Sercan Ulusoy - Academia.edu (original) (raw)
Papers by Sercan Ulusoy
Infection, 2018
Purpose In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcome... more Purpose In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). Methods Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status. Results Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, Conclusions These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.
Open Forum Infectious Diseases, 2015
Journal of Microbiology and Infectious Diseases, 2015
Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which... more Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which are found in soil. In this report, we describe a renal transplant patient who had a skin-soft tissue infection at the anterior side of her left tibia due to P. boydii. Tissue biopsy was taken from her tibial lesion. Pathologic examination revealed hyphae plus fungal spores and mycological cultures were positive for P. boydii. The fungus was also identified by molecular methods. Fluconazole and topical isoconazole nitrate were given to the patient until the antifungal susceptibility results were seen. Fluconazole was changed to itraconazole via susceptibility results. Clinical response was seen at the 1 month control. Because of limited data regarding the optimal antifungal drug choice and duration of treatment for P. boydii infections, the proper identification of pathogen and antifungal susceptibility tests have vital importance.
Mediterranean Journal of Infection Microbes and Antimicrobials, 2014
Bruselloz karaciğer tutulumu dahil olmak üzere birçok organı tutabilen sistemik bir hastalıktır. ... more Bruselloz karaciğer tutulumu dahil olmak üzere birçok organı tutabilen sistemik bir hastalıktır. Bu çalışmada kliniğimizde takibi yapılan brusellozlu olgularda hastalığın karaciğer ve dalak üzerine olan etkileri irdelenmiştir. Materyal ve Metod: Bu çalışmada kliniğimizde Temmuz 2006 ile Ekim 2014 tarihleri arasında takip ettiğimiz bruselloz olguları geriye dönük taranmıştır. Bruselloz tanısı mikrobiyolojik kültür olumluluğu ve/veya Wright aglütinasyon testinin 1/160 ve üzeri titrede saptanması ile konuldu. Bulgular: Çalışmaya 102 olgu [43 kadın (%42.2), 59 erkek (%57.8), yaş ortalaması 47.1 ± 16] dahil edilmiştir. Seksen iki (%80.3) hastada 1/160 ve üzeri wright aglütinasyon testi olumluluğu ile üç hastada tanı wright aglütinasyon testi olumsuz olmasına karşın anti-human globülin testi ile tanı konuldu. On yedi (%16.7) hastanın tanısı ise sadece kan kültürü olumluluğu ile konuldu. En sık ilk üç semptom ateş (%63.7), halsizlik (%48) ve bel-kalça ağrısıydı (%48). Ultrasonografi ile hepatomegali ve splenomegali sırasıyla 16 (%15.8) ve 19 (% 18.8) olguda tespit edildi. Hastalarda AST, ALT, ALP, GGT ve toplam bilirubin testlerinde yükseklik sırasıyla %23.8, %24.8, %26.8, %36.6, %12.9 oranında saptandı. Kırk iki (%41.2) hastada bulgu veren karaciğer ilişkili patolojiye rastlanmadı. Herhangi bir patolojiye rastlanmayan hastaların yaş ortalaması 51.1 ± 14.9 yıl iken, diğer hastalarda 44.3 ± 16.3 yıl olarak bulundu (p= 0.035). Tüm hastalarda tedavi sonunda karaciğer fonksiyon testlerinde düzelme saptandı. Hastaların hiçbirinde ciddi yan etki görülmemiştir. Sonuç: Bruselloz öncelikle retiküloendotelyal sistemi etkileyerek karaciğer hasarına da neden olabilen ama tedaviye yanıt oranı yüksek zoonotik bir hastalıktır. Bununla birlikte olgularımızın önemli kısmında ultrasonografi ile karaciğer ilgili herhangi bir patoloji saptanmamıştır. Ülkemiz gibi brusellozun yaygın görüldüğü bölgelerde karaciğer bulgusu olmayan olgularda da bruselloz akılda tutulmalıdır.
