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Öğe Acinetobacter baumannii Infections and Antibiotic Resistance in Hospitalized Patients in an Education and Research Hospital: A Six-Year Analysis(Bilimsel Tip Yayinevi, 2020) Arslan Gulen, Tugba; Imre, Ayfer; Odemis, Ilker; Kayabas, UnerIntroduction: Acinetobacter baumanii causes difficulties in the treatment of nosocomial infections due to increasing resistance worldwide. With an increase in resistant infections, the use of colistin has come to the fore. We aimed to investigate the antimicrobial resistance profile of A. baumanii strains isolated from clinical specimens as hospital-acquired colonizations and infection agents and to evaluate the clinical and microbiologic responses and adverse effects of antibiotic regimens used in patients who were isolated because of having infectious agents. Materials and Methods: A retrospective descriptive study of 326 adult patients with nosocomial A. baumannii colonizations and infections was conducted between January 2012 and December 2017 in Nigde Education and Research Hospital. In addition, a total of 212 adult patients who received at least 72 hours of antimicrobial therapy were evaluated. Standard and automated methods were used to identify isolated strains and antibiotic susceptibility. The antimicrobial susceptibility profile change over the 6-year period was evaluated. Adverse effects, and clinical and microbiologic response were evaluated in patients receiving antimicrobial therapy. Analysis of the variables was performed using SASS 22.0 (IBM Corporation, Armonk, New York, United States). Results: When antimicrobial resistance rates were examined, it was seen that imipenem (99.7%), ampicillin sulbactam (81.6%), cefoperazone sulbactam (60.3%), netilmicin (89.4%), tobramycin (88.4%), gentamicin (83.1%), amikacin (91.6%) and tigecycline (33.7%) had resistance rates; colistin resistance was not detected in the isolates. Resistance rate to other antibiotic groups was 100%. The resistance rates of ampicillin sulbactam, cefoperazone sulbactam, gentamicin, amikacin, and tigecycline were found to be statistically significant (p< 0.05). There were no significant differences in terms of nephrotoxicity, and clinical and microbiologic response among patients in whom colistin was used in combination with carbapenem, ampicillin/sulbactam, cefoperazone/sulbactam, and tigecycline (p> 0.05). Conclusion: In accordance with the global data, antimicrobial resistance rate in A. baumanii isolates was found to be high in our study. Treatment regimens in which colistin is used with other antimicrobial agents have no superiority in terms of efficacy and adverse effects. There is a clear need for new and effective antimicrobial agents in the treatment of resistant A. baumanii infections.Öğe Adult Tetanus With Fatal Course: A Case Report(Aves, 2019) Arslan-Gulen, Tugba; Destegul, Dilek; Ortakoylu-Kilickaya, Refika; Imre, Ayfer; Atan-Ucar, Zuhal; Kayabas, UnerDespite improvements in medicine, tetanus is still a fatal infectious disease which can be prevented by immunoprophylaxis and it should always be kept in mind after injuries. In this case report, we present a patient who had no previous immunization history and did not have tetanus prophylaxis completed at the first visit of the emergency department after injury. The patient was followed with a clinical picture of generalized tetanus in intensive care unit, but autonomic dysfunction could not be taken under control despite treatment and resulted in mortality. Tetanus prophylaxis should be questioned in patients applying with injury or trauma. Strategies should be developed in order to achieve regular vaccination, with respect to adult immunization in particular.