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Öğe The accuracy and validity of a weekly point-prevalence survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey(Elsevier Sci Ltd, 2011) Üstün, Cemal; Hoşoğlu, Salih; Geyik, Mehmet Faruk; Parlak, Zafer; Ayaz, CelalObjective: To evaluate the validity of a weekly point-prevalence survey (WPS) by comparing it with a prospective-active incidence survey (PIS). Methods: WPS and PIS were conducted at a tertiary referral hospital between January and December 2006. Each Wednesday, an infection control team reviewed all clinical records of patients with hospital-acquired infections (HAIs) by WPS. Routine PIS was conducted with daily visits by the same team. The Rhame and Sudderth formula was used for converting the data between WPS and PIS. Results: During the study period, 1287 HAIs were detected in 37 466 patients by WPS. The mean observed prevalence and calculated prevalence were 5.42% and 5.45%, respectively. The reanimation intensive care unit (ICU) (49.4%) and burns unit (27.6%) had the highest prevalence rates. Pneumonia (0.94%) and urinary tract infections (0.37%) were the most frequent infections. Overall 602 HAIs were detected in 545 patients by PIS. The mean observed incidence and calculated incidence were 2.42/1000-admissions and 2.41/1000-admissions, respectively. The Critical care ICU (37.0/1000-admissions) and burns unit (24.8/1000-admissions) had the highest incidences of HAI. Pneumonia (0.64/1000-admissions) and urinary tract infections (0.37/1000-admissions) were the most frequent infections. Conclusions: This study confirms a close relationship between prevalence and incidence data. WPS may be a useful method for following HAIs when PIS cannot be performed. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Acute hepatitis: a rare complication of Epstein-Barr virus (EBV) infection(J Infection Developing Countries, 2010) Uluğ, Mehmet; Çelen, Mustafa Kemal; Ayaz, Celal; Geyik, Mehmet Faruk; Hoşoğlu, SalihInfectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes (> 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.Öğe Are sinus-track cultures reliable for identifying the causative agent in chronic osteomyelitis?(Springer, 2009) Uluğ, Mehmet; Ayaz, Celal; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Hoşoğlu, Salih; Necmioğlu, SerdarThe infection of bone that contains bone marrow called osteomyelitis, and is caused by different microorganisms. In this study, we aimed to determine the diagnostic value and accuracy of cultures of material from a sinus track compared with those of cultures of bone specimens that have been controversial. Prospective study was conducted at Hospital University of Dicle, a 1,090-bed university-based hospital located in DiyarbakA +/- r, Turkey. Between May 2005 and September 2006, sinus-track cultures were compared with those of bone cultures from 43 patients with chronic osteomyelitis. The patients' mean age was 30.6 +/- A 3.6 years, and 29 (67%) male and 14 (33%) female. Organisms isolated from bone cultures were Staphylococcus 69% (29/42), Escherichia coli 9.5% (4/42), Pseudomonas aeruginosa 9.5% (4/42), Proteus mirabilis 7% (3/42), respectively. Cultures of sinus track and bone specimens gave identical results in 38% of patients. The value of bone culture in the therapy of osteomyelitis must be emphasized; it is the only reliable means of determining the responsible agent, up on which the antibiotic therapy is based. The correlation between sinus track and bone cultures was 38%, i.e., failure in the treatment for 6 patients out of 10.Öğe Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience(Elsevier Brazil, 2010) Çelen, Mustafa Kemal; Uluğ, Mehmet; Ayaz, Celal; Geyik, Mehmet Faruk; Hoşoğlu, SalihObjective: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. Material and methods: in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of >= 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Results: fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of >= 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. Conclusion: in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.