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Öğe A 5-year surveillance of healthcare-associated infections in a university hospital: A retrospective analysis(Sage Publications Inc, 2022) Erdem, İlknur; Yıldırım, İlker; Şafak, Birol; Karaali, Ritvan; Erdal, Berna; Ardıç, Enes; Arar, CavidanObjectives: Nosocomial infections or healthcare-associated infections are a significant public health problem around the world. This study aimed to assess the rate of laboratory-confirmed healthcare-associated infections, frequency of nosocomial pathogens, and the antimicrobial resistance patterns of bacterial isolates in a University Hospital. Methods: A retrospective evaluation of healthcare-associated infections in a University Hospital, between the years 2015 and 2019 in Tekirdag, Turkey. Results: During the 5 years, the incidence densities of healthcare-associated infections in intensive care units and clinics were 10.31 and 1.70/1000 patient-days, respectively. The rates of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections in intensive care units were 11.57, 4.02, and 1.99 per 1000 device-days, respectively. The most common healthcare-associated infections according to the primary sites were bloodstream infections (55.3%) and pneumonia (20.4%). 67.5% of the isolated microorganisms as nosocomial agents were Gram-negative bacteria, 24.9% of Gram-positive bacteria, and 7.6% of Candida. The most frequently isolated causative agents were Escherichia coli (16.7%) and Pseudomonas aeruginosa (I 5.7%). The rate of extended-spectrum beta-lactamase production among E. coli isolates was 51.1%. Carbapenem resistance was 29.8% among isolates of P. aeruginosa, 95.1 % among isolates of Acinetobacter baumannii, and 18.2% among isolates of Klebsiella pneumoniae. Colistin resistance was 2.4% among isolates of A. baumannii. Vancomycin resistance was 5.3% among isolates of Enterococci. Conclusion: Our study results demonstrate that healthcare-associated infections are predominantly originated by intensive care units. The microorganisms isolated from intensive care units are highly resistant to many antimicrobial agents. The rising incidence of multidrug-resistant microorganisms indicates that more interventions are urgently needed to reduce healthcare-associated infections in our intensive care units.Öğe A Case of Acute Cholestatic Hepatitis Due to Epstein-Barr Virus Infection(Aves, 2020) Ardic, Enes; Karaali, Rıdvan; Yağmur, Orhan; Atar, Resit Volkan; Kardan, Muhammed Enes; Doğan, Mustafa; Erdem, İlknurHepatic involvement during the Epstein-Barr virus (EBV) infection is frequently seen. Elevated liver enzymes occur usually from mild to moderate. However, acute cholestatic hepatitis is a rare complication. Herein, we report a 26-year-old male with acute cholestatic hepatitis due to EBV infection.Öğe A case report of brain abscess caused by carbapenem- resistant Klebsiella pneumoniae(Inst Medicina Tropical Sao Paulo, 2023) Tunçkale, Tamer; Kavak, Çağlar; Şafak, Birol; Gönen, Aysun; Erdem, İlknurThe treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.Öğe A rare cause of fever in an adult: a case of familial Mediterranean fever(Dove Medical Press Ltd, 2018) Erdem, İlknur; Saritas, Fatih; Karaali, Rıdvan; Ardic, Enes; Emeksiz, Gaye Kübra; Kara, Sonat Pınar; Bol, OguzhanBackground: Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent fever attacks and serositis. Nonspecific manifestations of the FMF can mimic many common acquired disorders such as infections and acute abdomen. This can delay recognition for many years and lead to comprehensive assessments and even unnecessary surgeries. Untreated FMF may lead to serious complications such as end-stage renal disease and malabsorption due to amyloid deposits in the kidneys and the digestive system. Colchicine has been used successfully to treat FMF since the 1970s. Case presentation: A 30-year-old male was admitted to our hospital with the complaints of fever, nausea, vomiting, and generalized myalgia and weakness for 15 days. The day after hospitalization, the patient had abdominal pain. Approximately a month