Mikrobiyoloji bülteni, 2007
Implementation of antiviral therapy leads to the emergence of mutant strains during the treatment... more Implementation of antiviral therapy leads to the emergence of mutant strains during the treatment in chronic hepatitis B. Hepatitis B virus (HBV) with primary antiviral resistance may be rarely encountered. In this report, a chronic hepatitis B case who had never received adefovir dipivoxil but had primary adefovir resistance, was presented. HBeAg positive 25-year-old male patient was treated with interferon (IFN)-alpha (thrice a week 10 MU) and lamivudine (100 mg/daily) combination for one year. At the end of this treatment although HBV-DNA was under the detectable limit and ALT levels returned to normal, anti-HBe antibodies did not develop. During the course of lamivudin treatment on the third year virus was found to be resistant to lamivudin [FLM+YMDD+YIDD+YVDD (Inno-LiPA HBV DR, Innogenetics Ghent, Belgium)] and adefovir was added to the lamivudin therapy. At the end of eight months of combination therapy, ALT levels did not return to normal and HBV-DNA was still in detectable l...
Journal of Microbiology and Infectious Diseases, 2014
Hepatit A is usually a self-limited, asymptomatic infection. However, severe manifestations of he... more Hepatit A is usually a self-limited, asymptomatic infection. However, severe manifestations of hepatitis may occur rarely in adult patients. Here, we present a case of prolonged, relapsed cholestasis secondary to acute hepatitis infection in an adult patient. A 25-year old male patient had been given symptomatic treatment for weakness, abdominal pain, loss of appetite, pruritis, nausea and generalized jaundice. A week later, he had been diagnosed with acute hepatitis A infection. He admitted to our clinic two months after the first episode with complaints of pruritis and jaundice. His laboratory results included a serum alanine aminotransferase (ALT) level of 86 U/L, aspartate transferase (AST) of 91 U/L, total bilirubin of 46.5 mg/dl and direct bilirubin of 33.9 mg/dl. ursodeoxycholic acid (UDCA) therapy was started due to protracted jaundice, severe itching and a marked elevation in bilirubin levels, which was replaced with prednisolone therapy at a dose of 1 mg/kg/day at 12 days. Most of his clinical symptoms resolved with much lower serum bilirubin levels. No clinical or biochemical deterioration was observed after discontinuation of therapy. One year later his general condition was good with no relapse. There are few case reports in literature about the use of corticosteroids for treatment of prolonged cholestatic jaundice in patients with hepatitis A infection. Based on our findings, we suggest that this type of therapy may be beneficial for relief of symptoms and improvement of serum biochemistry.
Mikrobiyoloji bülteni, 2008
Group C streptococci are flora members of skin, nasopharynx, gastrointestinal and genitourinary s... more Group C streptococci are flora members of skin, nasopharynx, gastrointestinal and genitourinary systems. They are rare causes of human pharyngitis, arthritis, pneumonia, meningitis and bacteremia. In this report, a 71-years old male patient with Streptococcus equisimilis arthritis/prosthetic joint infection has been presented. The patient was admitted to the emergency service with the complaints of erythema, swelling and tenderness on right knee which had total knee prosthesis. Examination of synovial fluid punction sample yielded abundant amount of leukocytes (> 1000 cells/mm3). Empirical ampicillin-sulbactam (1 g q6h, parenterally) therapy was initiated. Bacteria which have been cultivated from synovial fluid specimen were identified as S. equisimilis. The isolate was found to be susceptible to penicilin, erythromycin and teicoplanin, and resistant to chloramphenicol and tetracycline. Although clinical presentation improved during the first ten days, symptoms recurred after the...