Öğe The evaluation of cultures of endotracheal aspirates and isolated bacteria in the diagnosis of ventilator-associated pneumonia(Duzce University Medical School, 2011) Uluğ, Mehmet; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Hoşoğlu, Salih; Ayaz, CelalAim: The aim of this study was to determine the ventilator-associated pneumonia (VAP) agents in isolates from endotracheal aspirate samples obtained from patients in intensive care unit (ICU) on mechanical ventilation and their susceptibility to several antibiotics. Material and Methods: Patients that received mechanical ventilation for longer than 48 hours in the ICU were diagnosed as VAP with the clinical and microbiological criteria, were enrolled in this study. Bacteria isolated from the endotracheal aspiration samples of them were identified by conventional methods and Sceptor systems, and their antibiotic susceptibilities were investigated by the National Committee for Clinical Laboratory Standards (NCCLS). Findings: A total of 72 patients were involved in this study and 84 strains were isolated. Among these patients, 12 (14.3%) had polymicrobial etiologic agent. Most commonly encountered microorganisms were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter spp., respectively. Most of the Gram-negative bacteria were susceptible to imipenem, amikacin and ciprofloxacin. Although methicillin resistant S. aureus rate was found %100, glycopeptides resistance was not found. It was determined that 58 (92%) of the Gram-negative bacteria produced ESBL. Results: As a result, VAP is an important and frequently seen infection in ICU. High resistance rates for antibiotics suggested that the treatment of the empirical antibiotics recommended for VAP cases should be updated according to the surveillance data. © 2011 Düzce Medical Journal.Öğe Evaluation of false negativity of the Widal test among culture proven typhoid fever cases(J Infection Developing Countries, 2008) Hoşoğlu, Salih; Boşnak, Vuslat; Akalın, Şerife; Geyik, Mehmet Faruk; Ayaz, CelalBackground: The Widal test is the most common, specific and quick diagnostic method available in the world for diagnosis of typhoid fever; however, false negativity is one of the obstructive features of the test. The aim of this study was to evaluate the associated factors with Widal test negativity in an endemic area. Methods: Widal test negativity was retrospectively analyzed among culture-proven typhoid fever cases. The potential features including age, gender, previous antibiotic usage, duration of symptoms, leucopoenia, hematocrit value, and erythrocyte sedimentation rate (ESR) were evaluated for association with Widal test negativity. Results: A total of 166 culture-proven typhoid fever cases (93 or 56.0% males) were included in the study. The mean age +/- SD was 23.3 +/- 10.6 years. Mean time of interval between first symptom and test performance time was 10.6 +/- 7.8 days. The Widal test (STO and/or STH) was found positive in 75 cases (45.2%). The statistical analyses revealed that none of these variables were significant for false negativity of the Widal test. Age was found to be a possible factor for a false negative Widal test (p=0.06). Conclusion: Of existing compatible clinical findings, age should be considered in cases of Widal test negativity.Öğe THE EVALUATION OF GERIATRIC INFECTIONS DICLE EXPERIENCE(Nobel Ilac, 2010) Uluğ, Mehmet; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Hoşoğlu, Salih; Ayaz, CelalObjective Although successes have been achieved in the treatment of the infectious diseases with antibiotics in nowadays infectious diseases are still serious problem in the elderly This study was conducted in order to determine the pattern of clinical infectious diseases in hospitalized elderly Patients C. Material and Method In this study the data of all elderly patients aged 65 and older were hospitalized to our clinic between May 2000 and May 2005 were evaluated retrospectively We reviewed 301 patients for diagnostic studies risk factors isolated microorganisms and morbidity and mortality rates Results Infections as a cause of hospitalization were identified as the following frequency sepsis (19 2%) pneumonia (17 9%) acute gastroenteritis (16 9%) acute bacterial meningitis (5 3%) and urinaty tract infection (3 6%) respectively E colt was the most isolated microorganism in these patients