before, the patient was treated for a diagnosis of urinary tract infection, with similar complaints. MEFV gene mutation analysis revealed homozygosity for the R202Q mutation. FMF was considered in the patient due to the presence of recurrent febrile serositis attacks and R202Q homozygous mutation in the FMF gene analyses. Colchicine was started 3x0.5 mg/day by consulting rheumatology on day 8 of admission. After the colchicine treatment, the patient's complaints markedly improved and the inflammatory markers returned to normal levels. At his follow-up visit at 6 months, the patient remained asymptomatic. Conclusion: We present a case of adult-onset FMF accompanied by peritonitis as a disease among the rare causes of fever in an adult who was treated with colchicine. Based on this case, we suggest that FMF should be kept in mind in the differential diagnosis of patients with periodic fever syndromes.Öğe Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010)(Natl Inst Infectious Diseases, 2012) İnan, Asuman Şengöz; Özgültekin, Asu; Akçay, Seniha Şenbayrak; Engin, Derya Öztürk; Turan, Güldem; Ceran, Nurgül; Erdem, İlknurThe aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum beta-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed.Öğe An unusual presentation of brucellosis: hepatic microabscesses(Wiley-Blackwell, 2017) Erdem, İlknur; Ali, Ritvan Kara; Elbasan, Senay; Özçağlayan, Ömer; Değirmenci, Pelin Osanmaz; Sedef, Samet; Topkaya, Aynur ErenHepatic abscess due to Brucella species is an extremely rare complication especially in acute illness. Here, we report a case of hepatic microabscesses probably caused by Brucella in a 33-year-old woman with acute infection who was successfully treated with a combination of doxycycline and rifampicin for 3 months.Öğe Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria(Wiley-Blackwell, 2009) Erdem, İlknur; Özgültekin, Asu; İnan, Asuman Şengöz; Engin, Derya Öztürk; Akçay, Seniha Şenbayrak; Turan, G.; Göktaş, PaşaP>In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs.Öğe Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis(Wolters Kluwer Medknow Publications, 2008) Erdem, İlknur; Hakan, Tayfun; Ceran, Nurgül; Metin, Fatma; Akçay, Seniha Şenbayrak; Küçükercan, Metin; Göktaş, PaşaBackground: Nosocomial meningitis is a rare complication following neurosurgical procedures and is associated with high morbidity and mortality. Aim: The aim of this study was to describe the clinical characteristics and the risk factors associated with mortality in patients who developed nosocomial meningitis following neurosurgical operations. Setting and design: Tertiary care hospital and an observational study. Materials and Methods: The study subjects included 2265 patients who underwent various neurosurgical operations during 2003-05. The diagnosis of nosocomial meningitis was based on the Center for Disease Control criteria. Statistical analysis: It was performed by using Statistical Package for Social Sciences for Windows 10.0 program. Results: The incidence of postoperative nosocomial meningitis was 2.7% (62 episodes in 49 patients among 2265 patients operated). Staphylococcus aureus and Acinetobacter spp. were the most frequently isolated pathogens. Of the 49 with meningitis 20 (40.8%) patients died. In the logistic regression analysis model, Glascow coma scale score less than 10 (Odds Ratio (OR): 19.419, 95% Confidence Interval (CI); 1.637-230.41, P = 0.001), and low cerebrospinal fluid glucose level (= 30 mg/dL) (OR: 10.272, 95% CI; 1.273-82.854, P= 0.002), and presence of concurrent nosocomial infection (OR: 28.744, 95% CI; 1.647-501.73, P= 0.001) were the independent risk factors associated with mortality. Conclusion: The mortality in patients who developed meningitis was high. The high percentage of concurrent nosocomial infections was associated with a high mortality rate which was a serious problem.