Derya Aysev - Academia.edu (original) (raw)

Papers by Derya Aysev

Research paper thumbnail of Campylobacter jejuni gastroenteritis in Turkish children

Infection, 1997

Four hundred children between the ages of 1 month and 14 years with the complaint of diarrhea wer... more Four hundred children between the ages of 1 month and 14 years with the complaint of diarrhea were studied to assess Campylobacterjejuni isolation rates in childhood acute gastroenteritis in Turkey and to darify clinical presentations of C. jejuni enteritis. C. jejuni was found to be the second most common isolate with a rate of 8.3%, the first being Shigella strains. The highest isolation rate was in the 6 to 14-year age range at 12%. The most frequent symptoms in patients with (7. jejuni enteritis were abdominal pain (51.5%), vomiting (36.4%) and fever (30.3%). Stool examination revealed bloody mucous stool in 51.5% of the patients, and erythrocytes and/or leucocytes were detected in 42.4%. Only 12.1% of the patients with C. jejuni enteritis were hospitalized in this study.

Research paper thumbnail of STREPTOKOKSIK FARENJİT TANISINDA BREESE SKORLAMA SİSTEMİ

Ankara Üniversitesi Tıp Fakültesi Mecmuası, 1998

... Betül Ulukol Bulut* • Ayla Günlemez* • Derya Aysev* • Şükrü Cin ... Bu araştırmaya Şubat 1995... more ... Betül Ulukol Bulut* • Ayla Günlemez* • Derya Aysev* • Şükrü Cin ... Bu araştırmaya Şubat 1995-Ocak 1996 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Çocuk Hastalıkları Polikliniğine üst solunum yolu enfeksiyo-nuna ilişkin yakınmalar ve semptomlar ile başvuran ...

Research paper thumbnail of Detection of virulence factors of Escherichia coli from children by multiplex polymerase chain reaction

International Journal of Clinical Practice

A total of 161 Escherichia coli (E. coli) strains isolated from children with urinary tract infec... more A total of 161 Escherichia coli (E. coli) strains isolated from children with urinary tract infection (UTI) were analysed for the genes encoding the virulence factors such as pyelonephritis (pap), s fimbriae (sfa), afimbrial adhesin I (afaI), haemolysin (hly), cytotoxic necrotising factor I (cnf I) and aerobactin (aer) by multiplex PCR. Ninety-four E. coli strains were found to carry at least one virulence factor. Therefore, 58.38% of total population was positive for one virulence gene at least. Percentage of genes within the total population for pap, sfa, afaI, hly, cnf I and aer was found as 22.98, 6.21, 9.94, 1.24, 9.94 and 39.75, respectively. Our analysis showed that sfa-pap (p < 0.001); pap-aer, afaI-aer and cnf I-pap (P < 0.05) and hly-sfa (p < 0.01) significantly co-occurred in their respective samples. In the light of these findings, we suggest an important role of pap causing UTI.

Research paper thumbnail of Alternative diagnostic method for streptococcal pharyngitis: Breese scoring system

The Turkish journal of pediatrics

This study was performed to determine the effectiveness of the Breese scoring system for the diag... more This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.

Research paper thumbnail of Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of PCV7 to the national vaccine schedule

Research paper thumbnail of Invasive Candida infections in children: the clinical characteristics and species distribution and antifungal susceptibility of Candida spp

The Turkish journal of pediatrics

The aims of the study were to examine the distribution of Candida spp. isolated from sterile body... more The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, fluconazole, voriconazole, and caspofungin, and factors affecting mortality with invasive Candida infections in children. Thirty-five children with invasive candidiasis between January 2004 and January 2008 were evaluated retrospectively. The antifungal susceptibility of isolated Candida species was studied by Etest. Of the invasive Candida infections, 65.7% were due to C. albicans. The second most common isolated species was C. parapsilosis (11.4%). The rates of resistance to fluconazole, amphotericin B and voriconazole were 8.5%, 2.8% and 5.7%, respectively. Caspofungin was the most effective antifungal agent. 22.8% of the patients died in the first 30 days. In univariate analyses, increased mortality was associated with stay in the intensive care unit, the presence of central venous catheter (CVC), failure to rem...

Research paper thumbnail of Successful treatment of multidrug-resistant Escherichia coli bacteremia with tigecycline in an acute myeloid leukemia child

The Turkish journal of pediatrics

The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients b... more The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients because of the limited antibacterial choices. Tigecycline, first member of the glycylcyclines, has in vitro activity against a wide variety of organisms, including multidrug-resistant pathogens; however, it has not yet been approved for use in children. Herein, we report a nine-year-old girl with acute myeloid leukemia who was treated successfully with tigecycline due to multidrug-resistant Escherichia coli bacteremia.

Research paper thumbnail of Risk factors for nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of heptavalent pneumococcal conjugate vaccine (PCV7) to the national vaccine schedule

The Turkish journal of pediatrics

The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7)... more The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7) on nasopharyngeal (NP) carriage rates of Streptococcus pneumoniae in healthy Turkish children. The study was conducted on 1101 healthy Turkish children between 1 month and 18 years of age. The median and mean ages of the children were 25 months (1 month-18 years) and 45.7±49.6 months, respectively. S. pneumoniae was isolated in 241/1101 (21.9%) children included in the study. According to multivariate analysis, being <5 years of age, presence of a child attending a daycare center, recovery from respiratory infection within the last month, low income level of the family, and presence of more children in the family were found to be the risk factors for the NP pneumococcal carriage. The carriage rate of NP pneumococci in healthy children was not influenced by PCV7 in Turkey.