Öğe Choroidal thickness and retinal nerve fiber layer analysis in acute systemic brucellosis(Sage Publications Inc, 2021) Zor, Kursad Ramazan; Gulen, Tugba Arslan; Bicer, Gamze Yildirim; Kucuk, Erkut; Imre, Ayfer; Odemis, Ilker; Kayabas, UnerIntroduction This study aims to detect changes in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in acute stage brucellosis. Methods Fnewly diagnosed patients with acute brucellosis and 19 healthy individuals as control group were included in the study. Choroidal thickness and RNFL thickness were measured using the Spectral Domain Cirrus OCT Model 400 (Carl Zeiss Meditec, Jena, Germany) for each participant in the patient and control group. Results In the brucella group, in the right eyes, the mean nasal choroidal thickness was 272.77 +/- 50.26 mu m (p = 0.689), the mean subfoveal choroidal thickness was 321.14 +/- 33.08 mu m (p = 0.590), the mean temporal choroidal thickness was 278.86 +/- 48.84 mu m (p = 0.478), and the mean RNFL thickness was 90.43 +/- 8.93 mu m (p = 0.567). In the left eyes, the mean nasal choroidal thickness was 282.29 +/- 48.93 mu m (p = 0.715), the mean subfoveal choroidal thickness was 316.79 +/- 39.57 mu m (p = 0.540), the mean temporal choroidal thickness was 284.93 +/- 50.57 mu m (p = 0.392), and the mean RNFL thickness was 92.64 +/- 8.95 mu m (p = 0.813). Conclusion No difference was found between the control and the brucella groups regarding to all choroidal regions and RNFL thickness.Öğe Deep Venous Thrombosis as a Complication of Brucellosis: A Case Report on Diagnosis and Treatment Management(Galenos Yayincilik, 2019) Arslan Gulen, Tugba; Serhatlioglu, Faruk; Imre, Ayfer; Kayabas, Uner[Abstract Not Available]Öğe Evaluation of Culture-confirmed Extrapulmonary Tuberculosis Cases in a University Hospital(Galenos Yayincilik, 2019) Toplu, Sibel Altunisik; Kayabas, Uner; Otlu, Baris; Bayindir, Yasar; Ersoy, Yasemin; Memisoglu, FundaIntroduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis and can involve any organ, especially the lungs. In recent years, especially in developed countries, the incidence of TB has increased due to the growing number of people with acquired immunodeficiency. This has led to an increase in the incidence of extrapulmonary TB (EPTB). This study examined patients with EPTB confirmed by positive M. tuberculosis culture in Inonu University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Molecular Microbiology Laboratory. Materials and Methods: Patients with positive M. tuberculosis culture in the molecular microbiology laboratory of our hospital between January 1, 2004 and December 31, 2014 were retrospectively evaluated according to culture-confirmed site of involvement, acid-fast bacillus (AFB), polymerase chain reaction (PCR) positivity, drug resistance, and mortality. Results: The study included 132 patients; 41 (31.1%) were male and 91 (68.9%) were female. The mean age was 46.4 +/- 18.5 (17-86) years. Extrapulmonary TB types were TB lymphadenitis in 48 patients (36.4%), musculoskeletal TB in 23 (17.4%), disseminated TB in 17 (12.9%), urinary TB in 11 (8.3%), abdominal TB in 11 (8.3%), TB meningitis in eight (6.1%), pleural TB in six (4.5%), genital TB in five (3.8%), and cutaneous TB in three patients (2.3%). Acid-fast bacillus positivity rates were 21.7% in musculoskeletal samples, 16.6% in pleural samples, 12.5% in cerebrospinal fluid, 9% in urinary tract samples, and 6.2% in lymph nodes. Polymerase chain reaction positivity was not detected in cerebrospinal fluid or skin samples. The rate of resistance to at least one anti-tuberculous drug was 20%. Mortality was 16.1% (n=9) in the 56 patients (42.4%) with available data. Conclusion: Lymphatic TB was the most common form in our patients. According to national data, pleural TB is among the common forms of EPTB in Turkey. However, the rate of pleural TB was low in our study due to the lack of pleural biopsy in our hospital during the study period. In TB-endemic regions such as Turkey, it is important to consider EPTB in the differential diagnosis of patients with relevant clinical findings and to confirm the diagnosis with TB culture primarily, as well as methods such as AFB staining and PCR.Öğe Evaluation of Nosocomial Infections after ABO-Compatible and Incompatible Liver Transplantations(Galenos Yayincilik, 2018) Bayar, Filiz Surucu; Bayindir, Yasar; Isik, Burak; Ozgor, Dincer; Kayabas, Uner; Kuzucu, Cigdem; Yilmaz, SezaiIntroduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABO-compatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO-incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABO-incompatible patients. However, further studies are needed on this topic.