Öğe Community-acquired Lower Urinary Tract Infections: Etiology, Antimicrobial Resistance, and Treatment Results in Female Patients(Wolters Kluwer Medknow Publications, 2018) Erdem, İlknur; Karaali, Rıdvan; Ardic, Enes; Omar, Şenay Elbasan; Mutlu, Reyhan; Topkaya, Aynur ErenBackground/Purpose: Most community-acquired urinary tract infections (UTIs) are usually treated empirically. The knowledge of antibiotic resistance patterns of the microorganisms causing UTI is essential for defining the empirical treatment. Objective: The aim of the present study is to determine the distribution of bacterial strains isolated from lower UTIs and their resistance patterns against commonly used antimicrobial agents and treatment results in female patients. Subjects and Methods: This is a retrospective analysis of medical case records of 90 female patients with lower UTI for a period of 4 years from January 2013 to December 2016 in a tertiary care hospital in the Trakya region of Turkey. Results: The most common causative agent was Escherichia coli (66.6% of cases) followed by Klebsiella pneumoniae (16.6%). Fosfomycin was the most active agent against E. coli (resistant isolates: 5.5%), followed by nitrofurantoin (resistant isolates: 7.4%). Extended-spectrum beta-lactamases (ESBLs) production was observed in 29 (32.2%) isolates (22 in E. coli, 6 in K. pneumoniae, and 1 in Enterobacter spp.). The antimicrobial resistance rates among ESBL-producing E. coli isolates for trimethoprim-sulfamethoxazole, ciprofloxacin, fosfomycin, and nitrofurantoin were 77.7%, 72.7%, 13.6%, and 18.2%, respectively (P < 0.05). The estimated microbiological eradication rates for nitrofurantoin and fosfomycin were 89.7% and 83.8%, respectively. Conclusions: The results of the present study indicate that nitrofurantoin and fosfomycin may be considered for empirical therapy of lower UTIs in Trakya region of Turkey.Öğe Comparison of antibiotic use in the COVID-19 pandemic with the pre-pandemic period in a university hospital(Termedia Publishing House Ltd, 2022) Erdem, İlknur; Ardıç, Enes; Türker, Ece; Kardan, Muhammed Enes; Demirkapu, Mahluga JavarovaIntroduction: The appropriate use of antibiotics is an important strategy in slowing the development of antimicrobial resistance. This study aimed to evaluate antibiotic consumption and antibiotic use during the coronavirus disease 2019 (COVID-19) pre-pandemic period and pandemic period. Methods: Antibiotic consumption was evaluated with the antibiotic consumption index (ACI). Results: Antibiotics with the largest increase in ACI value during the pandemic period compared to the previous year increased from 0.4 to 1.8 DDI/100 bed days in moxifloxacin. Teicoplanin, linezolid, and clindamycin were not affected in terms of consumption. Conclusions: It was observed that the use of many intravenous antibiotics in our hospital increased during the pandemic period.Öğe Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome(Public Library Science, 2018) Çağ, Yasemin; Karabay, Oğuz; Sipahi, Oguz Resat; Aksoy, Firdevs; Durmuş, Gül; Batırel, Ayşe; Vahaboglu, Haluk; Erdem, İlknurSepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.Öğe Does transcription factor, induced by daptomycin and vancomycin, affect HIF-1?, Chondroadherin, and COL2A1?(2018) Karaarslan, Numan; Yılmaz, İbrahim; Şirin, Duygu Yaşar; Özbek, Hanefi; Kaya, Yasin Emre; Akyuva, Yener; Doğan, Mustafa; Erdem, İlknurAim: In this study, it was firstly aimed to investigate the effect of Daptomycin (DAP) on the proliferation in Vancomycin (VCM)-administered primary chondrocyte cultures and non-drug-administered primary chondrocyte cultures. Our second objective was to investigate the effects of DAP and VCM on the NP-specific marker protein chondroadherin (CHAD), which is associated with spinal cord and dorsal column growth, on the transcription factor-1 alpha (HIF-1?), which is induced by hypoxia, and on a type II collagen (COL2A1), which is also known to play a significant role in the development of extracellular matrix, at the pharmaco-molecular level.Material and Methods: Standard human primary chondrocyte cultures were established. DAP and VCM were added to the samples. In all groups, molecular analysis was performed at 0th, 24th and 48th hours. In addition, the surface morphology of the cells was evaluated.Results: Changes in cell morphology and cell death in cultures were observed 24 hours after administration of antibiotics to cell cultures. It was observed that drug administration was associated with the cell viability and that cell viability rate for two antibiotics was similar at the 0th and 48th hours. The expression of three genes decreased at the 24th hour in the experimental group where DAP was administered.Conclusion: Thanks to this molecular-based research, it should not be forgotten that DAP and VCM active pharmacological agents, especially used in the treatment of Methicillin-resistant Staphylococcus aureus induced surgical infections, have a negative effect on human chondrocyte and ECM components.Öğe Effectiveness of fixed-dose combination of paritaprevir, ritonavir, ombitasvir, and dasabuvir in patients with chronic hepatitis C virus infection and chronic kidney diseases: real-life experiences(Lippincott Williams & Wilkins, 2019) Örmeci, Necati; Sezgin, Orhan; Karaali, Rıdvan; Aygen, Bilgehan; Turan, Dilara; Yaras, Serkan; Asiller, Özgün; Karaali, Rıdvan; Erdem, İlknurIntroduction Both hepatitis C virus infection (HCV) and chronic kidney disease (CKD) have been comorbid illnesses with increasing morbidity and mortality. The present study was conducted to present real-life experiences about treatment of HCV and CKD with a fixed-dose combination of paritaprevir 150 mg/day, ritonavir 100 mg/day as a booster, ombitasvir 25 mg/day, and dasabuvir 250 mg twice/day, the PROD regimen. Patients and methods This was a multicenter, retrospective cohort study. Seventy-five patients with both HCV and CKD were treated with a PROD-based regimen with or without ribavirin. Fifty-three of 75 patients were on maintenance hemodialysis program. Seven patients had compensated liver cirrhosis. The patients with genotype 1a or compensated liver cirrhosis were treated with the PROD regimen and ribavirin in a dose of 200 mg every other day for 12 weeks. The patients with genotype 1b were treated with PROD for 12 weeks. The patients with genotype 4 were treated with a combination of paritaprevir, ritonavir, ombitasvir, and ribavirin 200 mg every other day. Results All patients except one were HCV-RNA negative (98.6%) at the end of treatment. One patient had decompensated after the fourth day of therapy. She stopped the treatment, and she was exitus after 2 months. Two patients died of reasons not related to the drugs 2 months after negativity of HCV-RNA. Sustained viral rate 12 weeks after treatment was found in 96% of the patients. Conclusion The PROD regimen was very effective and safe for treatment in patients with HCV and CKD who were in stages 4 and 5. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.Öğe Evaluation of Treatment Results with Direct Acting Antiviral Drugs of Cirrhotic/Non-cirrhotic Chronic Liver Disease Caused by Hepatitis C Virus Genotype 1b Infection(Galenos Yayincilik, 2020) Doğan, Mustafa; Topçu, Birol; Karaali, Rıdvan; Erdem, İlknurObjectives: This study aimed to investigate the effect of treatment with direct-acting antivirals (DAAs) on the virological response and on the some parameters used to evaluate liver function in cases with chronic liver disease due to hepatitis C virus (HCV) genotype 1b. Materials and Methods: This study included cases who were treated with DAAs after HCV genotype 1b infection. HCV-RNA levels and biochemical and hematological parameters measured at the beginning of treatment, 12th week and 52th week after the treatment were transferred to the SPSS statistics software. model for end-stage liver disease (MELD) and Child-Pugh scores were also calculated and added to these data. Results: The study group consisted of a total of 102 patients, including 33 (32%) males and 69 (68%) females. Compensated cirrhosis was detected in 26.5% of the patients (n=27). There was a significant change in serum albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT) and alpha-fetoprotein (AFP) parameters in patients with compensated cirrhosis after treatment, and total bilirubin, hemoglobin, ALT, AST, GGT, ALP and AFP parameters in the group without cirrhosis (p<0.05). Only a significant decrease was observed in the MELD score of the patients with compensated cirrhosis (p=0.007). Conclusion: The ombitasvir/paritaprevir/ritonavir+dasabuvir and ledipasvir/sofosbuvir regimens are very effective and safe in the treatment of patients who develop chronic liver disease and compensated liver cirrhosis after HCV genotype 1b infection.