Research paper thumbnail of Nasopharyngeal colonization with penicillin-resistant Streptococcus pneumoniae in Turkish children

Pediatrics International, 2000

Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of ... more Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world-wide increase in the frequency of penicillin-resistant S. pneumoniae. One hundred and fifty sick children with a clinical diagnosis of pneumonia, meningitis, acute otitis media, acute sinusitis and septicemia or bacteremia, and 150 healthy children without any infection were examined. Streptococcus pneumoniae, which were isolated from the nasopharynx, were analyzed with respect to penicillin susceptibility using the agar dilution method. The S. pneumoniae carriage rate was observed to be 43.3% in the group of sick children and 30.0% in the control group (P &lt; 0.05). The penicillin resistance of S. pneumoniae isolated from the nasopharynx was determined to be 35.4% from a total of 110 isolates, with an intermediate resistance of 32.7% and a high resistance of 2.7%. The penicillin resistance of S. pneumoniae carried in the nasopharynx was determined to be 41.5% in the group of sick children and 26.6% in the control group (P &gt; 0.05). Resistance rates of other antibiotics were determined as follows: cefotaxime 2.7%, erythromycin 19%, clarithromycin 5.4%, tetracycline 21.8%, trimethoprim-sulfamethoxazole 4.5% and rifampin 0%. Penicillin resistance of S. pneumoniae has recently become a problem in Turkey. Because of this, we require new strategies to limit the spread of drug-resistant S. pneumoniae.

Research paper thumbnail of Investigation of risk factors for tonsillopharyngitis with macrolide resistant Streptococcus pyogenes in Turkish children

Pediatrics International, 2002

Background : Streptococcus pyogenes is the most important causative agent of tonsillopharyngitis.... more Background : Streptococcus pyogenes is the most important causative agent of tonsillopharyngitis. Although penicillin is the drug of choice in streptococcal tonsillopharyngitis, macrolides are recommended drugs in patients who have an allergy to penicillin. However, resistance to macrolides is an important problem in some regions of the world. Risk factors for resistance development have not been investigated sufficiently. Objectives : To investigate the risk factors for the development of tonsillopharyngitis with macrolide resistant S. pyogenes. Methods : Three hundred and forty-five children with tonsillopharyngitis caused by S. pyogenes were investigated for various risk factors. Streptococcus pyogenes isolated from children's throat culture were examined for erythromycin, clarithromycin and azithromycin susceptibility. Results : Two hundred and sixty-three children were found eligible for the analysis of risk factors. Resistances to erythromycin, clarithromycin and azithromycin were detected as 3.8, 4.2 and 4.2%, respectively. Macrolide use of the family members in the last 3 months (odds ratio = 7.04, P = 0.005) has been determined to be a risk factor for the development of tonsillopharyngitis with macrolide resistant S. pyogenes . Conclusion : Restriction of macrolide antibiotic use appears to be the most important measure to prevent the development of tonsillopharyngitis with resistant S. pyogenes .

Research paper thumbnail of SERRATİA RUBİDAEA SEPTİSEMİSİ i «ÜÇ OLGU SUNUSU

Son zamanlarda uygulanan yoğun kemoterapi planlari ile maliyn hastalikli çocuklarda yaşam süresi ... more Son zamanlarda uygulanan yoğun kemoterapi planlari ile maliyn hastalikli çocuklarda yaşam süresi uzamiştir. Ancak bu yoğun kemo- terapilerin ve gereken destek tedavilerin uygulanabilmesi için santral venöz kateter (SVK) yerleştirilmesi gereklidir. Bizim hastalarimizda da yaklaşik bir yildir tani sonrasinda SVK yerleştirilmekte daha sonra bu kateterlerin izlemi dikkatle yapilmaktadir. Şimdiye kadar önemli bir komplikasyon gelişmemiştir. Bu izlem sirasinda ortaya çikan Ser- ratia

Research paper thumbnail of Fungi balls and treatment in infancy

Pediatrics International, 2001

Research paper thumbnail of Characterization of Shigella Strains Isolated in Ankara, Turkey by Antimicrobial Resistance Models, Plasmid Profile Analysis and Pulsed-Field Gel Electrophoresis