Öğe Examination of Tuberculin Skin Test Results of Health Care Workers in a Hospital and Healthy Individuals Who Are Not in Risk of Tuberculosis(Aves, 2020) Imre, Ayfer; Arslan-Gulen, Tugba; Kocak, Muradiye; Bas-Sarahman, Emine; Kayabas, UnerObjective: This study was carried out to determine the Bacillus Calmette-Guerin (BCG) vaccination status and tuberculin skin test (TST) responses in health care workers and to compare the results with the results of healthy individuals who had TST screening in Tuberculosis Dispensary. Methods: Demographic characteristics of the two groups were analysed by survey form. The TST results and BCG scar counts on the left shoulder of the participants were obtained from Infection Control Committee and Tuberculosis Dispensary records and evaluated retrospectively. After data were recorded in IBM SPSS Statistics for Windows. Version 22.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA) statistical program, descriptive statistics were used for demographic variables, Shapiro -Wilk test was used for normality test, Mann -Whitney U test was used for continuous variables and Pearson chi(2) test were used for the other categorical variables. Results: A total of 294 cases were included in the study. Number of scars ranged from one to four in each group, and the BCG vaccination rate was 98.6% in health care workers and 87.1% in control group (p<0.05). The TST induration diameters of the healthcare workers ranged from 0 to 22 mm, and the results of 32 (21.8%) employees were found to be positive. In the control group, the induration diameters were between 0-18 mm, and 12 (8.2%) were found to be positive. Differences between groups in terms of both mean diameters of induration and the TST positivity were statistically significant (p<0.05). The TSTpositive health care workers were evaluated for tuberculosis (TB) and TB was not detected in any of them. Conclusions: Health care workers are in the risk group for TB. For this reason, employee health units of each hospital should implement TST and tuberculosis screening programs in a planned way. We determined that health care workers had high TST induration diameters, but none of them had active TB. This may be explained by repeated BCG vaccinations and exposure to mycobacteria other than Mycobacterium tuberculosis.Öğe Factors Affecting the Colistin Nephrotoxicity: Advanced Age and/or Other Factors?(Galenos Yayincilik, 2022) Gulen, Tugba Arslan; Imre, Ayfer; Kayabas, UnerIntroduction: The population is aging, and older adults comprise most patients in the intensive care units. Colistin (COL) has been re-introduced to treat increasingly common resistant Gram-negative bacterial infections. Our study aims to investigate the factors affecting COL nephrotoxicity in a general population and geriatric age group. Materials and Methods: This retrospective study included 170 patients, a total of 116 (68.2%) of whom were in the geriatric group (age >= 65). Acute renal failure was evaluated using the RIFLE score. Factors associated with COL nephrotoxicity were described firstly in a general population and then in the geriatric group patients. Results: Advanced age [Odds ratio (OR): 1.043; 95% confidence interval (CI): 1.018-1.068; p=0.001] and initial serum creatinine level (OR: 23.122; 95 % CI: 3.123-171.217; p=0.002) were found to be the independent risk factors associated with nephrotoxicity. In the evaluation of the geriatric population based on nephrotoxicity, the initial serum urea and creatinine levels, and overall mortality rates were found to be statistically significantly higher in the group with nephrotoxicity (p<0.05). Initial serum creatinine level (OR: 22.48; 95 % CI: 2.835-178.426; p=0.003) and concomitant nephrotoxic agent use (OR: 2.516; 95 % CI: 1.275-4.963; p=0.008) were independent risk factors associated with nephrotoxicity in geriatric patients. Conclusion: Advanced age was found to be a risk factor for COL nephrotoxicity. Closed observation should be done especially in the geriatric patients who have initial serum creatinine levels close to the upper limit, concomitant use of the nephrotoxic drugs should be avoided, and if possible, evaluation should be made in terms of non-COL treatment options in these patients.