International Journal of Infectious Diseases, 2014
Background: Candidaemia is a potentially devastating bloodstream infection predominantly affectin... more Background: Candidaemia is a potentially devastating bloodstream infection predominantly affecting hospitalised, severely ill patients. Despite substantial advances in antifungal agents, candidaemia remains associated with high mortality. Candidaemia may cause severe sepsis and septic shock leading to multiorgan failure. Other complications include deep organ involvement, endocarditis and septic thrombosis. Optimising outcomes of candidaemia and prevention of complications requires timely initiation of adequate antifungal therapy. Methods & Materials: Case report Results: A 73-year-old patient was admitted for pancreatic head resection due to a benign tumour. Two week after the resection patient became septic based on a candidaemia with Candida albicans. The primary antifungal treatment with Anidulafungin was started and on day 7 after improvement of patient the therapy was switched to Fluconazole for another 15 days. All blood cultures taken under antifungal therapy were negative. Transoesophageal echocardiography offered no signs of an endocarditis of the biological aortic valve prosthesis, placed in 2007, or another valve. Ten weeks after the successful treatment of the candidaemia the patient developed septic shock with severe thrombocytopenia. Another transoesophageal echocardiography revealed major vegetation attached to the biological aortic valve prosthesis which was implanted in 2007. During open heart surgery, whitish large, polypous vegetation (outside dimensions of 25 x 22 x 20 mm) was found covering virtually the complete valve opening area of the valve prosthesis. The valve with adherent vegetation was removed en bloc and replaced by a new bioprosthesis. Histopathology revealed a fungal mass comprised of yeasts cells and pseudohyphae that were microbiologically identified as Candida albicans. After the replacement of the valve antifungal treatment with Caspofungin was started. An ophthalmologist diagnosed a bilateral endophthalmitis as a further complication of candidaemia seven days later. Caspofungin was stopped and the antifungal treatment was continued by Fluconazole. Furthermore it was done vitrectomy on the left eye. The patient succumbed three weeks later from acute subarachnoidal hemorrhage. Conclusion: This case shows an endocarditis and endophthalmitis as very late complications of candidaemia almost three month ago. We have to discuss the antifungal management of the primary candidaemia as step down regimen in a patient with biological aortic valve prosthesis as possible cause for these complications.
Tropical doctor, 2003
One hundred and sixty-six presumed brucellosis patients were included in the study. These patient... more One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16-75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37...
Mikrobiyoloji Bulteni, 2014
Mikrobiyoloji Bulteni, 2014
Mikrobiyoloji Bulteni, 2013
Bu çalışmada, hastanemizin anesteziyoloji ve reanimasyon yoğun bakım ünitesi (YBÜ)'nde yatan hast... more Bu çalışmada, hastanemizin anesteziyoloji ve reanimasyon yoğun bakım ünitesi (YBÜ)'nde yatan hastalarda genişlemiş-spektrumlu beta-laktamaz (GSBL) üreten Klebsiella pneumoniae ve Escherichia coli'nin gastrointestinal kolonizasyonu için risk faktörlerinin araştırılması amaçlanmıştır. Çalışmaya, anesteziyoloji ve reanimasyon YBÜ'de prospektif olarak izlenen erişkin olgular dahil edilmiş; olgulardan rektal sürüntü örnekleri hastaneye yattıkları ilk 48 saat içinde alınmış ve taburcu ya da eks oluncaya kadar geçen sürede her hafta tekrarlanmıştır. Alınan örnekler Stuart besiyeri içerisinde laboratuvara ulaştırılmış ve biri 4 mg/L seftazidim içeren iki EMB besiyerine ekilerek 48 saat inkübe edilmiştir. E.coli ve K.pneumoniae izolatlarının tanımlanması klasik yöntemlerle yapılmış; antibiyotik duyarlılık testleri Mueller Hinton agar kullanılarak disk difüzyon yöntemiyle uygulanmış ve "Clinical and Laboratory Standards Institute (CLSI)" protokollerine göre değerlendirilmiştir. GSBL üretimi çift disk sinerji yöntemiyle doğrulanmıştır. Çalışma
ANKEM Dergisi, 2011
Evaluation of 133 Patients with Acute Pyelonephritis Acute pyelonephritis (APN) is bacterial or f... more Evaluation of 133 Patients with Acute Pyelonephritis Acute pyelonephritis (APN) is bacterial or fungal infection of the urinary tract or renal parenchyma. In this study, patients followed up between January 2003 and March 2011 with pyelonephritis were evaluated for laboratory findings, complicating factors and clinical outcome. During the study period there were 133 patients diagnosed with acute pyelonephritis (38 % male, 62 % female, aged 48.8±18.7 years). Seventy-two patients (54 %) had their first APN attack whereas 61 patients had their second or more episodes. There were no complicating factors in 25 % of patients however 16 % of patients had more than one complicating factor, and urinary catheterisation and obstructive uropathy were the most common complicating factors. In this series, complicating factors were detected by ultrasonography in 45 patients (34 %) who did not have such a medical history. In conclusion, APN is a common clinical entity and cases should be evaluated in terms of complicating factors.