Mikrobiyoloji Bulteni, 2013

Shigella is one of the most important causative agents of diarrhea especially in childhood. Since... more Shigella is one of the most important causative agents of diarrhea especially in childhood. Since man is the main reservoir of Shigella and human to human transmission is possible, Shigella can easily spread in public and cause outbreaks. In this study, a total of 60 Shigella strains isolated in Ankara, Turkey by years 2001, 2008 and 2009 were investigated by their antimicrobial susceptibility profiles, plasmid profile analysis (PPA) and pulsed-field gel electrophoresis (PFGE). For epidemiological investigation, the results obtained by antibiotic resistance typing (ART) which was the phenotyping method, was compared to the results of the genotyping methods which were PPA and PFGE. Of the isolates 49 (81.6%) were S.sonnei, 10 (16.6%) were S.flexneri and one was (1.6%) S.dysenteriae. Antimicrobial susceptibilities were evaluated by disc diffusion method and the highest resistance rates were found against trimethoprim/sulfamethoxazole (91.6%), followed by tetracycline (68.3%) and ampicillin (26.6%). Resistance against ampicillin, chloramphenicol and amoxycillin/clavulanic acid were found higher in S.flexneri isolates than S.sonnei (p&amp;amp;amp;amp;amp;amp;lt; 0.001). All isolates were found to be susceptible to ciprofloxacin, gentamicin and ceftazidime. S.sonnei demonstrated 12 and S.flexneri demonstrated 4 antibiotic resistance models. All isolates were carrying plasmids with varying sizes and varying numbers between 1 to 7. S.sonnei isolates demonstrated 27 and S.flexneri isolates demonstrated 8 plasmid profiles. S.sonnei isolates were clustered in 4 patterns and S.flexneri were clustered in 5 patterns by PFGE. This method demonstrated obvious clonal similarity among S.sonnei strains isolated in Ankara and discriminative power (DP) was calculated as 0.26. PPA and ART demonstrated higher DP among S.sonnei strains (0.97 and 0.75, respectively). In this study gain or loss of instable genetic mobile elements were thought to be responsible for higher discriminative powers of PPA and ART methods. These typing methods were found to be appropriate for the epidemiological investigation of strains collected in a short time period. PFGE was found to be convenient for the evaluation of clonal relatedness of the strains, however, in such geographical areas where the same clone was in circulation, use of ART and/or PPA together with PFGE would be useful for precise discrimination of Shigella strains.

Research paper thumbnail of Alternative Treatment Protocols in Giardiasis: A Pilot Study

Scandinavian Journal of Infectious Diseases, 1996

The aim of the study was to test new treatment protocols for giardiasis, which are less toxic, ch... more The aim of the study was to test new treatment protocols for giardiasis, which are less toxic, cheaper, and easier to use than the conventional treatment. 48 children who had been diagnosed as having giardiasis in a health-screening program involving 2 schools, were randomized to receive four different treatment protocols. The children were split into 4 treatment groups: I, mebendazole 100 mg t.i.d. for 1 day; II, mebendazole 100 mg t.i.d. for 7 days; III, metronidazole 15 mg/kg as one dose for 7 days; and IV, ornidazole 40 mg/kg as a single dose. The results were evaluated by microscopic examination of stools. The responses to the treatments revealed that the effectiveness of ornidazole was 100%, metronidazole 92.9%, mebendazole for 7 days 58.3%, and mebendazole for 1 day 41.7%. Minor side-effects were seen in only 3 children receiving ornidazole: 1 had urticaria, while the other 2 suffered from vertigo and nausea. The results of this study show that ornidazole as a single dose can be used as an alternative protocol for treating giardiasis. Further studies should be done to determine the safest effective total single dose.

Research paper thumbnail of The value of the levels of acute phase reactants for the prediction of familial Mediterranean fever associated amyloidosis: a case control study

Rheumatology International, 2007

In order to determine the role of levels of acute phase proteins (APPs) for the development of am... more In order to determine the role of levels of acute phase proteins (APPs) for the development of amyloidosis in familial Mediterranean fever (FMF) patients, the levels of serum amyloid A (SAA), C reactive protein (CRP), Wbrinogen and erythrocyte sedimentation rate were measured in paired sera of 36 FMF patients during and in between acute attacks, 39 of their healthy parents (obligate heterozgotes), and 15 patients with FMF associated amyloidosis. To compare the levels of APPs, 39 patients with chronic infections or inXammatory diseases who may develop secondary amyloidosis, 20 patients with acute infections who are known to have elevated acute phase response but will never develop amyloidosis and 19 healthy controls were included. The median levels of all APPs are increased in the patients with FMF during attacks and a signiWcant decrease was observed after the attack was over. The level of SAA was above reference range in all FMF patients during the attack free period and the level of at least one other APP was also above normal in 64% of the patients. Both CRP and SAA levels were found to be higher in obligate heterozygotes compared to controls. The levels of SAA in patients with FMF during the attack-free period, obligate heterozygotes and patients with FMF-amyloidosis were found to be similar. The levels in each group were found to be higher than SAA levels found in healthy controls yet lower than the levels measured in the patients with acute infections and patients with chronic inXammation or chronic infections. In conclusion, our results show that SAA level reXects subclinical inXammation with high sensitivity but its value for the prediction of amyloid formation process seems to be low.

Research paper thumbnail of RIGHT ATRIAL CATHETER-RELATED COMPLICATIONS IN PEDIATRIC ONCOLOGY PATIENTS: The Situation in a Developing Country

Pediatric Hematology-Oncology, 1999

The complications of right atrial catheters (RACs) in pediatric oncology patients are unknown for... more The complications of right atrial catheters (RACs) in pediatric oncology patients are unknown for centers in developing countries. This study examined the complications of RACs at Ankara University Medical School, Turkey. A total of 90 RACs were placed in 61 children for long-term chemotherapy with a total experience of 15,536 catheter days. The rate of catheter-related sepsis was 4.9 episodes per 1000 catheter days. Coagulase-negative staphylococci and Candida species were the most common organisms, accounting for 25.0 and 13.1% of all organisms, respectively. The most common reasons for the removal of the RACs were infection (42.4%) and dislodgement (32.2%). The rates of complications were significantly higher in this study than in western studies. This increase could be explained by the differences in catheter care practices in the Turkish center. In conclusion, the use of RACs in a developing country necessitates an appraisal of the benefits and risks for each patient and improvement of catheter care procedures.

