Serap Gencer - Academia.edu (original) (raw)

Papers by Serap Gencer

Research paper thumbnail of Retrospective analysis of viral pneumonia cases due to pandemic H3N2

Aim: To evaluate clinical, laboratory, radiological and demographic data of H3N2 pneumonia cases ... more Aim: To evaluate clinical, laboratory, radiological and demographic data of H3N2 pneumonia cases admitted to Pulmonology department during H3N2 pandemic season and compare with non-H3N2 community acquired pneumonia (CAP) cases. Methods: The study population consisted of all CAP cases admitted to our Pulmonology department between December 2013 – February 2014 influenza season. The patient files were evaluated for physical findings, laboratory data, radiological findings, treatment and outcome of cases. H3N2 was diagnosed by polymerase chain reaction (PCR) of throat swabs. The clinical, radiological and laboratory findings of H3N2 pneumonia cases were compared with non-H3N2 pneumonia cases. Mann Whitney U, Ki-square, Fisher9s exact, logistic regression analysis by forward stepwise method were used for statistical analyses. P value Results: During H3N2 pandemic season, 69 cases were diagnosed as CAP; 62 (89,8%) were non-H3N2 CAP, 7(10,2%) were H3N2 pneumonia. The demographic data, CURB-65, PSI scores, clinical, radiological and laboratory findings of two gorups were similar (p>0,05). The rates of treatment failure and/or transport to intensive care unit with need of invasive mechanical ventilation were significantly higher in H3N2 group (71,4% vs. 25,8%, p=0,024; OR: 7,18; 95%CI: 1,26 – 40,77). Mortality rates were similar in both groups ((p>0.05). Conclusion: The need of MV and intensive care treatment is more frequent in H3N2 pneumonia cases. Correct diagnosis, close follow-up and intensive care support is of vital importance in patients admitted due to CAP during influenza season and suspected to have viral pneumonia.

Research paper thumbnail of The Global Influenza Hospital Surveillance Network (GIHSN): A new platform to describe the epidemiology of severe influenza

Influenza and other respiratory viruses, Jan 21, 2015

Influenza is a global public health problem. However, severe influenza only recently has been add... more Influenza is a global public health problem. However, severe influenza only recently has been addressed in routine surveillance. The Global Influenza Hospital Surveillance Network (GIHSN) was established to study the epidemiology of severe influenza in consecutive seasons in different countries. Our objective is to describe the GIHSN approach and methods. The GIHSN uses prospective active surveillance to identify consecutive influenza admissions in permanent residents of well-defined geographic areas in sites around the world. A core common protocol is followed. After consent, data are collected on patient characteristics and clinical outcomes, respiratory swabs are obtained, and the presence of influenza virus and subtype or lineage is ascertained by polymerase chain reaction. Data are collated and analyzed at the GIHSN coordination center. GIHSN has run its activities for two consecutive influenza seasons, 2012-2013 and 2013-2014, and hospitals in Brazil, China, France, Russia, Tu...

Research paper thumbnail of Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is not detected in the vagina: A prospective study

PLOS ONE, Sep 30, 2021

Objective To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pr... more Objective To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vagina of women diagnosed with coronavirus disease-19 (COVID-19) pneumonia. Study design The study was conducted prospectively in a university affiliated hospital. Forty-one women of reproductive age whose nasopharyngeal PCR test were positive for SARS-CoV-2 and clinically diagnosed with pneumonia were included in the study. Vaginal swabs were obtained for SARS-CoV-2 PCR tests when the patients were admitted to the inpatient service before pneumonia treatment was initiated. Results Vaginal swab samples of 38 patients were analysed with SARS-CoV-2 PCR tests. None of the vaginal swabs were positive for SARS-CoV-2. Conclusions SARS-CoV-2 does not infect the vagina of women diagnosed with SARS-CoV-2 pneumonia.

Research paper thumbnail of Predictive values of serum amyloid-A and CRP for infection in febrile neutropenic cancer patients

Journal of Microbiology and Infectious Diseases, Dec 1, 2014

Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) f... more Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) for infection and mortality in patients with febrile neutropenia (FEN). Methods: Daily measurement of serum SAA and CRP levels of patients during antibiotherapy for FEN. Results: Sixty-five FEN episodes of 52 patients were evaluated. Median CRP and SAA levels on 1st day of FEN were 137 mg/L (23-420 mg/L) and 547 mg/L (11-1660 mg/L), respectively. For detection of infection of infection the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of SAA at a level of >80 mg/L were as 100%, 48% and 100%. Whilethe sensitivity, PPV, and NPV of CRP at a level of >50mg/L were as 86%, 47% and 60%, respectively. Predictive values of initial SAA and CRP levels for infection didn't differ significantly (CRP: p=0.24, SAA: p=0.39). SAA and CRP levels on the last day of FEN course were significant for infection and mortality (for infection: p=0.003 for CRP and p=0.026 for SAA; for mortality: p<0.001 for CRP and p=0.021 for SAA). Both initial and daily SAA and CRP levels correlated with each other positively and statistically significantly (p<0.001). The area under the curve (AUC) on the receiver operating character (ROC) curve for CRP and SAA were 0.72 (p=0.003, 95% CI: 0.59-0.86) and 0.68 (p=0.19, 95% CI: 0.54-0.82), respectively. Conclusions: Despite low predictive values in decision of initial therapy, these parameters would be helpful in decision of modification and evaluation of response to therapy.

