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Öğe Çok ilaca dirençli gram negatif bakterilerdeki seftazidim-avibaktam duyarlılığının araştırılması(2023) Akbaş, Emel; Keskin, Banu Hümeyra; Kayman, Hande; Yekenkurul, Dilek; Çalışkan, Emel; Öksüz, Şükrü; Şahin, İdrisÇoklu ilaca dirençli (MDR) Gram negatif bakteriyel patojenler ciddi mortalite ve morbidite ile seyreden enfeksiyonlara neden olabilirler. Bu izolatların etken olduğu enfeksiyonlarda tedavi seçenekleri sınırlıdır. Çalışmamızda çeşitli klinik örneklerden izole edilen MDR Gram negatif bakterilerde seftazidim-avibaktam duyarlılık oranının araştırılması amaçlanmıştır. Çalışmaya Düzce Üniversitesi Tıbbi Mikrobiyoloji Laboratuvarında Temmuz 2018-Temmuz 2022 tarihleri arasında çeşitli klinik örneklerden izole edilen Enterobacterales ve Pseudomonas aeruginosa suşları dahil edildi. Tür düzeyinde tanımlama ve antimikrobiyal duyarlılık testleri için klasik yöntemlere ilave olarak otomatize sistem (VITEK 2 Compact /Phoenix) kullanıldı. Bunların içinden MDR olduğu saptanan izolatlarda disk difüzyon yöntemi ile seftazidim-avibaktam (10-4 ?) (Bioanalyse, Türkiye) duyarlılığı araştırıldı. Çeşitli klinik örneklerden toplam 83 adet MDR Enterobacterales ve 33 adet MDR P. aeruginosa olmak üzere 116 suş izole edildi. İzolatların 45’i (%38.7) seftazidim-avibaktama duyarlı bulundu. Seftazidim-avibaktam duyarlılığı Enterobacterales için %44.6 iken, P. aeruginosa suşlarında %24.2 olarak saptandı. Sonuç olarak çalışmamızda, MDR Enterobacterales’te en etkili antibiyotik kolistin (p<0.001), ikinci seftazidim-avibaktam (p<0.001) oldu. MDR P. aeruginosa suşlarında da en etkili antibiyotik kolistin (p<0.001) olmakla birlikte; gentamisin, amikasin ve seftazidim-avibaktam duyarlılıklarının benzer olduğu görüldü (p<0.819). Yapılan çalışmalarda P. aeruginosa'nın seftazidim-avibaktama karşı direnç oranlarının diğer Gram-negatif patojenlere göre daha yüksek olduğu gösterilmiştir. Sonuçlarımız seftazidim-avibaktamın MDR-Enterobacterales ile gelişen enfeksiyonların tedavisi için bir alternatif olabileceğini; ancak, MDR-P. aeruginosa suşlarında duyarlılık test sonuçlarının önemli olduğunu düşündürmektedir.Öğe COVID-19 Enfeksiyonunda Ağırlaştırıcı Risk Faktörlerinin Araştırılması(2023) Yekenkurul, Dilek; Ince, Nevin; Yıldırım, Mustafa; Sungur, Mehmet Ali; Escan, Elif; Davran, Fatih; Altınsoy, Hasan BakiAmaç: Koronavirüs hastalığı-2019, yaklaşık iki yıl önce Çin'de başlayan ancak tüm dünyayı etkisi altına alan bir salgına neden olmuştur. Koronavirüs hastalığı-2019 enfeksiyonu ile takip edilen hastaların değerlendirilmesi, ciddi enfeksiyon için risk faktörlerinin ve göstergelerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Koronavirüs hastalığı-2019 enfeksiyonu ile 15 Mart- 01 Haziran 2020 tarihleri arasında yatarak tedavi gören hastalar araştırıldı. Hastalar oksijen satürasyonlarına göre iki gruba ayrıldı; oksijen satürasyonu % 90'ın üzerinde olan hastalar grup 1, % 90 ve altı olan hastalar grup 2 olarak belirlendi. Bu iki grup ağırlaştırıcı risk faktörleri açısından karşılaştırıldı. Bulgular: Bu çalışmaya 90 hasta (46 kadın, 44 erkek) dahil edildi. Bilgisayarlı toraks tomografisinde orta-şiddetli pnömonik tutulum (p=0,002) ve yüksek ateş (pÖğe COVID-19 Hastalarında HBV, HCV, HIV Prevalansı ve Klinik Seyre Etkisi(2024) Yekenkurul, Dilek; Gürbüz, Ali Rıza; İnce, Nevin; Çalışkan, EmelAmaç: COVID-19, hepatit B gibi viral enfeksiyonlarda hepatik alevlenmeyle seyredebilir. COVID-19 hastalarında HBV, HCV, HIV prevalansının ve klinik seyrinin araştırılması amaçlanmıştır. Materyal ve Metot: COVID-19 nedeniyle yatarak takip edilen, hepatit ve HIV serolojik tetkikleri istenen hastalar çalışmaya dahil edildi. Hastaların demografik verileri; HBV, HCV, HIV serolojileri; ALT, AST sonuçları kaydedildi. Bulgular: Çalışmaya alınan 226 