Research paper thumbnail of Fungal colonization and infection in children with acute leukemia and lymphoma during induction therapy

Medical and Pediatric Oncology, 1999

Fungal infection represents a growing problem in children with hematologic malignancies. During c... more Fungal infection represents a growing problem in children with hematologic malignancies. During chemotherapy induced neutropenia, colonization with fungi is considered a major risk factor for subsequent fungal infection. The rates and risk factors for mycotic infections in pediatric oncology patients is undetermined, particularly for centers in developing countries. The aim of this study was to evaluate the rates and risk factors of fungal colonization in children with acute leukemia and lymphoma at one of the major pediatric hematology/oncology centers in Turkey. Fifty-two consecutive children newly diagnosed with acute leukemia and lymphoma during intensive remission induction therapy were evaluated for the occurrence of fungal colonization (defined as at least one positive surveillance culture) and infection. Thirty-six of the 52 patients (69.2%) were colonized by Candida albicans which was the only fungus isolated from surveillance cultures. There were three (5.8%) proven systemic fungal infections: two cases of candidemia and one case of brain abscess with Aspergillus spp. isolated from tissue. All patients with fungal colonization were receiving prophylactic or curative antibiotics. No significant association was found between type of disease and fungal colonization, but there was a significant association with neutropenia. Our findings suggest that there is a high rate of fungal colonization in children receiving remission induction therapy for acute leukemia and lymphoma. Limiting the use of antibiotics and instituting antifungal chemoprophylaxis may decrease the rate, while the early initiation of empiric antifungal therapy in patients with fever and suspected mycotic colonization may increase survival in these patients.

Research paper thumbnail of Successful treatment of central venous catheter infection due to Candida lipolytica by caspofungin-lock therapy

Mycoses, 2011

Özdemir, H., Karbuz, A., Çiftçi, E., Dinçaslan, HU, İnce, E., Aysev, D., Yavuz, G. and Doğru, Ü.(... more Özdemir, H., Karbuz, A., Çiftçi, E., Dinçaslan, HU, İnce, E., Aysev, D., Yavuz, G. and Doğru, Ü.(2011), Successful treatment of central venous catheter infection due to Candida lipolytica by caspofungin-lock therapy. Mycoses, 54: no. doi: 10.1111/j. 1439-0507.2010. 01964. x

Research paper thumbnail of Genotype distribution of Candida albicans isolates by 25S intron analysis with regard to invasiveness. Die Genotyp-Verteilung von Candida albicans-Isolaten mittels 25S Intron-Analyse und der Bezug zur Invasivitat

Mycoses, 2004

The aim of this study was to genotype Candida albicans strains isolated from patients with invasi... more The aim of this study was to genotype Candida albicans strains isolated from patients with invasive and non-invasive deep-seated infections. For this purpose, 301 C. albicans isolates (81 invasive and 220 non-invasive) were genotyped by using specific PCR primers designed to span the transposable group I intron of the 25S rDNA gene. Fifty-three of the 81 invasive isolates were genotype A (65.4%), eight were genotype B (9.9%) and 20 were genotype C (24.7%), while 98 of the 220 non-invasive isolates were genotype A (44.6%), 46 were genotype B (20.9%) and 76 were genotype C (34.5%). Genotype A was more prevalent among invasive isolates and genotypes B and C were more prevalent among non-invasive isolates (P = 0.0046). Genotypes D and E which represent C. dubliniensis were not found. These results indicate that there may be a relationship between C. albicans genotypes and invasiveness; genotype A being more invasive than others. The presence or absence of the transposable group I intron in the 25S rDNA gene may be important in determining the invasiveness of C. albicans.

Research paper thumbnail of The Validity of Diagnostic Criteria for Streptococcal Pharyngitis in Integrated Management of Childhood Illness (IMCI) Guidelines

Journal of Tropical Pediatrics, 2003

The WHO&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Integrated Management of Childh... more The WHO&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Integrated Management of Childhood Illness (IMCI) programme is being implemented in Turkey with an additional section relating to throat problems for our country&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s adaptation. The aim of this study is to evaluate the validity of this additional part and suggest new combinations for the diagnosis of streptococcal pharyngitis to improve the guidelines. Throat swabs were obtained from 245 children between 0 and 17 years of age with signs and symptoms of upper respiratory tract infections. Considering the throat culture based diagnosis as the gold standard, the validity of the symptoms alone and in combinations were calculated. The combination in Turkey&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s IMCI guideline was found to be 36.9 per cent sensitive and 68.3 per cent specific. Sensitivities of combinations including at least two of the following three symptoms, namely sore throat, pharyngeal erythema, and pharyngeal exudates or sore throat, pharyngeal erythema, and fever, were 76.9 and 87.7 per cent, respectively. Specificities of the same combinations were 49.4 and 30.6 per cent. We concluded that new combinations with a higher sensitivity may be considered as a criterion for antibiotic treatment.