Hypertension chronic obstructive pulmonary disease and diabetes were seen as risk factors in our patients Seventy three patients died during hospital stay due to their infection and chronic diseases Conclusion Under diagnosis of the elderly diseases is very common due to many factors related to elderly family members and health workers Prognosis is rather worse especially in sepsis due to pneumonia and urinary tract infectionsÖğe The evaluation of geriatric infections: Dicle experience [Geri?atri?k i?nfeksi?yonlarin de?erlendi?ri? lmesi?: Di?cle deneyi?mi?](2010) Uluğ, Mehmet; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Hoşoğlu, Salih; Ayaz, Celal• Objective: Although successes have been achieved in the treatment of the infectious diseases with antibiotics in nowadays, infectious diseases are still serious problem in the elderly. This study was conducted in order to determine the pattern of clinical infectious diseases in hospitalized elderly patients. • Material and Method: In this study, the data of all elderly patients aged 65 and older, were hospitalized to our clinic between May 2000 and May 2005 were evaluated retrospectively. We reviewed 301 patients for diagnostic studies, risk factors, isolated microorganisms and morbidity and mortality rates. • Results: Infections as a cause of hospitalization were identified as the following frequency; sepsis (19.2%), pneumonia (17.9%), acute gastroenteritis (16.9%), acute bacterial meningitis (5.3%) and urinary tract infection (3.6%), respectively. E. coli was the most isolated microorganism in these patients. Hypertension, chronic obstructive pulmonary disease and diabetes were seen as risk factors in our patients. Seventy-three patients died during hospital stay due to their infection and chronic diseases. • Conclusion: Under diagnosis of the elderly diseases is very common due to many factors related to elderly, family members and health workers. Prognosis is rather worse especially in sepsis due to pneumonia and urinary tract infections.Öğe The evaluation of gram negative bacilli isolated from inpatiens and its antibiotic resistance [Yatan hastalardan i?zole edilen gram negatif bakteriler ve antibiyotik dirençlerinin de?erlendirilmesi](2010) Özmen, Esen; Geyik, Mehmet Faruk; Uluğ, Mehmet; Çelen, Mustafa Kemal; Hoşoğlu, Salih; Ayaz, CelalAim: Resistance to gram negative bacilli is increasing all over the world. In this study, the resistance of gram negative bacilli, which were isolated from inpatients, was evaluated for selected antibiotics. The aim of this study was to acquire the significant results for empiric therapy. Material and Method: Eight hundered ninety eight strains which were isolated from inpatients were investigated between May 2003 and April 2005 from clinical speciments at Dicle University Hospital, Diyarbakir. The microdiluation test was used to determine for antibiotics resistance. Findings: Escherichia coli (n=282), Enterobacter spp. (n=215), Pseudomonas aeruginosa (n=101), Klebsiella spp. (n=95), Stenotrophomanas maltophilia (n=69) and Acinetobacter spp. (n=52) were the most frequent isolates. The resistance ratio among whole isolates against ceftriaxone was 73%, cefotaxime 68%, ceftazidime 63%, trimetoprim/sulfamethoxazole 60%, ciprofloksasin 51%, amikasin 20%, imipenem 3% and meropenem 2%. The resistance to the third generation cephalosporins, trimetoprim/sulfamethoxazole and ciprofloxacin was found higher than other antibiotics in this study. Results: In conclusion, antimicrobial resistance must be monitored for each hospital for a reasonable empirical antibiotic therapy. Surveillance studies might be useful for empirical treatment approach. © 2010 Düzce Medical Journal.Öğe NASOPHARYNGEAL CARCINOMA IN THE ETIOLOGY OF FEVER OF UNKNOWN ORIGIN(Nobel Ilac, 2010) Uluğ, Mehmet; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Tekin, Recep; Ayaz, CelalFever of unknown origin is defined as a temperature higher than 38.3 degrees C lasting three weeks or longer and not beind diagnosed even after one week of study in-hospital settings. Infections and malignancies had been the most common causes of fever of unknown origin overall. Nasopharyngeal carcinoma,constituting less than 0.03% of all malignant tumors and only 2% of all head and neck cancer. Ebstein Barr virus infection consumption of smoked and salted fish and vitamin-C deficient diet have been blamed in its etiology. In this study,we present two cases who were admitted to our clinic with fever of unknown origin initially and later diagnosed with nasopharyngeal carcinoma atypically progressing.