Research paper thumbnail of Angio-oedema as an unusual tolerable side effect of voriconazole therapy

Journal of Medical Microbiology, Aug 1, 2008

Voriconazole (VRC) has not previously been reported to cause angio-oedema. Here, we report a case... more Voriconazole (VRC) has not previously been reported to cause angio-oedema. Here, we report a case of angio-oedema associated with VRC therapy. A 37-year-old woman with relapsing invasive vertebral aspergillosis received intravenous VRC and developed angio-oedema 10 days after starting therapy. This condition rapidly diminished after administration of intravenous antihistaminics and did not necessitate cessation of VRC treatment. The treatment was continued for 6 months without recurrence of the symptoms. After 18 months, the patient was in good health. To our knowledge, this is the first report of an angio-oedema associated with VRC.

Research paper thumbnail of Febril nötropenik kanser hastalarında serum amiloid-A and C-reaktif protein CRP'nin enfeksiyon için öngörü değeri

Journal of Microbiology and Infectious Diseases, 2014

Research paper thumbnail of Evaluation of the Side Effects of Antiretroviral Treatment

Mediterranean journal of infection, microbes & antimicrobials, Dec 27, 2018

The frequency of antiretroviral therapy (ART)-induced side effects varies in HIV-infected patient... more The frequency of antiretroviral therapy (ART)-induced side effects varies in HIV-infected patients. In this study, we aimed to compare drug-induced side effects developing in patients receiving different ART regimens. Materials and Methods: This study was performed after obtaining approval of İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital's Ethics Committee (89513307/1009/515) on 30.12.2015. Ninety-five patients with HIV infection followed-up between January 2012 and December 2015 who received ART were included in this study. Their clinical and laboratory findings were evaluated retrospectively and possible drug-related side effects were investigated. Antiretroviral therapy regimens were compared using chi-square test and Fisher's exact test for categorical variables and with Mann-Whitney U test for numerical variables; changes in numerical variables were compared using Wilcoxon test. SPSS 22.0 software (Chicago, IL, USA) was used for data analyses. Results: All cases were treated with regimens consisting of tenofovir/emtricitabine (TDF/FTC). Three patients restarted treatment after quitting for several months, thus 98 regimens administered to 95 patients were evaluated. Forty-nine of them received protease inhibitors (PIs), 44 received integrase inhibitors (INSTIs), and five received non-nucleoside reverse transcriptase inhibitors. The median (IQR) follow-up period was seven (4-13) months. None of the patients had renal function abnormality before ART but during treatment three (3.1%) of them needed renal dose adjustment for TDF/FTC. Compared to baseline values, there were significant differences in creatinine and creatinine clearance levels during treatment (p<0.001). Hyperlipidemia developed in 50% of the patients who did not have hyperlipidemia at start of treatment and this rate differed significantly between the PI and INSTI regimens (69% and 26%, respectively, χ 2 =11.214, p=0.001). Seventeen percent of the patients developed an elevation in ALT levels during the treatment, but none required treatment change for this reason. Treatment changes were made 27 times in 21 patients while 15 of these changes were due to probable side effects. Thus, of 125 treatment regimens, possible clinical side effects were observed in 30 (24%), 13 of which were diarrhea. Gastrointestinal side effects were observed in 26% with PI-based regimens and neuropsychiatric side effects were observed in 6% with INSTI-based regimens. Conclusion: The most common side effects were hyperlipidemia (50%) and diarrhea (23%). Diarrhea was responsible for two-thirds of the ART switches in our study. It is important to monitor patients receiving ART for possible side effects. The results of longer and more comprehensive follow-up are needed to obtain more definitive data.

Research paper thumbnail of CLSI ve EUCAST Önerilerine Göre Genişlemiş Spektrumlu Beta-Laktamaz Üreten Escherichia coli İdrar İzolatlarında Fosfomisin Duyarlılığı

Mikrobiyoloji Bulteni, Oct 28, 2014

Üriner sistem enfeksiyonlarının en sık etkeni olan Escherichia coli'de giderek artan antibiyotik ... more Üriner sistem enfeksiyonlarının en sık etkeni olan Escherichia coli'de giderek artan antibiyotik direnci, i i ampirik tedavi seçiminde ve tedavi başarısında sorun yaratmaktadır. Bu çalışmada, özellikle genişlemiş spektrumlu beta-laktamaz (GSBL) üreten izolatların tedavisinde iyi bir seçenek olarak sunulan fosfomisinin in vitro etkinliğinin araştırılması amaçlanmıştır. Çalışmaya, Mayıs 2011-Mayıs 2012 tarihleri arasında ayaktan ve yatan hastalara ait idrar örneklerinden izole edilen, 118'i GSBL pozitif, 126'sı GSBL negatif olmak üzere toplam 244 E.coli suşu dahil edilmiştir. İzolatların antibiyotik duyarlılıkları CLSI (Clinical and i Laboratory Standards Institute) önerilerine göre disk difüzyon yöntemi (DDY) ile, GSBL üretimleri ise çift disk sinerji yöntemiyle araştırılmış; fosfomisin minimum inhibitör konsantrasyonu (MİK) değerleri E-test yöntemiyle belirlenmiştir. İzolatların fosfomisin zon çapları ve MİK değerleri CLSI ve EUCAST (European Committee on Antimicrobial Susceptibility Testing) sınır değerlerine göre ayrı ayrı yorumlanmıştır. GSBL üreten ve üretmeyen izolatların fosfomisin ve diğer antibiyotiklere karşı duyarlılıkları ve fosfomisinin farklı yöntemlere ait sonuçları karşılaştırılmış; fosfomisin zon çapları ve MİK değerleri arasındaki korelasyon hesaplanmıştır. Çalışmamızda, siprofl oksasin, trimetoprim-sülfametoksazol, gentamisin ve amikasine

Research paper thumbnail of Spontaneous Bacterial Peritonitis Caused by Brucella melitensis

Scandinavian Journal of Infectious Diseases, May 1, 2003

This report presents a case of blood and ascitic fluid culture-proven spontaneous bacterial perit... more This report presents a case of blood and ascitic fluid culture-proven spontaneous bacterial peritonitis caused by Brucella melitensis in a 67-y-old male with congestive heart failure. Ten cases of reported previously brucella peritonitis are reviewed, 3 of which were ascitic fluid culture negative.