Research paper thumbnail of Campylobacter jejuni gastroenteritis in Turkish children

Infection, 1997

Four hundred children between the ages of 1 month and 14 years with the complaint of diarrhea wer... more Four hundred children between the ages of 1 month and 14 years with the complaint of diarrhea were studied to assess Campylobacterjejuni isolation rates in childhood acute gastroenteritis in Turkey and to darify clinical presentations of C. jejuni enteritis. C. jejuni was found to be the second most common isolate with a rate of 8.3%, the first being Shigella strains. The highest isolation rate was in the 6 to 14-year age range at 12%. The most frequent symptoms in patients with (7. jejuni enteritis were abdominal pain (51.5%), vomiting (36.4%) and fever (30.3%). Stool examination revealed bloody mucous stool in 51.5% of the patients, and erythrocytes and/or leucocytes were detected in 42.4%. Only 12.1% of the patients with C. jejuni enteritis were hospitalized in this study.

Research paper thumbnail of STREPTOKOKSIK FARENJİT TANISINDA BREESE SKORLAMA SİSTEMİ

Ankara Üniversitesi Tıp Fakültesi Mecmuası, 1998

... Betül Ulukol Bulut* • Ayla Günlemez* • Derya Aysev* • Şükrü Cin ... Bu araştırmaya Şubat 1995... more ... Betül Ulukol Bulut* • Ayla Günlemez* • Derya Aysev* • Şükrü Cin ... Bu araştırmaya Şubat 1995-Ocak 1996 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Çocuk Hastalıkları Polikliniğine üst solunum yolu enfeksiyo-nuna ilişkin yakınmalar ve semptomlar ile başvuran ...

Research paper thumbnail of Detection of virulence factors of Escherichia coli from children by multiplex polymerase chain reaction

International Journal of Clinical Practice

A total of 161 Escherichia coli (E. coli) strains isolated from children with urinary tract infec... more A total of 161 Escherichia coli (E. coli) strains isolated from children with urinary tract infection (UTI) were analysed for the genes encoding the virulence factors such as pyelonephritis (pap), s fimbriae (sfa), afimbrial adhesin I (afaI), haemolysin (hly), cytotoxic necrotising factor I (cnf I) and aerobactin (aer) by multiplex PCR. Ninety-four E. coli strains were found to carry at least one virulence factor. Therefore, 58.38% of total population was positive for one virulence gene at least. Percentage of genes within the total population for pap, sfa, afaI, hly, cnf I and aer was found as 22.98, 6.21, 9.94, 1.24, 9.94 and 39.75, respectively. Our analysis showed that sfa-pap (p < 0.001); pap-aer, afaI-aer and cnf I-pap (P < 0.05) and hly-sfa (p < 0.01) significantly co-occurred in their respective samples. In the light of these findings, we suggest an important role of pap causing UTI.

Research paper thumbnail of Alternative diagnostic method for streptococcal pharyngitis: Breese scoring system

The Turkish journal of pediatrics

This study was performed to determine the effectiveness of the Breese scoring system for the diag... more This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.

Research paper thumbnail of Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of PCV7 to the national vaccine schedule

Research paper thumbnail of Invasive Candida infections in children: the clinical characteristics and species distribution and antifungal susceptibility of Candida spp

The Turkish journal of pediatrics

The aims of the study were to examine the distribution of Candida spp. isolated from sterile body... more The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, fluconazole, voriconazole, and caspofungin, and factors affecting mortality with invasive Candida infections in children. Thirty-five children with invasive candidiasis between January 2004 and January 2008 were evaluated retrospectively. The antifungal susceptibility of isolated Candida species was studied by Etest. Of the invasive Candida infections, 65.7% were due to C. albicans. The second most common isolated species was C. parapsilosis (11.4%). The rates of resistance to fluconazole, amphotericin B and voriconazole were 8.5%, 2.8% and 5.7%, respectively. Caspofungin was the most effective antifungal agent. 22.8% of the patients died in the first 30 days. In univariate analyses, increased mortality was associated with stay in the intensive care unit, the presence of central venous catheter (CVC), failure to rem...

Research paper thumbnail of Successful treatment of multidrug-resistant Escherichia coli bacteremia with tigecycline in an acute myeloid leukemia child

The Turkish journal of pediatrics

The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients b... more The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients because of the limited antibacterial choices. Tigecycline, first member of the glycylcyclines, has in vitro activity against a wide variety of organisms, including multidrug-resistant pathogens; however, it has not yet been approved for use in children. Herein, we report a nine-year-old girl with acute myeloid leukemia who was treated successfully with tigecycline due to multidrug-resistant Escherichia coli bacteremia.

Research paper thumbnail of Risk factors for nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of heptavalent pneumococcal conjugate vaccine (PCV7) to the national vaccine schedule

The Turkish journal of pediatrics

The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7)... more The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7) on nasopharyngeal (NP) carriage rates of Streptococcus pneumoniae in healthy Turkish children. The study was conducted on 1101 healthy Turkish children between 1 month and 18 years of age. The median and mean ages of the children were 25 months (1 month-18 years) and 45.7±49.6 months, respectively. S. pneumoniae was isolated in 241/1101 (21.9%) children included in the study. According to multivariate analysis, being <5 years of age, presence of a child attending a daycare center, recovery from respiratory infection within the last month, low income level of the family, and presence of more children in the family were found to be the risk factors for the NP pneumococcal carriage. The carriage rate of NP pneumococci in healthy children was not influenced by PCV7 in Turkey.