ANKEM Dergisi, 2012
Aspergillus spp., yeryüzünde her yerde yaygın olarak bulunan, önemli bir fırsatçı küf mantarıdır.... more Aspergillus spp., yeryüzünde her yerde yaygın olarak bulunan, önemli bir fırsatçı küf mantarıdır. Aspergillus fumigatus invazif aspergillozun en sık rastlanan etkenidir. Bağışıklık sistemi baskılanmış hastalarda nadir olarak spondilodiskit etkeni olarak saptanabilmektedir. Bu yazıda, amiloidoza bağlı gelişen nefrotik sendrom nedeniyle steroid kullanan ve hemodiyalize giren bir olguda A.fumigatus'un etken olduğu ve vorikonazol ile tedavi edilen bir spondilodiskit olgusu sunulmuştur.
Infectious Diseases in Clinical Practice, 2012
Our study aims to determine the efficacy of infectious disease consultations and the interrelatio... more Our study aims to determine the efficacy of infectious disease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 nonYinfectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have separately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expectation of NIDSs in critical infection cases to start the therapy immediately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely accepted among other clinicians and appears to be of a crucial importance.
Scandinavian Journal of Infectious Diseases, 2011
Background: Linezolid is a bacteriostatic antibiotic with good cerebrospinal fl uid penetration. ... more Background: Linezolid is a bacteriostatic antibiotic with good cerebrospinal fl uid penetration. The aim of this study was to evaluate the effi cacy of linezolid in methicillin-resistant staphylococcal (methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS)) meningitis. Methods: We extracted data and outcomes for all adult patients (age Ͼ 18 y) with culture-proven MRSA or MRCoNS meningitis treated with linezolid between January 2006 and September 2010 in our hospital. Demographic, clinical, and laboratory data and predisposing factors, as well as information on response to treatment and outcome were obtained by regular visits. Results: A total of 17 cases (9 MRCoNS, 7 MRSA, and 1 MRCoNS and MRSA mixed) fulfi lled the inclusion criteria. All patients had hospitalacquired meningitis and had undergone neurosurgery. Cumulative microbiological success on day 5 was 88%. There was 1 staphylococcal meningitis-related death. There were no severe adverse events. Conclusions: Our experience with linezolid suggests that it can be an alternative for the treatment of MRCoNS-and MRSA-related meningitis.
Medical Science Monitor, 2012
The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a ... more The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) meningitis. Material/Methods: Meningitis was induced by intracisternal inoculation of ATCC 43300 strain. After 16 h incubation time and development of meningitis, the vancomycin group received vancomycin 20 mg/kg every 12 h. The linezolid-10 and linezolid-20 groups received linezolid in 10 and 20 mg/kg dosages every 12 h, respectively. The control group did not receive any antibiotics. Cerebrospinal fluid bacterial counts were measured at the end of 16-h incubation time and at the end of 24-h treatment. Results: Bacterial counts were similar in all groups at 16 h. At the end of treatment the decrease in bacterial counts in the vancomycin group was approximately 2 logs higher than the linezolid-20 group (p>0.05) and approximately 4 logs higher than in the linezolid-10 group (p: 0.037) (Vancomycin group:-2.860±4.495 versus Linezolid-20:-0.724±4.360, versus Linezolid-10: 1.39±3.37). Full or partial bacteriological response was higher in vancomycin versus linezolid-10 (p: 0.01), but not vancomycin versus linezolid-20 or linezolid-10 versus-linezolid-20 groups. Conclusions: Our results suggest that linezolid is not statistically inferior to vancomycin in the treatment of MRSA meningitis in an experimental rabbit model in 20 mg/kg q12 h dosage; however, it is inferior in 10 mg/kg q12 h dosage. Additional data should gathered to confirm these findings in advance of clinical trials to assess efficacy in humans.