Research paper thumbnail of Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients

Journal of Infection, Jul 1, 2003

Febrile neutropenic cancer patients are at risk for development of serious infections, morbidity ... more Febrile neutropenic cancer patients are at risk for development of serious infections, morbidity and mortality. The aim of this study was to determine the type and frequency of infections and to evaluate some prognostic risk factors. 220 episodes of neutropenic fever in 177 cancer patients have been reviewed. Infections could be documented microbiologically in 38 (17.3%) episodes and suspected clinically in 29 (13.2%). The most common focus of infection was the lower respiratory tract (11.4%) followed by the urinary tract (6.4%). The most frequently isolated pathogen was Escherichia coli (31%) followed by Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%) and Streptococcus pneumoniae (13%). The median durations of neutropenia and fever were 4 and 3 days, respectively. Mortality was seen in 25 patients (11.4%). Its rate was higher in documented infections except for non-bacteremic microbiologic infections in which no death was seen. Hypotension and shock were the most significant determinants of poor prognosis. The management of these special patients should be given adequate attention and be considered important since the success of therapy depends on revealing of etiologic agents.

Research paper thumbnail of Infections in Renal Transplant Patients: Risk Factors and Infectious Agents

Transplantation Proceedings, Apr 1, 2013

Infectious complications after renal transplantation (RT) are associated with significant morbidi... more Infectious complications after renal transplantation (RT) are associated with significant morbidity. They continue to be the most frequent cause of mortality. We investigated the incidence of infections, the causative pathogens, and risk factors contributing to this complication during the first year. We included demographic and clinical data of the 124 patients who underwent RT in our hospital from December 2004 to June 2010. for statistical analysis. Fifty (40.3%) RT recipients developed 80 episodes of infection: urinary tract (n = 68; 85%), intraabdominal (n = 4; 5%), surgical wound (n = 3; 3.8%), or central venous catheter (n = 3; 4%). Eight (10%) were bacteremic. The most commonly isolated bacteria scene (76/80) was Escherichia coli (n = 43; 56.5%) followed by Klebsiella spp. (n = 10; 13.2%) and Pseudomonas spp. (n = 10; 13.2%). Cytomegalovirus infection was detected in 2 recipients; fungal and mycobacterial infections, in no case. It was noteworthy that 52.8% of E. coli and Klebsiella spp. produced extended-spectrum beta-lactamase. Ninety percent of infections developed within 6 months after transplantation. When we compared infected versus noninfected cases, the presence of a double J catheter was the most significant risk factor (P = .018; odds ratio [OR] = 0.234; 95% confidence interval [CI] = 0.070-0.781). In contrast to the initial years after the start of RT in our hospital the incidence of infection decreased over time together with a decrease number and durations of catheterization (P = .008; OR = 2.707; 95% CI = 1.292-5.672). Urinary tract infections were the predominant problem with most isolates resistant to extended-spectrum antibiotics. Therefore, invasive catheters and prophylactic antibiotics should not be used for longer than necessary and infection control measures implemented to decrease the incidence of infections and bacterial resistance.

Research paper thumbnail of Gram-negatif Bakteriyemi İlişkili Sepsiste Mortalite Göstergeleri: Pitt Bakteriyemi Skoru, qSOFA, SIRS

Flora infeksiyon hastalıkları ve klinik mikrobiyoloji dergisi, Dec 20, 2021

Giriş: Sepsis infeksiyona karşı gelişen patolojik, biyokimyasal ve fizyolojik anormalliklerle sey... more Giriş: Sepsis infeksiyona karşı gelişen patolojik, biyokimyasal ve fizyolojik anormalliklerle seyreden sendrom olup yüksek mortalite ve morbiditeyle seyretmektedir. Çalışmamızda gram-negatif bakteriyemi ile ilişkili sepsiste Pitt bakteriyemi skoru, sistemik inflamatuvar yanıt sendromu (SIRS) kriterleri ve quick Sequential Organ Failure Assessment (qSOFA) skorlarının mortaliteyi öngörme gücünü saptamayı amaçladık.

Research paper thumbnail of Evaluation of Various Risk Factors for Infections Caused By Gram-Negative Bacteria Producing Extended-Spectrum Beta-Lactamase

DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2008

Son y›llarda gram-negatif bakterilerde genifllemifl spektrumlu beta-laktamaz (GSBL) üretimi, cidd... more Son y›llarda gram-negatif bakterilerde genifllemifl spektrumlu beta-laktamaz (GSBL) üretimi, ciddi infeksiyonlar›n tedavisinde artan soruna yol açmaktad›r. Bu artan dirence yol açan risk faktörlerini ortaya koymak amac›yla, GSBL üreten ve üretmeyen gram-negatif basillerin izole edildi¤i olgular karfl›laflt›r›ld›.