hastanın 118’i (%52) erkek, 108’i (%48) kadındı, yaş ortalaması 63,47±16,09 yıldı. HBsAg pozitifliği altı (%3), izole Anti-HBcIgG pozitifliği altı (%3), Anti-HCV pozitifliği yedi (%3) hastada mevcuttu. Anti-HIV pozitifliği saptanmadı. HBsAg pozitif hastaların ikisinde HBV-DNA negatif, dördünde pozitifti. Anti-HCV pozitif hastalarda HCV-RNA negatifti. İstatistiksel olarak anlamlı olmasa da HBsAg pozitif hastaların yaş ortancası daha düşük; ALT, AST ortancası daha yüksekti. Ancak yatış süresi ile yoğun bakıma devir ve taburcu olma durumu tüm gruplarda benzerdi. Sonuç: HBsAg pozitif hasta grubunda karaciğer enzimlerinin yüksek olduğu saptanmıştır. Bu nedenle COVID-19’un HBsAg pozitif hastalarda hepatik alevlenmeye sebep olabileceği düşünülmüştür.Öğe Düzce Üniversitesi Araştırma Hastanesi’nde Enfeksiyon Hastalıkları Servisinde Takip Edilen COVID-19 Hastalarının Yatış Süresine Etki Eden Faktörler(2024) Çakır, Yasemin; İnce, Nevin; Yekenkurul, Dilek; Yıldırım, Mustafa; Sungur, Mehmet Ali; Öztürk, Cihadiye Elif; Unlu, Elif NisaAmaç: Aralık 2019’da ortaya çıkan ve tüm dünyada pandemiye sebep olan yeni coronavirüs 19 hastalığı (COVID-19), iki yıldan uzun süredir tüm dünyada milyonlarca insanı enfekte etmiştir. Bu çalışmada, COVID-19 tanısı ile hastanede yatan hastaların yatış süresine etki eden faktörlerin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Mart-Haziran 2020 tarihleri arasında enfeksiyon hastalıkları servisinde yatan COVID-19 tanılı hastalar dahil edildi. Hastaların demografik özellikleri, vital bulguları, hemogram, üre, kreatin, C-reaktif protein (CRP), alanin aminotransferaz (ALT), aspartat transaminaz (AST), laktat dehidrojenaz (LDH), protrombin zamanı (PT), uluslararası normalleştirilmiş oran (INR), procalsitonin (pct), d-dimer, ferritin, troponin, nötrofil/lenfosit oranı (NLR) trombosit-lenfosit oranı (PLR), monosit-lenfosit oranı (MLR) ve ortalama trombosit hacmi (MPV)-lenfosit oranı (MPVLR), COVID-19 PCR, akciğer görüntüleme bulguları, tedavi ve hastane yatış süreleri retrospektif olarak incelendi. Bulgular: Çalışmamızda hastaların yaş ortalaması 56,51±15,48, kadın erkek oranı 1/1, ortalama yatış süresi 7,58±3,35 gündü. DM, HT ve malignitesi olan hastalarda, favipravir, enoksaparin ve vitamin C desteği alan hastalarda daha uzun hastane yatışı olduğu, uzun süre hastane yatışı olan hastalarda ateş, pct, AST, LDH değerlerinin kısa yatış süresi olan hastalara göre daha yüksek olduğu saptandı. Lenfosit sayısı ve yüzdesi, NLR, monosit sayısı ve MPV/lenfosit oranı yedi günden uzun süre yatan hastalarda anlamlı derecede düşük bulundu. Sonuç: Hastaneye başvuru şikayetlerinin yatış süresini öngörmede etkisiz olduğu saptandı.Öğe Evaluation of Factors Affecting Antiretroviral Treatment Changes in HIV- Positive Patients in a University Hospital(Bilimsel Tip Yayinevi, 2023) Çakır, Yasemin; İnce, Nevin; Çalışkan, Emel; Tunca, Bekir; Yekenkurul, DilekIntroduction: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is the leading cause of death from infectious diseases in the world. With the antiretroviral treatments developed over the years, viral replication is suppressed even though the disease cannot be cured yet. However, antiretroviral therapy (ART), like all drugs, has brought with it undesirable side effects as well as positive effects. In addition, demographic characteristics, accompanying comorbidities, organ dysfunctions, viral load, CD4 T lymphocyte count, ART resistance status, coinfections, pregnancy are also effective factors in the initial ART decision and change. In this study, we aimed to show the treatment status of HIV-positive patients followed in the infectious diseases outpatient clinic of our hospital and to determine the factors that affect ART change. Materials and Methods: Demographic data of HIV-positive patients followed in