Öğe Stevens-johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature(Versita, 2010) Uluğ, Mehmet; Uluğ, Nuray Can; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Ayaz, CelalStevens-Johnson syndrome (SJS) is a rare, life-threatening acute allergic drug reaction presenting with target lesions and blebs of epidermis. Although a variety of etiologies such as infections and underlying malignancies have been implicated as potential causes of SJS, drugs remain the predominant inciting agent. This report presents a SJS case due to combined use of lamotrigine and fluoxetine. A 41-year-old man was admitted to our clinic with fever, skin eruptions (especially on the face and trunk) and lesions around the mouth. The patient's history revealed lamotrigine and fluoxetine use during the previous three weeks for major depression. Dermatological examination revealed a typical clinical picture of SJS; his psychotropic medications were all stopped. While topical and ocular prednisolone (1mg/kg/day) cares were initiated, steroid dosage was reduced within 15 days. The condition of patient rapidly improved through this treatment. Effective management of SJS begins with prompt recognition of the entity, combined with attention to each of the major organs that may be affected, potential comorbidities and withdrawal of all potentially causative drugs. Clinicians should bear in mind the possibility that drugs with potential risk in developing SJS must be used carefully.Öğe Surveillance of Nosocomial Infections in Dicle University Hospital: a Ten-Year Experience(Tubitak Scientific & Technical Research Council Turkey, 2008) Geyik, Mehmet Faruk; Hoşoğlu, Salih; Ayaz, Celal; Çelen, Mustafa Kemal; Üstün, CemalAim: The main objective was to recognize the evaluation of surveillance program on the nosocomial infections (NIs) in Dicle University Hospital (DUH) Materials and Methods: A prevalence study was performed prospectively, at the DUH from 1997 to 2006. Active surveillance for NIs were performed by infection control team, using the criteria proposed by the Centers for Diseases Control and Prevention (CDC) and National Nosocomial Infections Surveillance System (NNIS) methodology. This team includes infection control doctor and two nurses, who visited hospital units three times a week. All cases with NI were recorded using a standard data collection form. Results: During ten years of follow up period, 3382 NI episodes were detected in 3075 patients out of 250209 inpatients. The overall incidence rates (NI/100) and incidence densities (NI/1000 days of stay) of NIs were 1.4% (range 0.8-2.5/100) and 1.7/1000 patients-days (range 0.7-2.5/1000), respectively. NIs were seen frequently in intensive care unit (20.1 episodes per 1000 bed-days), burn unit (14.5 episodes per 1000 bed-days), and neurology (3.7 episodes per 1000 bed-days). The most common NIs according to the primary sites were urinary tract infection (24%), bloodstream infection (22%), pneumonia (13%) and surgical site infection (13%). The most prevalent microorganisms were Escherichia coli (26%), Pseudomonas aeruginosa (15%), coagulase-negative staphylococci (14%) and Staphylococcus aureus (13%). Amikacin and meropenem were the most effective agents against Gram-negative bacteria. Meticillin resistance among S. aureus isolates was 67% and all were sensitive to vancomycin. Conclusions: This study represents that the rate of NIs reduced with appropriate interventions. Surveillance and constant monitoring are effective along with educating the staff about infection control practices.