Research paper thumbnail of Nasopharyngeal colonization with penicillin-resistant Streptococcus pneumoniae in Turkish children

Pediatrics International, 2000

Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of ... more Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world-wide increase in the frequency of penicillin-resistant S. pneumoniae. One hundred and fifty sick children with a clinical diagnosis of pneumonia, meningitis, acute otitis media, acute sinusitis and septicemia or bacteremia, and 150 healthy children without any infection were examined. Streptococcus pneumoniae, which were isolated from the nasopharynx, were analyzed with respect to penicillin susceptibility using the agar dilution method. The S. pneumoniae carriage rate was observed to be 43.3% in the group of sick children and 30.0% in the control group (P &lt; 0.05). The penicillin resistance of S. pneumoniae isolated from the nasopharynx was determined to be 35.4% from a total of 110 isolates, with an intermediate resistance of 32.7% and a high resistance of 2.7%. The penicillin resistance of S. pneumoniae carried in the nasopharynx was determined to be 41.5% in the group of sick children and 26.6% in the control group (P &gt; 0.05). Resistance rates of other antibiotics were determined as follows: cefotaxime 2.7%, erythromycin 19%, clarithromycin 5.4%, tetracycline 21.8%, trimethoprim-sulfamethoxazole 4.5% and rifampin 0%. Penicillin resistance of S. pneumoniae has recently become a problem in Turkey. Because of this, we require new strategies to limit the spread of drug-resistant S. pneumoniae.

Research paper thumbnail of Investigation of risk factors for tonsillopharyngitis with macrolide resistant Streptococcus pyogenes in Turkish children

Pediatrics International, 2002

Background : Streptococcus pyogenes is the most important causative agent of tonsillopharyngitis.... more Background : Streptococcus pyogenes is the most important causative agent of tonsillopharyngitis. Although penicillin is the drug of choice in streptococcal tonsillopharyngitis, macrolides are recommended drugs in patients who have an allergy to penicillin. However, resistance to macrolides is an important problem in some regions of the world. Risk factors for resistance development have not been investigated sufficiently. Objectives : To investigate the risk factors for the development of tonsillopharyngitis with macrolide resistant S. pyogenes. Methods : Three hundred and forty-five children with tonsillopharyngitis caused by S. pyogenes were investigated for various risk factors. Streptococcus pyogenes isolated from children's throat culture were examined for erythromycin, clarithromycin and azithromycin susceptibility. Results : Two hundred and sixty-three children were found eligible for the analysis of risk factors. Resistances to erythromycin, clarithromycin and azithromycin were detected as 3.8, 4.2 and 4.2%, respectively. Macrolide use of the family members in the last 3 months (odds ratio = 7.04, P = 0.005) has been determined to be a risk factor for the development of tonsillopharyngitis with macrolide resistant S. pyogenes . Conclusion : Restriction of macrolide antibiotic use appears to be the most important measure to prevent the development of tonsillopharyngitis with resistant S. pyogenes .

Research paper thumbnail of SERRATİA RUBİDAEA SEPTİSEMİSİ i «ÜÇ OLGU SUNUSU

Son zamanlarda uygulanan yoğun kemoterapi planlari ile maliyn hastalikli çocuklarda yaşam süresi ... more Son zamanlarda uygulanan yoğun kemoterapi planlari ile maliyn hastalikli çocuklarda yaşam süresi uzamiştir. Ancak bu yoğun kemo- terapilerin ve gereken destek tedavilerin uygulanabilmesi için santral venöz kateter (SVK) yerleştirilmesi gereklidir. Bizim hastalarimizda da yaklaşik bir yildir tani sonrasinda SVK yerleştirilmekte daha sonra bu kateterlerin izlemi dikkatle yapilmaktadir. Şimdiye kadar önemli bir komplikasyon gelişmemiştir. Bu izlem sirasinda ortaya çikan Ser- ratia

Research paper thumbnail of Fungi balls and treatment in infancy

Pediatrics International, 2001

Research paper thumbnail of Characterization of Shigella Strains Isolated in Ankara, Turkey by Antimicrobial Resistance Models, Plasmid Profile Analysis and Pulsed-Field Gel Electrophoresis