Öğe Factors Affecting Inadequate Empirical Antimicrobial Therapy and the Clinical Course of Upper Urinary Tract Infections in Elderly Patients: A Multicenter Study(Galenos Yayincilik, 2020) Korkmaz, Pınar; Kurtaran, Behice; Özdemir Armağan, Şule; Turan Özden, Hale; Kaçar, Fatma; Ateş, Selma; Cagan Aktaş, Sabahat; Erdem, İlknurIntroduction: In this study, we aimed to determine the risk factors associated with inadequate empirical antibiotherapy (IEAT) and hospital-related mortality in elderly patients being treated for upper urinary tract infections (UTI). Materials and Methods: This study included individuals aged 65 years and over who were hospitalized after being diagnosed of community-acquired UTI or community-onset healthcare-associated UTI and followed-up in clinics and/or intensive care units (ICU) of 33 hospitals between March and September 2017. Results: A total of 525 patients (48% males; mean age: 76.46 +/- 7.93 years) were included in the study. Overall, 68.2% of the patients were hospitalized through the emergency department and 73.9% of patients were followed-up for pyelonephritis. Gram-negative, Gram-positive, and Gram-negative and positive mix growths were determined in 88%, 9.3%, and 2.7% of urine cultures, respectively. Fifty-six (10.7%) of the patients died. In multivariate analysis, the presence of chronic obstructive pulmonary disease [Odds ratio (OR): 2.278], age 85 years and over (OR: 2.816), admission to the ICU (OR: 14.831), and IEAT (OR: 2.364) were independent factors that significantly affected mortality. The presence of a urinary catheter, being followed-up in the ICU, benign prostate hypertrophy, use of antibiotics other than piperacillin-tazobactam and carbapenem were determined as independent factors that significantly affected IEAT (p<0.05). Conclusion: In our study, we found a direct correlation between IEAT and mortality. Therefore, knowing the most frequent microorganisms and antibiotic susceptibility profiles observed in the UTI of elderly patients may help to decrease the mortality and morbidity associated with these infections.Öğe Gemella morbillorum endocarditis in a patient with a bicuspid aortic valve(Kare Publ, 2021) Doğan, Mustafa; Topkaya, Aynur Eren; Alpsoy, Şeref; Gür, Özcan; Erdem, İlknurGemella morbillorum is one of the rare causative microorganisms of endocarditis. We herein report a case of infective endocarditis in a patient with bicuspid aortic valve caused by G. morbillorum. Infective endocarditis diagnosis was established based on the Modified Duke's criteria. The patient was successfully treated with medical-surgical management.Öğe Incidence, Etiology and Risk Factors Associated with Mortality of Nosocomial Candidemia in a Tertiary Care Hospital in Istanbul, Turkey(Karger, 2010) Erdem, İlknur; Oğuzoğlu, Naz; Engin, Derya Öztürk; Özgültekin, Asu; İnan, Asuman Şengöz; Ceran, Nurgül; Göktaş, PaşaObjective: The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. Subjects and Methods: This observational study was performed at Haydarpasa Numune Training and Research Hospital, a tertiary care hospital with 750 beds, between the years 2004 and 2007. Fifty defined cases with a nosocomial bloodstream infection caused by Candida species were included in the study. All demographic, microbiological and clinical records for each patient were collected using a standardized form. Blood culture was performed by automated blood culture system, and those samples positive for yeast were subcultured on Sabouraud agar. Results: The mean incidence density of nosocomial candidemia was 0.58/10,000 patient-days/year (range 0.17-1.4). Candidemia episodes increased from 0.17/10,000 to 1.4/10,000 patient-days/year (p < 0.0001). Candida