the infectious diseases outpatient clinic between January 2016 and May 2021, HIV-RNA and CD4 T lymphocyte results obtained before and after antiretroviral therapy, and the reasons for changing treatment were evaluated retrospectively. Results: The mean age of the patients included in the study was 40.0 +/- 13.9 (min: 20-max: 76), and 16 (18%) were female and 71 (82%) were male. Treatment was changed in 32% of the patients. Changes were made due to drug-related side effects in 43%, patient-related reasons (such as single tablet request, non-compliance with treatment) in 25%, and virological unresponsiveness in 18% of patients who underwent treatment change. The most common cause of drug changes due to side effects was hyperlipidemia. The treatment regimens that changed the initial treatment were most frequently TDF/FTC/LPV/r and TDF/FTC/EFV, respectively. Conclusion: As a result of our study, we found that the most common cause of ART change in HIV-positive patients in our hospital was drug-related side effects, and patient non-compliance was the second most common. It is important to know the factors that cause these changes in advance and to make choices accordingly when starting the treatment, in order to increase patient compliance and facilitate follow-up.Öğe Evaluation of Patients Who were Referred to Our Outpatient Clinic with Suspicious Sexual Contact(2021) Yekenkurul, DilekAim: Sexually transmitted infections are preventable, common diseases with serious complications and high morbidity.Patients with suspicious sexual contact in Turkish society, find it difficult to consult a physician due to public pressure.Patients with suspicious sexual contact who applied to the Infectious Diseases and Clinical Microbiology outpatientclinic were analyzed.Material and Methods: Patients (62 patients) over the age of 18, who applied to Infectious Diseases and ClinicalMicrobiology outpatient clinic with suspicious sexual contact, between March 2018-January 2019, were included in thestudy. The demographic characteristics of the patients such as age, gender, marital status; also complaints, using ofcondom, physical examination findings, and all examinations during the six-month follow-up were recorded.Results: In this study, 56 (90%) male and 6 (10%) female patients with a mean age of 33.40 ± 14.11 years wereincluded. High percentage (58;93%) of patients didn’t use condoms during sexual contact, 21(34%) of the patients hadmore than one partner, the most common diagnosis was urethritis (21; 34%), one patient in a bisexual relationship wasdiagnosed with acute HIV infection, and was observed that the diagnosis of syphilis (9; 15%) was quite high.Conclusion: Results such as the low rate of use of condoms made us think that there is a lack of knowledge aboutsexually transmitted diseases in the society. Considering the possibility of increasing infection rates in the comingyears; we think that the necessary importance should be given to sexually transmitted diseases and frequent publictrainings should be provided.Öğe An evaluation of six-year Stenotrophomonas maltophilia infections in a university hospital(Makerere Univ, Fac Med, 2020) Ince, Nevin; Yekenkurul, Dilek; Danis, Ayse; Caliskan, Emel; Akkas, IdrisBackground: Stenotrophomonas maltophilia is a Gram-negative bacillus and opportunistic emergent pathogen causing hospital-acquired infections (HAIs). Due to risk factors such as prolonged intensive care unit stay and invasive procedures, it has become one of the leading causes of HAIs. Objective: The aim of this study was to evaluate the epidemiology of S.maltophilia infections over a six-year period at D & uuml;zce University Hospital, Turkey. Methods: The incidence, clinical characteristics, antimicrobial susceptibility and outcomes of nosocomial S. maltophilia