Öğe Is the course of COVID-19 associated with tuberculin skin test diameter? A retrospective study(Wiley, 2022) Gulen, Tugba Arslan; Bayraktar, Muhammet; Yaksi, Nese; Kayabas, UnerThe pathogenesis of coronavirus disease 2019 (COVID-19) is still not fully understood. As severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has a similar pathogenetic pathway to Mycobacterium tuberculosis, it has been reported that there may be a relationship between Bacille Calmette-Guerin (BCG) vaccination rate and COVID-19 severity. This study investigated the relationship between tuberculin skin test (TST) induration diameter and the clinical course of COVID-19. Of 1963 adult patients who underwent TST, 76 patients with SARS-COV-2 infection confirmed by RT-PCR analysis of respiratory tract samples were included in the study. Relationships between COVID-19 clinical severity and TST positivity, induration size, and other clinical parameters were analyzed. Of the 76 patients, TST results were negative for 53 patients (69.7%) and positive for 23 patients (30.3%). COVID-19 severity was mild in 47 patients (61.8%), moderate in 22 patients (28.9%), and severe in seven patients (9.3%). All TST-positive patients had mild disease. Patients with mild disease had a significantly higher TST positivity rate (p < 0.001) and larger induration diameter (p < 0.001). The area under the receiver operating characteristic (ROC) curve of TST induration size for the differentiation of mild with moderate and severe disease was 0.768 (p < 0.001). The maximum Youden J index value was 0.522 at an induration diameter of 6.5 mm, which had a sensitivity of 66.0% and specificity of 86.2%. COVID-19 patients with positive TST showed a significantly higher rate of mild disease than those with negative TST. TST positivity is favorably associated with the course of COVID-19.Öğe Mucormycosis Presented with Facial Pain in a Renal Transplant Patient: A Case Report(Elsevier Science Inc, 2019) Berktas, Bayram; Taskapan, Hulya; Bayindir, Tugba; Kayabas, Uner; Yildirim, Ismail OkanIntroduction. Mucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint. Case. A 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oiyzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B. Conclusion. It should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain.Öğe The Effect of Sex-Specific Genetic Factors on the Host Immune Response to COVID-19: A Pilot Study(Erciyes Univ Sch Medicine, 2022) Bali, Dilara Fatma Akin; Gulen, Tugba Arslan; Ozmen, Esma; Yuce, Zeynep Ture; Yildiz, Orhan; Turunc, Tuba; Kayabas, UnerObjective: The aim of this study was to investigate the impact of sex-specific genetic factors in the pathogenesis and prog-nosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-induced macrophage activation syndrome (MAS), independent of age and comorbidity presence.Materials and Methods: Patients aged 18-50 years who had been diagnosed with coronavirus 2019 (COVID-19), the disease caused by the SARS-CoV2 virus, were enrolled in a prospective, case-control, multi-center study. Genetic alterations and messenger RNA (m-RNA) expression levels of the TLR7, TLR8, ACE2, CD40L, CXCR3, and TASL genes were determined using DNA sequencing analysis, and gene expression was determined using quantitative reverse transcriptase polymerase chain reaction testing. PolyPhen-2 (Polymorphism Phenotyping v2; Adzhubei et al., 2010) and SNAP2 (Rostlab, Munich, Germany) genetic analysis tools were used to define the pathogenic effects of detected mutations by sequencing the selected genes in hotspot regions.Results: The study group consisted of 80 patients diagnosed with COVID-19 and was divided into groups based on sex and MAS status. Twenty-nine mutations were detected in 6 genes. Among the alterations, 15 were identified in this study for the first time and 9 were pathogenic. Pathogenic missense mutations in the TLR7, TLR8, ACE2, and TASL genes were detected in the MAS (+) group. In males, decreased TLR7, TLR8, and CXCR3 expression was statistically significant in the MAS (+) group (p<0.050). CXCR3 expression was lower in the female and male MAS (+) groups compared with the MAS (-) groups (p<0.050).Conclusion: In the absence of major risk factors for COVID-19, the TLR7/8, ACE2, and CXCR3 variants and decreased m-RNA expression levels associated with genetic susceptibility may be independent prognostic risk factors for COVID-19.