Research paper thumbnail of Non-inferiority of Generic Tenofovir Disoproxil Fumarate/ E mtric itabi ne, Hivent® to Brand Name, Truvada® in HIV-Infected Patients

Cerrahpaşa medical journal, Oct 13, 2022

Research paper thumbnail of Comparison of the Efficacy of Beta-Lactam Monotherapy and Beta-Lactam and Amikacin Combination Therapy for the Empirical Treatment of Febrile Neutropenic Patients

DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2009

Giriş: Febril nötropeni hastalarına yaklaşım standart gibi gözükse de, riske dayalı grupların bel... more Giriş: Febril nötropeni hastalarına yaklaşım standart gibi gözükse de, riske dayalı grupların belirlenmesi ile tedavi yaklaşımı değişmiş ve monoterapi ön plana çıkmıştır. Bu çalışmanın amacı; kliniğimizde izlediğimiz febril nötropeni olgularının ampirik tedavisinde kullanılan beta-laktam monoterapisi ile beta-laktam ve amikasin kombinasyon tedavisinin etkinliğini karşılaştırmaktır.

Research paper thumbnail of Trends and factors associated with modification or discontinuation of the initial antiretroviral regimen during the first year of treatment in the Turkish HIV-TR Cohort, 2011–2017

Aids Research and Therapy, Jan 9, 2021

Background: There is limited evidence on the modification or stopping of antiretroviral therapy (... more Background: There is limited evidence on the modification or stopping of antiretroviral therapy (ART) regimens, including novel antiretroviral drugs. The aim of this study was to evaluate the discontinuation of first ART before and after the availability of better tolerated and less complex regimens by comparing the frequency, reasons and associations with patient characteristics. Methods: A total of 3019 ART-naive patients registered in the HIV-TR cohort who started ART between Jan 2011 and Feb 2017 were studied. Only the first modification within the first year of treatment for each patient was included in the analyses. Reasons were classified as listed in the coded form in the web-based database. Cumulative incidences were analysed using competing risk function and factors associated with discontinuation of the ART regimen were examined using Cox proportional hazards models and Fine-Gray competing risk regression models. Results: The initial ART regimen was discontinued in 351 out of 3019 eligible patients (11.6%) within the first year. The main reason for discontinuation was intolerance/toxicity (45.0%), followed by treatment simplification (9.7%), patient willingness (7.4%), poor compliance (7.1%), prevention of future toxicities (6.0%), virologic failure (5.4%), and provider preference (5.4%). Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (aHR = 4.4, [95% CI 3.0-6.4]; p < 0.0001) or protease inhibitor (PI)-based regimens (aHR = 4.3, [95% CI 3.1-6.0]; p < 0.0001) relative to integrase strand transfer inhibitor (InSTI)-based regimens were significantly associated with ART discontinuation. ART initiated at a later period (2015-Feb 2017) (aHR = 0.6, [95% CI 0.4-0.9]; p < 0.0001) was less likely to be discontinued. A lower rate of treatment discontinuation for intolerance/toxicity was observed with InSTI-based regimens (2.0%) than with NNRTI-(6.6%) and PI-based regimens (7.5%) (p < 0.001). The percentage of patients who achieved HIV RNA < 200 copies/mL within 12 months of ART initiation was 91% in the ART discontinued group vs. 94% in the continued group (p > 0.05).

Research paper thumbnail of Clinical efficacy and safety of prolonged versus intermittent administration of antipseudomonal beta-lactam antibiotics in adults with severe acute infections: A meta-analysis of randomized controlled trials

Journal of Infection and Chemotherapy

Research paper thumbnail of Uzamış ateşli nötropenik olgularda galaktomannan ölçümünün invaziv aspergilloz yönünden değerlendirilmesi

Flora infeksiyon hastalıkları ve klinik mikrobiyoloji dergisi, 2012

Research paper thumbnail of Assessment of C-Reactive Protein as a Marker of Infection and Mortality in Febrile Neutropenic Patients

Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2009

Introduction: Although various laboratory parameters have been shown to be useful in determining ... more Introduction: Although various laboratory parameters have been shown to be useful in determining the presence of infection and the prognosis in febrile neutropenic patients, none of these parameters are appropriate for routine use because of their high cost. C-reactive protein (CRP), used for years as a valuable parameter to follow various infections is inexpensive but it is not defined definitely for the follow up of febrile neutropenic patients. The aim of this study was to determine the diagnostic and prognostic value of CRP in febrile neutropenic patients. Five hundred and thirty eight episodes of adult cancer patients followed between January 2001 and December 2007 were included in this study and CRP was tested in the first 48 hours and at the end of the episode. Patients and Methods: Nephelometric method (Dade Behring BNII, Germany) was used for CRP measurement. CRP levels were compared between the groups established according to the infection detected and mortality. SPSS 11.5...

Research paper thumbnail of Comparison of the Efficacy of Beta-Lactam Monotherapy and Beta-Lactam and Amikacin Combination Therapy for the Empirical Treatment of Febrile Neutropenic Patients

Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2009

Introduction: Although the approach to febrile neutropenic patients seems to be standardized, it ... more Introduction: Although the approach to febrile neutropenic patients seems to be standardized, it constitutes a heterogeneous group. As several studies have defined risk groups among them, treatment approaches have changed and monotherapy became the most important one. Patients and Methods: The aim of this study was to compare the efficacy of beta-lactam monotherapy and beta-lactam and amikacin combination therapy for the empirical treatment. Febrile neutropenic episodes of adult cancer patients followed between May 1997 and December 2007 were evaluated retrospectively. Six hundred and forty four episodes in which ceftazidime, cefepime, cefoperazone/sulbactam and piperacillin/tazobactam were given with or without amikacin as empirical treatment were included in this study. Out of 644 episodes, 551 received monotherapy and 93 received combination therapy. Results: A total of 257 (39.9%) episodes presented infections, documented as bacteremia in 92 (14.3%), documented microbiologically...