in-fections during this period were retrospectively analyzed. Results: During the study period, 67 samples obtained from 61 patients were identified. Pneumonias (82%) were the most common HAIs, followed by bloodstream infections (10.5%), urinary tract infections (3%), skin and soft tissue infections (3%) and surgical site infection (1.5%). Admission to intensive care, hospitalization exceeding 30 days, and previous use of broad-spectrum antibiotics constituted risk factors. Resistance to cotrimoxazole (6%) was lower than that to levofloxacin (18%). Conclusion: The most important risk factors for S.maltophilia infection in patients are previous exposure to antibiotics, prolonged hospitalization and invasive procedures such as mechanic ventilation. Discharging patients as early as possible with the rational use of antibiotics may be effective in reducing S. maltophilia infections and resistance rates.Öğe Fatal neutropenic enterocolitis following methotrexate overdose: A case report(Duzce University Medical School, 2019) İnce, Nevin; Tunca, Bekir; Yekenkurul, Dilek; Yıldırım, MustafaMethotrexate, a folic acid antagonist, is widely used in the treatment of neoplasms in addition to diseases such as psoriasis and rheumatoid arthritis. Although well tolerated under normal conditions, the use of more than the recommended doses may cause life-threatening toxicities. Toxicity due to high doses of methotrexate is manifested by bone marrow inhibition, gastrointestinal mucosal damage and pancytopenia. Most cases result from overdose. However, serious adverse events that result in mortality, in particular those of mixing medication in elderly patients, are rare. Herein, we present the case of a 72-year-old man who admitted to the emergency department with painful oral ulcers, inability to swallow and a general impaired condition, and died of sepsis after developing neutropenic enterocolitis following a fever and neutropenia. © 2019, Duzce University Medical School. All rights reserved.Öğe Intraabdominal hemorrage due to acute pancreatitis: Case report(Duzce University Medical School, 2018) Yekenkurul, Erman; Yaşar, Mehmet; Yekenkurul, Dilek; İskender, AbdulkadirAcute pancreatitis is acute inflammation of pancreatic cells that may presents with non-specific findings such as abdominal pain and vomiting. Haemorrhage is a rare complication of acute pancreatitis, while complications such as pseudocyst, abscess, necrosis may also occur. Here, we present a case of 39-years-old male patient with intraabdominal bleeding due to idiopathic acute pancreatitis. Patient presented to emergency department with abdominal pain and lack of appetite; as a result of history, findings and investigations acute pancreatitis were considered. Oral feeding was stopped and nutritional support was given by vascular access and pain control was achieved. Due to decrease in hemoglobin and hemotacrit level diagnostic laparoscopy were performed. On exploration fragile and hemorrhagic pancreas was observed. Bleeding control was achieved; after symptomatic treatment abdominal pain regressed. Laboratory findings were completely recovered and patient was discharged. As a result; should also be noted that the rare complications of acute pancreatitis, such as hemorrhage,can be seen, so considering the patient's symptoms can mislead us further investigations should be made. © 2018, Duzce University Medical School. All rights reserved.