Öğe Surveillance of nosocomial infections in general surgery unit: Data of ten years period(2010) Üstün, Cemal; Geyik, Mehmet Faruk; Aldemir, Mustafa; Tekin, Recep; Çelen, Mustafa Kemal; Girgin, Sadullah; Ayaz, CelalAim: The aim of this study is to evaluate the epidemiologic data of nosocomial infection (NI) occurring in the General Surgery Unit (GSU). Method: This study was performed between January 1997 and December 2006. The surveillance method was active, prospective, and based on laboratory and patient. NIs were defined according to Centers for Diseases Control and Prevention criteria (CDC). Results: During the ten-year period, 305 NI episodes were detected in 290 patients. The overall incidence rates and incidence densities of NIs were 2.0% and 2.3/1,000 patient-day respectively. The most common NIs by primary site were surgical site infections, urinary tract infections, and pneumonia. The most prevalent microorganisms were Escherichia coli (36.8%), Staphylococcus aureus (17.7%) and Pseudomonas aeruginosa (10.5%). Meticillin resistance among S. aureus isolates was 76%. Meropenem and amikacin were the most effective agents against to Gram-negative bacteria. Conclusion: In order to detect of the variation and trends of NIs, the data of surveillance activities must be evaluated decisively and regularly with collaboration among infection control team, Infectious Disease clinic, and GSU. © 2010 Düzce Medical Journal.Öğe Ventilatör ilişkili pnömoni tanısında endotrakeal aspirat kültürünün ve izole edilen bakterilerin değerlendirilmesi(2011) Uluğ, Mehmet; Çelen, Mustafa Kemal; Geyik, Mehmet Faruk; Hoşoğlu, Salih; Ayaz, CelalAmaç: Bu çalışmada, yoğun bakım ünitesinde (YBÜ) mekanik ventilasyon uygulanan hastaların endotrakeal aspirat örneklerinden izole edilen ventilatörle ilişkili pnömoni (VİP) etkeni ile bu etkenlerin çeşitli antibiyotiklere karşı duyarlılıklarının saptanması amaçlanmıştır. Materyal ve metot: Çalışmaya, YBÜ’de 48 saatten fazla mekanik ventilasyon desteği uygulanan, klinik ve mikrobiyolojik verilerle VİP tanısı konulan hastalar alındı. Bu olguların endotrakeal aspirat örneklerinden izole edilen bakteriler konvansiyonel ve Sceptor yöntemleri ile tanımlandı ve bunların antibiyotik duyarlılıkları NCCLS kriterlerine uygun olarak araştırıldı. Bulgular: Çalışmaya 72 hasta ve bunlardan izole edilen 84 suş alındı. Bu hastaların 12’sinde (%14,3) polimikrobiyal etken saptandı. En sık saptanan etken Pseudomonas aeruginosa olup, bunu Staphylococcus aureus ve Acinetobacter spp. izlemekteydi. Gram negatif bakteriler çoğunlukla imipenem, amikasin ve siprofloksasine duyarlı bulundu. Metisiline dirençli S. aureus oranının %100 bulunmasına rağmen glikopeptid direnci görülmedi. Gram negatif bakterilerden 58’nin (%92) genişlemiş spektrumlu beta-laktamaz ürettiği saptandı. Sonuç: Sonuç olarak VİP, YBÜ’de sık görülen önemli bir infeksiyon hastalığıdır. Antibiyotiklere karşı görülen yüksek direnç oranları, VİP olgularının empirik tedavisinin sürekli güncellenmesi gerektiğini düşündürmektedir.Öğe Yatan hastalardan izole edilen gram negatif bakteriler ve antibiyotik dirençlerinin değerlendirilmesi(2010) Özmen, Esen; Geyik, Mehmet Faruk; Uluğ, Mehmet; Çelen, Mustafa Kemal; Hoşoğlu, Salih; Ayaz, CelalAmaç: Gram negatif bakteri (GNB)’lerde antibiyotik direnci tüm dünyada giderek artmaktadır. Bu çalışmada, yatan hastalardan izole edilen GNB’lerin bazı antibiyotiklere karşı direnç oranlarını belirleyerek, ampirik antibiyotik tedavisi için yol gösterici sonuçlar elde etmek amaçlandı. Materyal ve Metod: Bu çalışmada, Dicle Üniversitesi Tıp Fakültesi Hastanesinde Mayıs 2003 ile Nisan 2005 tarihleri arasında, yatan hastalarda çeşitli klinik örneklerden izole edilen 898 GNB incelendi. Antibiyotik direncini saptamak için mikrodilüsyon yöntemi kullanıldı. Bulgular: En sık izole edilen GNB’ler sırasıyla Escherichia coli (n282), Enterobacter spp. (n215), P. aeruginosa (n101), Klebsiella spp. (n95), S. maltophilia (n69) ve Acinetobacter spp. (n52) idi. Genel antibiyotik direnç oranları seftriakson için %73, sefotaksim için %68, seftazidim için %63, trimetoprim-sulfametaksazol için %60, siprofloksasin için %51, amikasin için %20, imipenem için %3 ve meropenem için %2 olarak tespit edildi. Bu çalışmada, izole edilen GNB’lerin üçüncü kuşak sefalosporinlere, trimetoprim-sulfametaksazole ve siprofloksasine karşı direnç oranları çalışılan diğer antibiyotiklere göre daha yüksek bulundu. Sonuç: Uygun ampirik antibiyotik tedavisi için her hastanenin kendi direnç oranlarını düzenli aralıklarla izlemesi gerekmektedir. Yapılacak sürveyans çalışmaları ampirik tedavi yaklaşımı için yol gösterici olacaktır.