Research paper thumbnail of Retrospective analysis of viral pneumonia cases due to pandemic H3N2

Aim: To evaluate clinical, laboratory, radiological and demographic data of H3N2 pneumonia cases ... more Aim: To evaluate clinical, laboratory, radiological and demographic data of H3N2 pneumonia cases admitted to Pulmonology department during H3N2 pandemic season and compare with non-H3N2 community acquired pneumonia (CAP) cases. Methods: The study population consisted of all CAP cases admitted to our Pulmonology department between December 2013 – February 2014 influenza season. The patient files were evaluated for physical findings, laboratory data, radiological findings, treatment and outcome of cases. H3N2 was diagnosed by polymerase chain reaction (PCR) of throat swabs. The clinical, radiological and laboratory findings of H3N2 pneumonia cases were compared with non-H3N2 pneumonia cases. Mann Whitney U, Ki-square, Fisher9s exact, logistic regression analysis by forward stepwise method were used for statistical analyses. P value Results: During H3N2 pandemic season, 69 cases were diagnosed as CAP; 62 (89,8%) were non-H3N2 CAP, 7(10,2%) were H3N2 pneumonia. The demographic data, CURB-65, PSI scores, clinical, radiological and laboratory findings of two gorups were similar (p>0,05). The rates of treatment failure and/or transport to intensive care unit with need of invasive mechanical ventilation were significantly higher in H3N2 group (71,4% vs. 25,8%, p=0,024; OR: 7,18; 95%CI: 1,26 – 40,77). Mortality rates were similar in both groups ((p>0.05). Conclusion: The need of MV and intensive care treatment is more frequent in H3N2 pneumonia cases. Correct diagnosis, close follow-up and intensive care support is of vital importance in patients admitted due to CAP during influenza season and suspected to have viral pneumonia.

Research paper thumbnail of The Global Influenza Hospital Surveillance Network (GIHSN): A new platform to describe the epidemiology of severe influenza

Influenza and other respiratory viruses, Jan 21, 2015

Influenza is a global public health problem. However, severe influenza only recently has been add... more Influenza is a global public health problem. However, severe influenza only recently has been addressed in routine surveillance. The Global Influenza Hospital Surveillance Network (GIHSN) was established to study the epidemiology of severe influenza in consecutive seasons in different countries. Our objective is to describe the GIHSN approach and methods. The GIHSN uses prospective active surveillance to identify consecutive influenza admissions in permanent residents of well-defined geographic areas in sites around the world. A core common protocol is followed. After consent, data are collected on patient characteristics and clinical outcomes, respiratory swabs are obtained, and the presence of influenza virus and subtype or lineage is ascertained by polymerase chain reaction. Data are collated and analyzed at the GIHSN coordination center. GIHSN has run its activities for two consecutive influenza seasons, 2012-2013 and 2013-2014, and hospitals in Brazil, China, France, Russia, Tu...

Research paper thumbnail of Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is not detected in the vagina: A prospective study

PLOS ONE, Sep 30, 2021

Objective To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pr... more Objective To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vagina of women diagnosed with coronavirus disease-19 (COVID-19) pneumonia. Study design The study was conducted prospectively in a university affiliated hospital. Forty-one women of reproductive age whose nasopharyngeal PCR test were positive for SARS-CoV-2 and clinically diagnosed with pneumonia were included in the study. Vaginal swabs were obtained for SARS-CoV-2 PCR tests when the patients were admitted to the inpatient service before pneumonia treatment was initiated. Results Vaginal swab samples of 38 patients were analysed with SARS-CoV-2 PCR tests. None of the vaginal swabs were positive for SARS-CoV-2. Conclusions SARS-CoV-2 does not infect the vagina of women diagnosed with SARS-CoV-2 pneumonia.

Research paper thumbnail of Predictive values of serum amyloid-A and CRP for infection in febrile neutropenic cancer patients

Journal of Microbiology and Infectious Diseases, Dec 1, 2014

Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) f... more Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) for infection and mortality in patients with febrile neutropenia (FEN). Methods: Daily measurement of serum SAA and CRP levels of patients during antibiotherapy for FEN. Results: Sixty-five FEN episodes of 52 patients were evaluated. Median CRP and SAA levels on 1st day of FEN were 137 mg/L (23-420 mg/L) and 547 mg/L (11-1660 mg/L), respectively. For detection of infection of infection the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of SAA at a level of >80 mg/L were as 100%, 48% and 100%. Whilethe sensitivity, PPV, and NPV of CRP at a level of >50mg/L were as 86%, 47% and 60%, respectively. Predictive values of initial SAA and CRP levels for infection didn't differ significantly (CRP: p=0.24, SAA: p=0.39). SAA and CRP levels on the last day of FEN course were significant for infection and mortality (for infection: p=0.003 for CRP and p=0.026 for SAA; for mortality: p<0.001 for CRP and p=0.021 for SAA). Both initial and daily SAA and CRP levels correlated with each other positively and statistically significantly (p<0.001). The area under the curve (AUC) on the receiver operating character (ROC) curve for CRP and SAA were 0.72 (p=0.003, 95% CI: 0.59-0.86) and 0.68 (p=0.19, 95% CI: 0.54-0.82), respectively. Conclusions: Despite low predictive values in decision of initial therapy, these parameters would be helpful in decision of modification and evaluation of response to therapy.