Öğe İnvazif Kandida Enfeksiyonu(2023) Altun, Gülsah; Akbaş, Türkay; Yekenkurul, DilekYüksek mortalite ve morbidite ile ilişkili olan fungal enfeksiyonların sıklığı giderek artmaktadır. Fungal enfeksiyonlarda en fazla saptanan etkenler kandida türleridir. Kandida enfeksiyonlarında en önemli risk faktörü, deri ve mukozaların kandida türleriyle kolonize olmasıdır. Vasküler ve üriner kateter uygulanması gibi invazif girişimler kolonizasyon ve enfeksiyon riskini arttırmaktadır. İmmunsupresif tedavi alımı, nötrofil ve lenfosit defektleri, fagosit anormallikleri, yoğun bakım ünitesinde yatışı olması, geniş spektrumlu antibiyotik kullanımı, mekanik ventilasyon, parenteral beslenme ve abdominal cerrahi de risk faktörlerindendir. Diğer enfeksiyonlardan ayırt edici semptom veya bulgusunun olmaması, kandida enfeksiyonlarının gözden kaçmasına ve geç tanı konulmasına sebep olmaktadır. Bu nedenle klinik tanı için uygulanabilirliği kolay olan kandidanın kolonize olma indeksi, Ostrosky klinik tahmin kuralı ve kandida skorlaması sistemleri geliştirilmiştir. Kesin tanı için maya veya hif formlarının, kan veya doku kültürlerinde gösterilmesi gerekmektedir. Mortalite riski yüksek olan bu enfeksiyonlarda, erken müdahale ölüm oranını azaltmaktadır. Tedavi yöntemleri profilaktik, ampirik, preempitif ve hedefe yönelik tedavi olmak üzere dört gruba ayrılmaktadır. Fungal enfeksiyon açısından yüksek riskli hastalarda, enfeksiyonun gelişmemesi için uygulanan koruyucu tedavi yöntemi profilaktik tedavidir. Ampirik tedavi, nedeni açıklanamayan ateşi olan ve steril olmayan alanlarda kandida üremesi saptanan hastalarda uygulanan tedavi yöntemidir. Yüksek olası invazif kandidiyazis için şokta olan hastalarda preempitif tedavi uygulanırken, steril ortamlarda kandida invazyonu gösterilen durumlarda hedefe yönelik tedavi verilmektedir.Öğe Investigation of the Factors Associated with Mortality in Catheter-Related Bloodstream Infections: Five-Year Observation(2020) Ince, Nevin; Yekenkurul, Dilek; Çalışkan, Emel; Gürbüz, Ali Rıza; Yener, SelviAim: Intravenous catheter use can cause various infections ranging from infection at the siteof catheter entry to bacteremia and colonization. The purpose of this study was to identify thecausative micro-organisms, and effects on morbidity-mortality of catheter-related bloodstreaminfections developing over the last five years.Material and Methods: Data for 194 patients who underwent central intravenous catheterinsertion in our hospital’s intensive care unit and other departments between November 2014and August 2019 were analyzed retrospectively. Blood samples taken from the catheter or thecatheter tip, and blood samples collected simultaneously from the peripheral vein wereincluded in the study, and culture results were recorded. Patients’ demographic data and theeffects of the factors identified on morbidity and mortality were subjected to statisticalanalysis.Results: Ninety-two (47.4%) of the 194 patients included in the study were female and 102(52.6%) were male, and mortality rate was 62.4% (n=121). The frequency of underlyingmedical conditions such as asthma, congestive heart failure, and cerebrovascular event, andreceiving treatments such as immunosuppression, transfusion, tracheostomy, nasogastric tube,and mechanical ventilation were higher in mortal cases than non-mortal cases. A total of twohundred and forty microorganisms were detected in 194 patients, 121 (50.4%) of which wereGram negative bacteria, while 68 (28.3%) were Gram positive bacteria, and 51 (21.3%) wereCandida species.Conclusion: As a result, it was observed that the advanced age, underlying diseases andpresence of resistant microorganisms were higher in mortal cases.