Mikrobiyoloji Bulteni, 2013

Shigella is one of the most important causative agents of diarrhea especially in childhood. Since... more Shigella is one of the most important causative agents of diarrhea especially in childhood. Since man is the main reservoir of Shigella and human to human transmission is possible, Shigella can easily spread in public and cause outbreaks. In this study, a total of 60 Shigella strains isolated in Ankara, Turkey by years 2001, 2008 and 2009 were investigated by their antimicrobial susceptibility profiles, plasmid profile analysis (PPA) and pulsed-field gel electrophoresis (PFGE). For epidemiological investigation, the results obtained by antibiotic resistance typing (ART) which was the phenotyping method, was compared to the results of the genotyping methods which were PPA and PFGE. Of the isolates 49 (81.6%) were S.sonnei, 10 (16.6%) were S.flexneri and one was (1.6%) S.dysenteriae. Antimicrobial susceptibilities were evaluated by disc diffusion method and the highest resistance rates were found against trimethoprim/sulfamethoxazole (91.6%), followed by tetracycline (68.3%) and ampicillin (26.6%). Resistance against ampicillin, chloramphenicol and amoxycillin/clavulanic acid were found higher in S.flexneri isolates than S.sonnei (p&amp;amp;amp;amp;amp;amp;lt; 0.001). All isolates were found to be susceptible to ciprofloxacin, gentamicin and ceftazidime. S.sonnei demonstrated 12 and S.flexneri demonstrated 4 antibiotic resistance models. All isolates were carrying plasmids with varying sizes and varying numbers between 1 to 7. S.sonnei isolates demonstrated 27 and S.flexneri isolates demonstrated 8 plasmid profiles. S.sonnei isolates were clustered in 4 patterns and S.flexneri were clustered in 5 patterns by PFGE. This method demonstrated obvious clonal similarity among S.sonnei strains isolated in Ankara and discriminative power (DP) was calculated as 0.26. PPA and ART demonstrated higher DP among S.sonnei strains (0.97 and 0.75, respectively). In this study gain or loss of instable genetic mobile elements were thought to be responsible for higher discriminative powers of PPA and ART methods. These typing methods were found to be appropriate for the epidemiological investigation of strains collected in a short time period. PFGE was found to be convenient for the evaluation of clonal relatedness of the strains, however, in such geographical areas where the same clone was in circulation, use of ART and/or PPA together with PFGE would be useful for precise discrimination of Shigella strains.

Research paper thumbnail of Alternative Treatment Protocols in Giardiasis: A Pilot Study

Scandinavian Journal of Infectious Diseases, 1996

The aim of the study was to test new treatment protocols for giardiasis, which are less toxic, ch... more The aim of the study was to test new treatment protocols for giardiasis, which are less toxic, cheaper, and easier to use than the conventional treatment. 48 children who had been diagnosed as having giardiasis in a health-screening program involving 2 schools, were randomized to receive four different treatment protocols. The children were split into 4 treatment groups: I, mebendazole 100 mg t.i.d. for 1 day; II, mebendazole 100 mg t.i.d. for 7 days; III, metronidazole 15 mg/kg as one dose for 7 days; and IV, ornidazole 40 mg/kg as a single dose. The results were evaluated by microscopic examination of stools. The responses to the treatments revealed that the effectiveness of ornidazole was 100%, metronidazole 92.9%, mebendazole for 7 days 58.3%, and mebendazole for 1 day 41.7%. Minor side-effects were seen in only 3 children receiving ornidazole: 1 had urticaria, while the other 2 suffered from vertigo and nausea. The results of this study show that ornidazole as a single dose can be used as an alternative protocol for treating giardiasis. Further studies should be done to determine the safest effective total single dose.

Research paper thumbnail of The value of the levels of acute phase reactants for the prediction of familial Mediterranean fever associated amyloidosis: a case control study

Rheumatology International, 2007

In order to determine the role of levels of acute phase proteins (APPs) for the development of am... more In order to determine the role of levels of acute phase proteins (APPs) for the development of amyloidosis in familial Mediterranean fever (FMF) patients, the levels of serum amyloid A (SAA), C reactive protein (CRP), Wbrinogen and erythrocyte sedimentation rate were measured in paired sera of 36 FMF patients during and in between acute attacks, 39 of their healthy parents (obligate heterozgotes), and 15 patients with FMF associated amyloidosis. To compare the levels of APPs, 39 patients with chronic infections or inXammatory diseases who may develop secondary amyloidosis, 20 patients with acute infections who are known to have elevated acute phase response but will never develop amyloidosis and 19 healthy controls were included. The median levels of all APPs are increased in the patients with FMF during attacks and a signiWcant decrease was observed after the attack was over. The level of SAA was above reference range in all FMF patients during the attack free period and the level of at least one other APP was also above normal in 64% of the patients. Both CRP and SAA levels were found to be higher in obligate heterozygotes compared to controls. The levels of SAA in patients with FMF during the attack-free period, obligate heterozygotes and patients with FMF-amyloidosis were found to be similar. The levels in each group were found to be higher than SAA levels found in healthy controls yet lower than the levels measured in the patients with acute infections and patients with chronic inXammation or chronic infections. In conclusion, our results show that SAA level reXects subclinical inXammation with high sensitivity but its value for the prediction of amyloid formation process seems to be low.

Research paper thumbnail of RIGHT ATRIAL CATHETER-RELATED COMPLICATIONS IN PEDIATRIC ONCOLOGY PATIENTS: The Situation in a Developing Country

Pediatric Hematology-Oncology, 1999

The complications of right atrial catheters (RACs) in pediatric oncology patients are unknown for... more The complications of right atrial catheters (RACs) in pediatric oncology patients are unknown for centers in developing countries. This study examined the complications of RACs at Ankara University Medical School, Turkey. A total of 90 RACs were placed in 61 children for long-term chemotherapy with a total experience of 15,536 catheter days. The rate of catheter-related sepsis was 4.9 episodes per 1000 catheter days. Coagulase-negative staphylococci and Candida species were the most common organisms, accounting for 25.0 and 13.1% of all organisms, respectively. The most common reasons for the removal of the RACs were infection (42.4%) and dislodgement (32.2%). The rates of complications were significantly higher in this study than in western studies. This increase could be explained by the differences in catheter care practices in the Turkish center. In conclusion, the use of RACs in a developing country necessitates an appraisal of the benefits and risks for each patient and improvement of catheter care procedures.