Research paper thumbnail of Angio-oedema as an unusual tolerable side effect of voriconazole therapy

Journal of Medical Microbiology, Aug 1, 2008

Voriconazole (VRC) has not previously been reported to cause angio-oedema. Here, we report a case... more Voriconazole (VRC) has not previously been reported to cause angio-oedema. Here, we report a case of angio-oedema associated with VRC therapy. A 37-year-old woman with relapsing invasive vertebral aspergillosis received intravenous VRC and developed angio-oedema 10 days after starting therapy. This condition rapidly diminished after administration of intravenous antihistaminics and did not necessitate cessation of VRC treatment. The treatment was continued for 6 months without recurrence of the symptoms. After 18 months, the patient was in good health. To our knowledge, this is the first report of an angio-oedema associated with VRC.

Research paper thumbnail of Febril nötropenik kanser hastalarında serum amiloid-A and C-reaktif protein CRP'nin enfeksiyon için öngörü değeri

Journal of Microbiology and Infectious Diseases, 2014

Research paper thumbnail of Evaluation of the Side Effects of Antiretroviral Treatment

Mediterranean journal of infection, microbes & antimicrobials, Dec 27, 2018

The frequency of antiretroviral therapy (ART)-induced side effects varies in HIV-infected patient... more The frequency of antiretroviral therapy (ART)-induced side effects varies in HIV-infected patients. In this study, we aimed to compare drug-induced side effects developing in patients receiving different ART regimens. Materials and Methods: This study was performed after obtaining approval of İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital's Ethics Committee (89513307/1009/515) on 30.12.2015. Ninety-five patients with HIV infection followed-up between January 2012 and December 2015 who received ART were included in this study. Their clinical and laboratory findings were evaluated retrospectively and possible drug-related side effects were investigated. Antiretroviral therapy regimens were compared using chi-square test and Fisher's exact test for categorical variables and with Mann-Whitney U test for numerical variables; changes in numerical variables were compared using Wilcoxon test. SPSS 22.0 software (Chicago, IL, USA) was used for data analyses. Results: All cases were treated with regimens consisting of tenofovir/emtricitabine (TDF/FTC). Three patients restarted treatment after quitting for several months, thus 98 regimens administered to 95 patients were evaluated. Forty-nine of them received protease inhibitors (PIs), 44 received integrase inhibitors (INSTIs), and five received non-nucleoside reverse transcriptase inhibitors. The median (IQR) follow-up period was seven (4-13) months. None of the patients had renal function abnormality before ART but during treatment three (3.1%) of them needed renal dose adjustment for TDF/FTC. Compared to baseline values, there were significant differences in creatinine and creatinine clearance levels during treatment (p<0.001). Hyperlipidemia developed in 50% of the patients who did not have hyperlipidemia at start of treatment and this rate differed significantly between the PI and INSTI regimens (69% and 26%, respectively, χ 2 =11.214, p=0.001). Seventeen percent of the patients developed an elevation in ALT levels during the treatment, but none required treatment change for this reason. Treatment changes were made 27 times in 21 patients while 15 of these changes were due to probable side effects. Thus, of 125 treatment regimens, possible clinical side effects were observed in 30 (24%), 13 of which were diarrhea. Gastrointestinal side effects were observed in 26% with PI-based regimens and neuropsychiatric side effects were observed in 6% with INSTI-based regimens. Conclusion: The most common side effects were hyperlipidemia (50%) and diarrhea (23%). Diarrhea was responsible for two-thirds of the ART switches in our study. It is important to monitor patients receiving ART for possible side effects. The results of longer and more comprehensive follow-up are needed to obtain more definitive data.

Research paper thumbnail of CLSI ve EUCAST Önerilerine Göre Genişlemiş Spektrumlu Beta-Laktamaz Üreten Escherichia coli İdrar İzolatlarında Fosfomisin Duyarlılığı

Mikrobiyoloji Bulteni, Oct 28, 2014

Üriner sistem enfeksiyonlarının en sık etkeni olan Escherichia coli'de giderek artan antibiyotik ... more Üriner sistem enfeksiyonlarının en sık etkeni olan Escherichia coli'de giderek artan antibiyotik direnci, i i ampirik tedavi seçiminde ve tedavi başarısında sorun yaratmaktadır. Bu çalışmada, özellikle genişlemiş spektrumlu beta-laktamaz (GSBL) üreten izolatların tedavisinde iyi bir seçenek olarak sunulan fosfomisinin in vitro etkinliğinin araştırılması amaçlanmıştır. Çalışmaya, Mayıs 2011-Mayıs 2012 tarihleri arasında ayaktan ve yatan hastalara ait idrar örneklerinden izole edilen, 118'i GSBL pozitif, 126'sı GSBL negatif olmak üzere toplam 244 E.coli suşu dahil edilmiştir. İzolatların antibiyotik duyarlılıkları CLSI (Clinical and i Laboratory Standards Institute) önerilerine göre disk difüzyon yöntemi (DDY) ile, GSBL üretimleri ise çift disk sinerji yöntemiyle araştırılmış; fosfomisin minimum inhibitör konsantrasyonu (MİK) değerleri E-test yöntemiyle belirlenmiştir. İzolatların fosfomisin zon çapları ve MİK değerleri CLSI ve EUCAST (European Committee on Antimicrobial Susceptibility Testing) sınır değerlerine göre ayrı ayrı yorumlanmıştır. GSBL üreten ve üretmeyen izolatların fosfomisin ve diğer antibiyotiklere karşı duyarlılıkları ve fosfomisinin farklı yöntemlere ait sonuçları karşılaştırılmış; fosfomisin zon çapları ve MİK değerleri arasındaki korelasyon hesaplanmıştır. Çalışmamızda, siprofl oksasin, trimetoprim-sülfametoksazol, gentamisin ve amikasine

Research paper thumbnail of Spontaneous Bacterial Peritonitis Caused by Brucella melitensis

Scandinavian Journal of Infectious Diseases, May 1, 2003

This report presents a case of blood and ascitic fluid culture-proven spontaneous bacterial perit... more This report presents a case of blood and ascitic fluid culture-proven spontaneous bacterial peritonitis caused by Brucella melitensis in a 67-y-old male with congestive heart failure. Ten cases of reported previously brucella peritonitis are reviewed, 3 of which were ascitic fluid culture negative.