Journal of Antimicrobial Chemotherapy, 2013
International Journal of Infectious Diseases, 2014
Healthcare-associated/nosocomial infections are increasing and important causes of morbidity afte... more Healthcare-associated/nosocomial infections are increasing and important causes of morbidity after spinal surgery in many countries around the world. 1-3 The efficacy of treatment choices is very limited in multidrug-resistant (MDR) Acinetobacter baumannii. For example, there is currently no universally effective antibiotic against MDR. Hence, treatment regimens are tailored according to antibiotic resistance patterns and available antibiotics. 4-6 Tigecycline is a relatively new glycylcycline antimicrobial, active in vitro against a variety of Gram-positive and Gram-negative organisms, including nosocomial MDR pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL) producers, and carbapenem-resistant A. baumannii. The US Food and Drug Administration (FDA) has approved tigecycline for the treatment of complicated intra-abdominal infections, complicated skin and skin structure infections, and community-acquired pneumonia (CAP). However, its pharmacological and microbiological profiles have encouraged physicians to use the drug in hospitalacquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and meningitis caused by MDR and tigecycline-sensitive pathogens featuring limited therapeutic options. Nevertheless, data regarding
International Journal of Infectious Diseases, 2007
Objectives: Infectious diseases (ID) trainees should be familiar with duties relevant to consulta... more Objectives: Infectious diseases (ID) trainees should be familiar with duties relevant to consultation practice. In this study we aimed to analyze the ID trainee night/weekend shift consultation process in terms of consultant characteristics, types of recommendations, and compliance with recommendations. Methods: All consultations performed by ID trainees on the night shift and at the weekends between 10 June and 10 August 2004 were recorded prospectively on standardized forms. Infectious diseases specialists assessed the appropriateness of recommendations the day after each consultation. Recommendations were considered complied with if they were carried out within 72 hours of the consultation. Results: Of 440 consultations, 163 were for a clinically diagnosed infection (without specific antibiotic request) and 79 were for treatment continuation. Overall, 152 consultations were for requesting specific antibiotic(s), and 327 antibiotics were recommended or approved in 270 consultations. Eight of these recommendations were inappropriate. Overall compliance to ID recommendations was 75.3% (418/555). In univariate analysis, the compliance rate to nontreatment recommendations (microbiologic cultures, radiology, biochemistry, etc.) was found to be lower than the rate of compliance to antibiotic recommendations (186/308 vs. 232/247, p < 0.05). In addition, compliance to recommendations made by the first-year trainees was lower than to the recommendations made by the other trainees. In logistic regression analysis only
Infection, 2018
Purpose In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcome... more Purpose In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). Methods Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status. Results Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, Conclusions These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.
Open Forum Infectious Diseases, 2015
Journal of Microbiology and Infectious Diseases, 2015
Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which... more Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which are found in soil. In this report, we describe a renal transplant patient who had a skin-soft tissue infection at the anterior side of her left tibia due to P. boydii. Tissue biopsy was taken from her tibial lesion. Pathologic examination revealed hyphae plus fungal spores and mycological cultures were positive for P. boydii. The fungus was also identified by molecular methods. Fluconazole and topical isoconazole nitrate were given to the patient until the antifungal susceptibility results were seen. Fluconazole was changed to itraconazole via susceptibility results. Clinical response was seen at the 1 month control. Because of limited data regarding the optimal antifungal drug choice and duration of treatment for P. boydii infections, the proper identification of pathogen and antifungal susceptibility tests have vital importance.