Research paper thumbnail of Fungal colonization and infection in children with acute leukemia and lymphoma during induction therapy

Medical and Pediatric Oncology, 1999

Fungal infection represents a growing problem in children with hematologic malignancies. During c... more Fungal infection represents a growing problem in children with hematologic malignancies. During chemotherapy induced neutropenia, colonization with fungi is considered a major risk factor for subsequent fungal infection. The rates and risk factors for mycotic infections in pediatric oncology patients is undetermined, particularly for centers in developing countries. The aim of this study was to evaluate the rates and risk factors of fungal colonization in children with acute leukemia and lymphoma at one of the major pediatric hematology/oncology centers in Turkey. Fifty-two consecutive children newly diagnosed with acute leukemia and lymphoma during intensive remission induction therapy were evaluated for the occurrence of fungal colonization (defined as at least one positive surveillance culture) and infection. Thirty-six of the 52 patients (69.2%) were colonized by Candida albicans which was the only fungus isolated from surveillance cultures. There were three (5.8%) proven systemic fungal infections: two cases of candidemia and one case of brain abscess with Aspergillus spp. isolated from tissue. All patients with fungal colonization were receiving prophylactic or curative antibiotics. No significant association was found between type of disease and fungal colonization, but there was a significant association with neutropenia. Our findings suggest that there is a high rate of fungal colonization in children receiving remission induction therapy for acute leukemia and lymphoma. Limiting the use of antibiotics and instituting antifungal chemoprophylaxis may decrease the rate, while the early initiation of empiric antifungal therapy in patients with fever and suspected mycotic colonization may increase survival in these patients.

Research paper thumbnail of Successful treatment of central venous catheter infection due to Candida lipolytica by caspofungin-lock therapy

Mycoses, 2011

Özdemir, H., Karbuz, A., Çiftçi, E., Dinçaslan, HU, İnce, E., Aysev, D., Yavuz, G. and Doğru, Ü.(... more Özdemir, H., Karbuz, A., Çiftçi, E., Dinçaslan, HU, İnce, E., Aysev, D., Yavuz, G. and Doğru, Ü.(2011), Successful treatment of central venous catheter infection due to Candida lipolytica by caspofungin-lock therapy. Mycoses, 54: no. doi: 10.1111/j. 1439-0507.2010. 01964. x

Research paper thumbnail of Genotype distribution of Candida albicans isolates by 25S intron analysis with regard to invasiveness. Die Genotyp-Verteilung von Candida albicans-Isolaten mittels 25S Intron-Analyse und der Bezug zur Invasivitat

Mycoses, 2004

The aim of this study was to genotype Candida albicans strains isolated from patients with invasi... more The aim of this study was to genotype Candida albicans strains isolated from patients with invasive and non-invasive deep-seated infections. For this purpose, 301 C. albicans isolates (81 invasive and 220 non-invasive) were genotyped by using specific PCR primers designed to span the transposable group I intron of the 25S rDNA gene. Fifty-three of the 81 invasive isolates were genotype A (65.4%), eight were genotype B (9.9%) and 20 were genotype C (24.7%), while 98 of the 220 non-invasive isolates were genotype A (44.6%), 46 were genotype B (20.9%) and 76 were genotype C (34.5%). Genotype A was more prevalent among invasive isolates and genotypes B and C were more prevalent among non-invasive isolates (P = 0.0046). Genotypes D and E which represent C. dubliniensis were not found. These results indicate that there may be a relationship between C. albicans genotypes and invasiveness; genotype A being more invasive than others. The presence or absence of the transposable group I intron in the 25S rDNA gene may be important in determining the invasiveness of C. albicans.

Research paper thumbnail of The Validity of Diagnostic Criteria for Streptococcal Pharyngitis in Integrated Management of Childhood Illness (IMCI) Guidelines

Journal of Tropical Pediatrics, 2003

The WHO&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Integrated Management of Childh... more The WHO&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Integrated Management of Childhood Illness (IMCI) programme is being implemented in Turkey with an additional section relating to throat problems for our country&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s adaptation. The aim of this study is to evaluate the validity of this additional part and suggest new combinations for the diagnosis of streptococcal pharyngitis to improve the guidelines. Throat swabs were obtained from 245 children between 0 and 17 years of age with signs and symptoms of upper respiratory tract infections. Considering the throat culture based diagnosis as the gold standard, the validity of the symptoms alone and in combinations were calculated. The combination in Turkey&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s IMCI guideline was found to be 36.9 per cent sensitive and 68.3 per cent specific. Sensitivities of combinations including at least two of the following three symptoms, namely sore throat, pharyngeal erythema, and pharyngeal exudates or sore throat, pharyngeal erythema, and fever, were 76.9 and 87.7 per cent, respectively. Specificities of the same combinations were 49.4 and 30.6 per cent. We concluded that new combinations with a higher sensitivity may be considered as a criterion for antibiotic treatment.