albicans and non-albicans Candida accounted for 15 (30%) and 35 (70%) cases, respectively. The overall mortality was 56% and was significantly associated with staying in the intensive care unit (odds ratio: 3.667, 95% confidence interval: 1.07-12.54, p = 0.034). Conclusion: This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period. Copyright (C) 2010 S. Karger AG, BaselÖğe Incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical hospital in Istanbul, intensive care unit of a teaching Turkey (2004-2006)(Natl Inst Infectious Diseases, 2008) Erdem, İlknur; Özgültekin, Asu; İnan, Asuman Şengöz; Dinçer, Emine; Turan, Güldem; Ceran, Nurgül; Göktaş, PaşaThe identification of microorganisms causing ventilator-associated pneumonia (VAP) is important for formulating appropriate therapies. In this study, we report the incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients diagnosed with VAP in our medical-surgical intensive care unit (ICU) during the years 2004-2006. VAP was diagnosed by using the clinical criteria of the Centers for Disease Control and Prevention. Antibiotic resistance patterns of isolated microorganisms were defined by standard methods. The VAP incidence rate was 22.6/1,000 ventilator days. The most frequently isolated pathogens were Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Ninety percent of Acinetobacter spp. isolates were resistant to ceftazidime, 64% to imipenem, and 80% to ciprofloxacin. Fifty-nine percent of P. aeruginosa isolates were resistant to ceftazidime, 32% to imipenem, and 62% to ciprofloxacin. Cefoperazone-sulbactam was the most active agent against Acinetobacter spp. In conclusion, the incidence of VAP and the prevalence of multidrug-resistant microorganisms are quite high in our ICU. Comparison of the resistance rates of isolates demonstrates that certain antibiotic agents are more effective than others.Öğe Incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical intensive care unit of a teaching hospital in Istanbul, Turkey (2004-2006)(2008) Erdem, İlknur; Özgültekin, Asu; İnan, Asuman Şengöz; Dinçer, E.; Turan, G.; Ceran, Nurgül; Göktaş, PaşaThe identification of microorganisms causing ventilator-associated pneumonia (VAP) is important for formulating appropriate therapies. In this study, we report the incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients diagnosed with VAP in our medical-surgical intensive care unit (ICU) during the years 2004-2006. VAP was diagnosed by using the clinical criteria of the Centers for Disease Control and Prevention. Antibiotic resistance patterns of isolated microorganisms were defined by standard methods. The VAP incidence rate was 22.6/1,000 ventilator days. The most frequently isolated pathogens were Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Ninety percent of Acinetobacter spp. isolates were resistant to ceftazidime, 64% to imipenem, and 80% to ciprofloxacin. Fifty-nine percent of P. aeruginosa isolates were resistant to ceftazidime, 32% to imipenem, and 62% to ciprofloxacin. Cefoperazone-sulbactam was the most active agent against Acinetobacter spp. In conclusion, the incidence of VAP and the prevalence of multidrug-resistant microorganisms are quite high in our ICU. Comparison of the resistance rates of isolates demonstrates that certain antibiotic agents are more effective than others.Öğe İnvaziv Aspergilloz Tedavisi(Namık Kemal Üniversitesi, 2018) Erdem, İlknur; Doğan, Mustafa; Karaali, Rıdvan; Ardinç, Enes; Elbasan Omar, Şenayİnvaziv aspergilloz (İA), Aspergillus türü mantarların neden olduğu genellikle immünyetmezlikli hastalarda görülen ve yüksek mortalite ile seyreden bir enfeksiyon hastalığıdır. En sık akciğer etkilenmekle birlikte mantar vücudun diğer organlarına da yayılarak hastalık yapabilir. Tedavisinde halen vorikonazol birinci seçenek antifungaldir. Vorikonazol alamayacak ya da vorikonazole cevap vermeyen hastalarda tedavide alternatif olarak isavukonazol, itrakonazol, amfoterisin B lipid formülasyonu, itrakonazol, kaspofungin, mikafungin ve posakonazol kullanılabilir. Bu yazıda invaziv aspergilloz tedavisi gözden geçirilmiştir.