Research paper thumbnail of Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients

Journal of Infection, Jul 1, 2003

Febrile neutropenic cancer patients are at risk for development of serious infections, morbidity ... more Febrile neutropenic cancer patients are at risk for development of serious infections, morbidity and mortality. The aim of this study was to determine the type and frequency of infections and to evaluate some prognostic risk factors. 220 episodes of neutropenic fever in 177 cancer patients have been reviewed. Infections could be documented microbiologically in 38 (17.3%) episodes and suspected clinically in 29 (13.2%). The most common focus of infection was the lower respiratory tract (11.4%) followed by the urinary tract (6.4%). The most frequently isolated pathogen was Escherichia coli (31%) followed by Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%) and Streptococcus pneumoniae (13%). The median durations of neutropenia and fever were 4 and 3 days, respectively. Mortality was seen in 25 patients (11.4%). Its rate was higher in documented infections except for non-bacteremic microbiologic infections in which no death was seen. Hypotension and shock were the most significant determinants of poor prognosis. The management of these special patients should be given adequate attention and be considered important since the success of therapy depends on revealing of etiologic agents.

Research paper thumbnail of Infections in Renal Transplant Patients: Risk Factors and Infectious Agents

Transplantation Proceedings, Apr 1, 2013

Infectious complications after renal transplantation (RT) are associated with significant morbidi... more Infectious complications after renal transplantation (RT) are associated with significant morbidity. They continue to be the most frequent cause of mortality. We investigated the incidence of infections, the causative pathogens, and risk factors contributing to this complication during the first year. We included demographic and clinical data of the 124 patients who underwent RT in our hospital from December 2004 to June 2010. for statistical analysis. Fifty (40.3%) RT recipients developed 80 episodes of infection: urinary tract (n = 68; 85%), intraabdominal (n = 4; 5%), surgical wound (n = 3; 3.8%), or central venous catheter (n = 3; 4%). Eight (10%) were bacteremic. The most commonly isolated bacteria scene (76/80) was Escherichia coli (n = 43; 56.5%) followed by Klebsiella spp. (n = 10; 13.2%) and Pseudomonas spp. (n = 10; 13.2%). Cytomegalovirus infection was detected in 2 recipients; fungal and mycobacterial infections, in no case. It was noteworthy that 52.8% of E. coli and Klebsiella spp. produced extended-spectrum beta-lactamase. Ninety percent of infections developed within 6 months after transplantation. When we compared infected versus noninfected cases, the presence of a double J catheter was the most significant risk factor (P = .018; odds ratio [OR] = 0.234; 95% confidence interval [CI] = 0.070-0.781). In contrast to the initial years after the start of RT in our hospital the incidence of infection decreased over time together with a decrease number and durations of catheterization (P = .008; OR = 2.707; 95% CI = 1.292-5.672). Urinary tract infections were the predominant problem with most isolates resistant to extended-spectrum antibiotics. Therefore, invasive catheters and prophylactic antibiotics should not be used for longer than necessary and infection control measures implemented to decrease the incidence of infections and bacterial resistance.

Research paper thumbnail of Gram-negatif Bakteriyemi İlişkili Sepsiste Mortalite Göstergeleri: Pitt Bakteriyemi Skoru, qSOFA, SIRS

Flora infeksiyon hastalıkları ve klinik mikrobiyoloji dergisi, Dec 20, 2021

Giriş: Sepsis infeksiyona karşı gelişen patolojik, biyokimyasal ve fizyolojik anormalliklerle sey... more Giriş: Sepsis infeksiyona karşı gelişen patolojik, biyokimyasal ve fizyolojik anormalliklerle seyreden sendrom olup yüksek mortalite ve morbiditeyle seyretmektedir. Çalışmamızda gram-negatif bakteriyemi ile ilişkili sepsiste Pitt bakteriyemi skoru, sistemik inflamatuvar yanıt sendromu (SIRS) kriterleri ve quick Sequential Organ Failure Assessment (qSOFA) skorlarının mortaliteyi öngörme gücünü saptamayı amaçladık.

Research paper thumbnail of Evaluation of Various Risk Factors for Infections Caused By Gram-Negative Bacteria Producing Extended-Spectrum Beta-Lactamase

DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2008

Son y›llarda gram-negatif bakterilerde genifllemifl spektrumlu beta-laktamaz (GSBL) üretimi, cidd... more Son y›llarda gram-negatif bakterilerde genifllemifl spektrumlu beta-laktamaz (GSBL) üretimi, ciddi infeksiyonlar›n tedavisinde artan soruna yol açmaktad›r. Bu artan dirence yol açan risk faktörlerini ortaya koymak amac›yla, GSBL üreten ve üretmeyen gram-negatif basillerin izole edildi¤i olgular karfl›laflt›r›ld›.