Mediterranean Journal of Infection Microbes and Antimicrobials, 2014
Bruselloz karaciğer tutulumu dahil olmak üzere birçok organı tutabilen sistemik bir hastalıktır. ... more Bruselloz karaciğer tutulumu dahil olmak üzere birçok organı tutabilen sistemik bir hastalıktır. Bu çalışmada kliniğimizde takibi yapılan brusellozlu olgularda hastalığın karaciğer ve dalak üzerine olan etkileri irdelenmiştir. Materyal ve Metod: Bu çalışmada kliniğimizde Temmuz 2006 ile Ekim 2014 tarihleri arasında takip ettiğimiz bruselloz olguları geriye dönük taranmıştır. Bruselloz tanısı mikrobiyolojik kültür olumluluğu ve/veya Wright aglütinasyon testinin 1/160 ve üzeri titrede saptanması ile konuldu. Bulgular: Çalışmaya 102 olgu [43 kadın (%42.2), 59 erkek (%57.8), yaş ortalaması 47.1 ± 16] dahil edilmiştir. Seksen iki (%80.3) hastada 1/160 ve üzeri wright aglütinasyon testi olumluluğu ile üç hastada tanı wright aglütinasyon testi olumsuz olmasına karşın anti-human globülin testi ile tanı konuldu. On yedi (%16.7) hastanın tanısı ise sadece kan kültürü olumluluğu ile konuldu. En sık ilk üç semptom ateş (%63.7), halsizlik (%48) ve bel-kalça ağrısıydı (%48). Ultrasonografi ile hepatomegali ve splenomegali sırasıyla 16 (%15.8) ve 19 (% 18.8) olguda tespit edildi. Hastalarda AST, ALT, ALP, GGT ve toplam bilirubin testlerinde yükseklik sırasıyla %23.8, %24.8, %26.8, %36.6, %12.9 oranında saptandı. Kırk iki (%41.2) hastada bulgu veren karaciğer ilişkili patolojiye rastlanmadı. Herhangi bir patolojiye rastlanmayan hastaların yaş ortalaması 51.1 ± 14.9 yıl iken, diğer hastalarda 44.3 ± 16.3 yıl olarak bulundu (p= 0.035). Tüm hastalarda tedavi sonunda karaciğer fonksiyon testlerinde düzelme saptandı. Hastaların hiçbirinde ciddi yan etki görülmemiştir. Sonuç: Bruselloz öncelikle retiküloendotelyal sistemi etkileyerek karaciğer hasarına da neden olabilen ama tedaviye yanıt oranı yüksek zoonotik bir hastalıktır. Bununla birlikte olgularımızın önemli kısmında ultrasonografi ile karaciğer ilgili herhangi bir patoloji saptanmamıştır. Ülkemiz gibi brusellozun yaygın görüldüğü bölgelerde karaciğer bulgusu olmayan olgularda da bruselloz akılda tutulmalıdır.
Mikrobiyoloji bülteni, 2007
Implementation of antiviral therapy leads to the emergence of mutant strains during the treatment... more Implementation of antiviral therapy leads to the emergence of mutant strains during the treatment in chronic hepatitis B. Hepatitis B virus (HBV) with primary antiviral resistance may be rarely encountered. In this report, a chronic hepatitis B case who had never received adefovir dipivoxil but had primary adefovir resistance, was presented. HBeAg positive 25-year-old male patient was treated with interferon (IFN)-alpha (thrice a week 10 MU) and lamivudine (100 mg/daily) combination for one year. At the end of this treatment although HBV-DNA was under the detectable limit and ALT levels returned to normal, anti-HBe antibodies did not develop. During the course of lamivudin treatment on the third year virus was found to be resistant to lamivudin [FLM+YMDD+YIDD+YVDD (Inno-LiPA HBV DR, Innogenetics Ghent, Belgium)] and adefovir was added to the lamivudin therapy. At the end of eight months of combination therapy, ALT levels did not return to normal and HBV-DNA was still in detectable l...
Journal of Microbiology and Infectious Diseases, 2014
Hepatit A is usually a self-limited, asymptomatic infection. However, severe manifestations of he... more Hepatit A is usually a self-limited, asymptomatic infection. However, severe manifestations of hepatitis may occur rarely in adult patients. Here, we present a case of prolonged, relapsed cholestasis secondary to acute hepatitis infection in an adult patient. A 25-year old male patient had been given symptomatic treatment for weakness, abdominal pain, loss of appetite, pruritis, nausea and generalized jaundice. A week later, he had been diagnosed with acute hepatitis A infection. He admitted to our clinic two months after the first episode with complaints of pruritis and jaundice. His laboratory results included a serum alanine aminotransferase (ALT) level of 86 U/L, aspartate transferase (AST) of 91 U/L, total bilirubin of 46.5 mg/dl and direct bilirubin of 33.9 mg/dl. ursodeoxycholic acid (UDCA) therapy was started due to protracted jaundice, severe itching and a marked elevation in bilirubin levels, which was replaced with prednisolone therapy at a dose of 1 mg/kg/day at 12 days. Most of his clinical symptoms resolved with much lower serum bilirubin levels. No clinical or biochemical deterioration was observed after discontinuation of therapy. One year later his general condition was good with no relapse. There are few case reports in literature about the use of corticosteroids for treatment of prolonged cholestatic jaundice in patients with hepatitis A infection. Based on our findings, we suggest that this type of therapy may be beneficial for relief of symptoms and improvement of serum biochemistry.
