levofloxacin therapy. After the first levofloxacin dose, erythematous dusky red macules occurred on her extremities and trunk, and on the following day, confluent purpuric lesions tended to run together over 85% of her body. Her biopsy results indicated TEN. Laboratory testing for serum ECP (eosinophil cationic peptide) and serum immunoglobulin (Ig) levels were performed, and blister fluid was investigated. The patient responded positively to omalizumab treatment and after treatment laboratory tests revealed decreased high sensitive CRP, ECP, IgG1, IgG2, IgG3, IgG4, IgA, and IgM levels. Conclusions: To the best of our knowledge, this is the first case of a patient with HCV who developed cutaneous adverse drug reaction on levofloxacin medication and recovered with omalizumab treatment. This is the first documentation of omalizumab treatment of a TEN patient.
Amaç: Son yıllarda, özellikle yoğun bakım ünitelerinde nonfermentatif Gram-negatif çomak infeksiy... more Amaç: Son yıllarda, özellikle yoğun bakım ünitelerinde nonfermentatif Gram-negatif çomak infeksiyonları artma eğilimindedir. Bu çalışmada hastanemizin Anesteziyoloji Yoğun Bakım Ünitesinde izlenen hastaların çeşitli klinik örneklerinden izole edilen Pseudomonas aeruginosa suşlarının antibiyotiklere duyarlılık oranlarını belirlenmesi amaçlanmıştır. Yöntemler: Yoğun Bakım Ünitesinde kafa travması nedeniyle izlenen 113 olgu çalışmaya alındı. Alınan kültürlerden izole edilen P. aeruginosa suşlarının antibiyotik duyarlılıkları Clinical and Laboratory Standards Institute (CLSI) kriterlerine göre disk difüzyon testi kullanılarak çalışıldı. Bulgular: 113 olgudan 14 (%12.4)'ünün kültürlerinde P. aeruginosa izole edildi. Bu 14 P. aeruginosa suşundan 6 (%42.8)'sı seftazidime, 6 (%42.8)'sı siprofloksasine, 5 (%35.7)'i sefoperazon-sulbaktama, 4 (% 28.6)'ü amikasine, 3 (%21.4)'ü piperasilintazobaktama ve 2 (%14.3)'si imipeneme dirençli olarak saptandı. Sonuçlar: Antibiyotik direncini önlemek için antibiyotik duyarlılıkları belirlenerek doğru antibiyotik kullanım politikaları geliştirilmelidir.
Annals of Clinical Microbiology and Antimicrobials, Nov 18, 2014
Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient sa... more Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI).
Immunopharmacology and Immunotoxicology, Apr 28, 2016
The term &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more The term &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD. The patients (N = 10) were presented to our clinic with low lung function, limited reversibility of airway obstruction, hyperinflation, abnormal body composition, dyspnea and episodic wheezing. Based on the clinical and laboratory findings, the patients were diagnosed with ACOS. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; serum IL-2 (sIL-2), sIL-4 sIL-6, sIL-10, sIL-17, sTNF-α and sIFN-γ levels were investigated as an apoptotic marker and a marker for inflammation. Having undergone omalizumab treatment and a long-term (12 months) later, patients had a decreased IgE, fractional exhaled nitric oxide concentrations (FENO), eosinophil, neutrophils, macrophages, eosinophil cationic peptide (ECP) and sIL-4 levels. To our knowledge, this is the first documentation of omalizumab use in ACOS. We demonstrated decreased IL-4, allergic pulmonary symptoms (dyspnea, wheezing, bronchial hyper responsiveness) and migraine attacks in the patients.
Background: Infections with multidrug-resistant Gram-negative bacteria such as Acinetobacter baum... more Background: Infections with multidrug-resistant Gram-negative bacteria such as Acinetobacter baumannii are major cause of morbidity and mortality. Colistin is used commonly to treat these infections. In this study, we evaluated the efficacy of different colistin combinations in a A. baumannii infection mouse model. Materials &amp;amp; methods: An A. baumannii mouse infection model was developed in 150 experimental animals. Treatment groups were as follows: colistin, colistin + rifampicin, colistin + trimethoprim/sulfamethoxazole, colistin + teicoplanin and a control group. The outcome was bacterial burden in the lung and liver tissues. The treatment groups were subdivided into 24-, 48- and 72-h groups. Results: Colistin and combinations reduce the A. baumannii burden significantly in lung and liver tissues compared with the control group. Compared with colistin alone colistin + rifampicin and colistin + TMP-SMX provided significantly better reduction in the bacterial burden. Conclusion: These results may suggest that rifampicin and TMP-SMX combination with colistin may have a potential role in the treatment of A. baumannii infections.