Research paper thumbnail of Non-inferiority of Generic Tenofovir Disoproxil Fumarate/ E mtric itabi ne, Hivent® to Brand Name, Truvada® in HIV-Infected Patients

Cerrahpaşa medical journal, Oct 13, 2022

Research paper thumbnail of Comparison of the Efficacy of Beta-Lactam Monotherapy and Beta-Lactam and Amikacin Combination Therapy for the Empirical Treatment of Febrile Neutropenic Patients

DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2009

Giriş: Febril nötropeni hastalarına yaklaşım standart gibi gözükse de, riske dayalı grupların bel... more Giriş: Febril nötropeni hastalarına yaklaşım standart gibi gözükse de, riske dayalı grupların belirlenmesi ile tedavi yaklaşımı değişmiş ve monoterapi ön plana çıkmıştır. Bu çalışmanın amacı; kliniğimizde izlediğimiz febril nötropeni olgularının ampirik tedavisinde kullanılan beta-laktam monoterapisi ile beta-laktam ve amikasin kombinasyon tedavisinin etkinliğini karşılaştırmaktır.

Research paper thumbnail of Trends and factors associated with modification or discontinuation of the initial antiretroviral regimen during the first year of treatment in the Turkish HIV-TR Cohort, 2011–2017

Aids Research and Therapy, Jan 9, 2021

Background: There is limited evidence on the modification or stopping of antiretroviral therapy (... more Background: There is limited evidence on the modification or stopping of antiretroviral therapy (ART) regimens, including novel antiretroviral drugs. The aim of this study was to evaluate the discontinuation of first ART before and after the availability of better tolerated and less complex regimens by comparing the frequency, reasons and associations with patient characteristics. Methods: A total of 3019 ART-naive patients registered in the HIV-TR cohort who started ART between Jan 2011 and Feb 2017 were studied. Only the first modification within the first year of treatment for each patient was included in the analyses. Reasons were classified as listed in the coded form in the web-based database. Cumulative incidences were analysed using competing risk function and factors associated with discontinuation of the ART regimen were examined using Cox proportional hazards models and Fine-Gray competing risk regression models. Results: The initial ART regimen was discontinued in 351 out of 3019 eligible patients (11.6%) within the first year. The main reason for discontinuation was intolerance/toxicity (45.0%), followed by treatment simplification (9.7%), patient willingness (7.4%), poor compliance (7.1%), prevention of future toxicities (6.0%), virologic failure (5.4%), and provider preference (5.4%). Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (aHR = 4.4, [95% CI 3.0-6.4]; p < 0.0001) or protease inhibitor (PI)-based regimens (aHR = 4.3, [95% CI 3.1-6.0]; p < 0.0001) relative to integrase strand transfer inhibitor (InSTI)-based regimens were significantly associated with ART discontinuation. ART initiated at a later period (2015-Feb 2017) (aHR = 0.6, [95% CI 0.4-0.9]; p < 0.0001) was less likely to be discontinued. A lower rate of treatment discontinuation for intolerance/toxicity was observed with InSTI-based regimens (2.0%) than with NNRTI-(6.6%) and PI-based regimens (7.5%) (p < 0.001). The percentage of patients who achieved HIV RNA < 200 copies/mL within 12 months of ART initiation was 91% in the ART discontinued group vs. 94% in the continued group (p > 0.05).

Research paper thumbnail of Clinical efficacy and safety of prolonged versus intermittent administration of antipseudomonal beta-lactam antibiotics in adults with severe acute infections: A meta-analysis of randomized controlled trials

Journal of Infection and Chemotherapy

Research paper thumbnail of Uzamış ateşli nötropenik olgularda galaktomannan ölçümünün invaziv aspergilloz yönünden değerlendirilmesi

Flora infeksiyon hastalıkları ve klinik mikrobiyoloji dergisi, 2012

Research paper thumbnail of Assessment of C-Reactive Protein as a Marker of Infection and Mortality in Febrile Neutropenic Patients

Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2009

Introduction: Although various laboratory parameters have been shown to be useful in determining ... more Introduction: Although various laboratory parameters have been shown to be useful in determining the presence of infection and the prognosis in febrile neutropenic patients, none of these parameters are appropriate for routine use because of their high cost. C-reactive protein (CRP), used for years as a valuable parameter to follow various infections is inexpensive but it is not defined definitely for the follow up of febrile neutropenic patients. The aim of this study was to determine the diagnostic and prognostic value of CRP in febrile neutropenic patients. Five hundred and thirty eight episodes of adult cancer patients followed between January 2001 and December 2007 were included in this study and CRP was tested in the first 48 hours and at the end of the episode. Patients and Methods: Nephelometric method (Dade Behring BNII, Germany) was used for CRP measurement. CRP levels were compared between the groups established according to the infection detected and mortality. SPSS 11.5...

Research paper thumbnail of Comparison of the Efficacy of Beta-Lactam Monotherapy and Beta-Lactam and Amikacin Combination Therapy for the Empirical Treatment of Febrile Neutropenic Patients

Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2009

Introduction: Although the approach to febrile neutropenic patients seems to be standardized, it ... more Introduction: Although the approach to febrile neutropenic patients seems to be standardized, it constitutes a heterogeneous group. As several studies have defined risk groups among them, treatment approaches have changed and monotherapy became the most important one. Patients and Methods: The aim of this study was to compare the efficacy of beta-lactam monotherapy and beta-lactam and amikacin combination therapy for the empirical treatment. Febrile neutropenic episodes of adult cancer patients followed between May 1997 and December 2007 were evaluated retrospectively. Six hundred and forty four episodes in which ceftazidime, cefepime, cefoperazone/sulbactam and piperacillin/tazobactam were given with or without amikacin as empirical treatment were included in this study. Out of 644 episodes, 551 received monotherapy and 93 received combination therapy. Results: A total of 257 (39.9%) episodes presented infections, documented as bacteremia in 92 (14.3%), documented microbiologically...