Öğe Monitoring of antibody levels in healthcare workers after inactivated coronavirus disease 19 vaccination(Assoc Medica Brasileira, 2023) Caliskan, Emel; Ozturk, Cihadiye Elif; Oksuz, Sukru; Ince, Nevin; Yekenkurul, Dilek; Kahraman, Gozde; Duran, PelinOBJECTIVE: Because of the coronavirus disease 19 pandemic, studies on vaccination are being conducted in our country as well as across the world. In this study, the antibody levels in healthcare workers vaccinated with two doses of inactivated vaccine and the factors affecting these levels were investigated. METHODS: Randomly selected volunteers from healthcare workers, who had been vaccinated with two doses of inactivated vaccine in January to February 2021, were included in the study. Blood samples were drawn twice, 1 month and 6 months after the second dose vaccine (CoronaVac:Sinovac Life Science Co, Ltd, Beijing, China). The antibody levels were determined by the chemiluminescence microparticle immunoassay method using kits for quantitative detection of immunoglobulin class G antibodies to severe acute respiratory syndrome coronavirus 2. RESULTS: The mean antibody levels of 129 volunteers were 1232.5 (min: 103 to max: 7151) AU/mL in the first month and 403.5 (min: 23 to max: 4963) AU/mL in the sixth month. According to the survey results, 91 (71%) volunteers had not been diagnosed with coronavirus disease 19 before vaccination. The antibody levels 1 month and 6 months after the second dose of vaccination were significantly higher in those who had been diagnosed with coronavirus disease 19 before vaccination than in those who had not. It was found that age, gender, fast food, or healthy nutrition had no effect on antibody levels. CONCLUSION: Vaccines are very important both to protect against coronavirus disease 19 and to experience only a mild form of the disease. Immunoglobulin class G levels formed after vaccination may be affected by many factors and may decrease over time.Öğe Multidrug-Resistant Gram-Negative Bacteria Rate and Risk Factors in the Neonatal Intensive Care Unit: A Single-Center Ten- Year Experience(Duzce Univ, Fac Medicine, 2023) Cakmak, Hatice Mine; Yekenkurul, Dilek; Sengun, Zehra; Yener, Selvi; Duran, Pelin Kamuran; Davran, Fatih; Kocabay, KenanObjective: Multidrug resistance (MDR) in gram-negative neonatal infections is difficult to manage, and the risk factors differ among different studies. Therefore, we aim to investigate the demographics, mortality, MDR status of gram-negative isolates, and risk factors for MDR gram-negative infections.Methods: We conducted a retrospective single-center study about MDR gram-negative infections in neonates between January 2012-January 2022 at Duzce University Hospital in Turkey. This study evaluates neonates with MDR gram-negative infections' risk factors and clinical features. All analyses were performed using IBM SPSS V23. In addition, univariate analyses and multivariate logistic regression models were studied to determine MDR's risk factors.Results: Of 107 gram-negative bacteria, 41 (38.3%) accounted for Enterobacter, 30 (28%) for Klebsiella pneumonia, and 22 (20.6%) for Escherichia coli. Additionally, 61 (56.5%) were MDR microorganisms. Among the susceptibility tests performed for selected isolates, 41 (77.4%) had resistance to piperacillin, 57 (75%) showed resistance to amoxiclav, and 16 (72.7%) had cefoxitin resistance. In addition, carbapenemase resistance was found in 24 (43.6%) and meropenem resistance in 13 (36.1%). Colistin, aztreonam, and tigecycline resistances were the least frequent. In addition, the following dependent risk factors increased the multidrug resistance risk in gram-negative infections; late-onset sepsis 3.547 fold (p=0.005), use of mechanical ventilation 3.143 fold (p=0.007), blood transfusion 3.587 fold (p=0.013), bronchopulmonary dysplasia 6.702 fold, (p= 0.015) and total parenteral nutrition 5.591 fold (p=0.001), lower gestational age 1.122 (1/0.891) fold (p=0.026), and birth weight 1.001 (1/0.999) fold, (p=0.013). Similarly, antibiotherapy duration was significantly higher in the MDR group than in the non-MDR group.Conclusions: The reported risk factors for MDR in gram-negative neonatal infections are all dependent risk factors. Hence clinicians must be alert to all potential risk factors.