Journal of health sciences and medicine, Sep 24, 2021
Objective: This study aimed to evaluate to prognosis of patients admitted to the COVID-19 isolati... more Objective: This study aimed to evaluate to prognosis of patients admitted to the COVID-19 isolation unit of the emergency department and present epidemiological data by examining their demographic, clinical, laboratory and lung tomography findings. Material and Method: A total of 504 patients presenting with COVID-19 symptoms were randomly and retrospectively evaluated based on electronic records obtained from the hospital archive. Results: Of the patients, 216 (42.9%) were female and 288 (57%) were male. The RT-PCR test was positive in 291 (57.7%) patients, and fever was the most common symptom in 280 (55.5%). A total of 133 patients (26.4%) were admitted to the inpatient ward. The WBC, Troponin-t, CRP, AST, ALT, LDH, D-dimer and ferritin levels were high and lymphocyte count was low in patients who were hospitalized. Sixty-one percent of the patients had a comorbid condition; 19% of had diabetes and 18.8% had hypertension as the most common underlying condition. Totally, 312 (61.9%) had favipiravir, 106 (21%) were favipiravir + hydroxychloroquine, 60 (11.9%) used hydroxychloroquine alone, 26 (5.2%) were followed up without treatment and to 147 of them, antibiotics were prescribed in addition to the medicine; 38.5% of the patients followed up in the intensive care unit were diabetic; 26 patients (5.2%) were followed up in the intensive care unit. The mortality rate was found to be 1.9%. At least one comorbid condition was present in all who were hospitalized and died in the intensive care unit. Conclusion: The importance of a healthy diet and regular physical activity for metabolic conditions such as diabetes and hypertension as well as for fighting infections is well known. We consider that the mortality and morbidity rates due to the COVID-19 pandemic can be reduced by developing reliable and safe antiviral treatment options and implementing effective and fair vaccination policies.
Ata Nevzat YALÇIN Akdeniz Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Kl. Mikrobiyoloj... more Ata Nevzat YALÇIN Akdeniz Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Kl. Mikrobiyoloji AD. ANTALYA ([email protected]) Klinik uygulamalarda ciddi bakteriyel infeksiyonların tedavisi sırasında gelişen antibiyotik direnci oldukça önem taşıyan bir konudur. Direnç oranlarının yükselmesi ile birlikte morbidite ve mortalitenin artışı yanında ciddi yüksek maliyetler dikkati çekmektedir. Hasta, klinisyen ve hastane idaresi bu durumdan oldukça önemli düzeyde etkilenmektedir. (1,2) Antibiyotiklere dirençli etkenlerin neden olduğu infeksiyonlar sadece morbidite ve mortaliteyi artırmakla kalmayıp, yanı sıra hastanede yatış süresinde uzama, maliyet ve değişik medikal komplikasyonlarda artış ile sonlanmaktadır. (3-6) Günümüzde genişlemiş spektrumlu beta-laktamaz üreten Escherichia coli, Klebsiella türleri ve diğer Enterobacteriaceae ailesinin üyeleri, Acinetobacter türleri ve Pseudomonas aeruginosa ile Metisiline dirençli Staphylococcus aureus, glikopeptidlere orta düzeyde-dirençli S.aureus, vankomisine dirençli enterokoklar, özellikle yoğun bakımlarda antibiyotik kullanımının neden olduğu değişik hastane infeksiyonlarından sorumlu tutulan dirençli mikroorganizmalardır. (1,2,7-9) Her antibiyoterapinin maliyeti üç komponent içermektedir: 1. İlacın ve kullanımının maliyeti, 2. İlacın yan etkilerinin maliyeti, 3. İlacın kullanımı nedeni ile getireceği direnç sorununun maliyeti, olarak gruplandırılabilir. Tahmin edileceği üzere hesaplaması en zor maliyet antibiyoterapinin gelecekte neden olacağı direnç sorunudur. (10) Günümüze kadar dirençli mikroorganizmalar ile oluşan infeksiyonların maliyeti ile ilgili birçok çalışma yapılmıştır. Sonuçların çok geniş aralıkta dağılıyor olması hasta özelliklerinin farklı olması (örneğin yaş, ilk tanı, altta yatan hastalık, hastalığın ciddiyeti), bakım verilen merkezin özellikleri, çalışmaların farklı ülkeler ve sağlık merkezlerinde yapılmış olması ve kullanılan metod gibi birçok değişkene bağlanabilir. (11,12) Gram pozitif mikroorganizma infeksiyonları ve maliyet Ott ve arkadaşları tarafından Ocak 2005-Aralık 2007 arasında MSSA ve MRSA'nın etken olduğu nozokomiyal pnömoni maliyetini hesaplamak amacı ile yapılan vaka-kontrol çalışmasında MRSA'nın etken olduğu vaka grubunda toplam maliyet anlamlı olarak daha yüksek bulunmuştur. (13) Lodise ve arkadaşlarının yaptığı 1999-2001 yılları arasında MRSA ve MSSA ilişkili kan-dolaşım infeksiyonu gelişen olguların retrospektif değerlendirmesinde MRSA'lı olgularda 1.5 kat artmış yatış süresi ve iki kat artmış maliyet bulunmuştur. MRSA kan-dolaşım infeksiyonu olgularda tedavide gecikme daha fazla bulunmuş olup bu tedavi mortalite üzerinde bağımsız risk faktörü olarak tespit edilmiştir. (14) Ben-David ve arkadaşları MRSA'ya bağlı gelişen kan-dolaşım infeksiyonları ile MSSA'ya bağlı gelişen kan dolaşım infeksiyonları ile maliyet, hastanede yatış süresi ve
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