Mikrobiyoloji bülteni, 2008
Group C streptococci are flora members of skin, nasopharynx, gastrointestinal and genitourinary s... more Group C streptococci are flora members of skin, nasopharynx, gastrointestinal and genitourinary systems. They are rare causes of human pharyngitis, arthritis, pneumonia, meningitis and bacteremia. In this report, a 71-years old male patient with Streptococcus equisimilis arthritis/prosthetic joint infection has been presented. The patient was admitted to the emergency service with the complaints of erythema, swelling and tenderness on right knee which had total knee prosthesis. Examination of synovial fluid punction sample yielded abundant amount of leukocytes (> 1000 cells/mm3). Empirical ampicillin-sulbactam (1 g q6h, parenterally) therapy was initiated. Bacteria which have been cultivated from synovial fluid specimen were identified as S. equisimilis. The isolate was found to be susceptible to penicilin, erythromycin and teicoplanin, and resistant to chloramphenicol and tetracycline. Although clinical presentation improved during the first ten days, symptoms recurred after the...
International Journal of Infectious Diseases, 2014
Background: Candidaemia is a potentially devastating bloodstream infection predominantly affectin... more Background: Candidaemia is a potentially devastating bloodstream infection predominantly affecting hospitalised, severely ill patients. Despite substantial advances in antifungal agents, candidaemia remains associated with high mortality. Candidaemia may cause severe sepsis and septic shock leading to multiorgan failure. Other complications include deep organ involvement, endocarditis and septic thrombosis. Optimising outcomes of candidaemia and prevention of complications requires timely initiation of adequate antifungal therapy. Methods & Materials: Case report Results: A 73-year-old patient was admitted for pancreatic head resection due to a benign tumour. Two week after the resection patient became septic based on a candidaemia with Candida albicans. The primary antifungal treatment with Anidulafungin was started and on day 7 after improvement of patient the therapy was switched to Fluconazole for another 15 days. All blood cultures taken under antifungal therapy were negative. Transoesophageal echocardiography offered no signs of an endocarditis of the biological aortic valve prosthesis, placed in 2007, or another valve. Ten weeks after the successful treatment of the candidaemia the patient developed septic shock with severe thrombocytopenia. Another transoesophageal echocardiography revealed major vegetation attached to the biological aortic valve prosthesis which was implanted in 2007. During open heart surgery, whitish large, polypous vegetation (outside dimensions of 25 x 22 x 20 mm) was found covering virtually the complete valve opening area of the valve prosthesis. The valve with adherent vegetation was removed en bloc and replaced by a new bioprosthesis. Histopathology revealed a fungal mass comprised of yeasts cells and pseudohyphae that were microbiologically identified as Candida albicans. After the replacement of the valve antifungal treatment with Caspofungin was started. An ophthalmologist diagnosed a bilateral endophthalmitis as a further complication of candidaemia seven days later. Caspofungin was stopped and the antifungal treatment was continued by Fluconazole. Furthermore it was done vitrectomy on the left eye. The patient succumbed three weeks later from acute subarachnoidal hemorrhage. Conclusion: This case shows an endocarditis and endophthalmitis as very late complications of candidaemia almost three month ago. We have to discuss the antifungal management of the primary candidaemia as step down regimen in a patient with biological aortic valve prosthesis as possible cause for these complications.
Tropical doctor, 2003
One hundred and sixty-six presumed brucellosis patients were included in the study. These patient... more One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16-75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37...
Mikrobiyoloji Bulteni, 2014
Mikrobiyoloji Bulteni, 2014
Mikrobiyoloji Bulteni, 2013
Bu çalışmada, hastanemizin anesteziyoloji ve reanimasyon yoğun bakım ünitesi (YBÜ)'nde yatan hast... more Bu çalışmada, hastanemizin anesteziyoloji ve reanimasyon yoğun bakım ünitesi (YBÜ)'nde yatan hastalarda genişlemiş-spektrumlu beta-laktamaz (GSBL) üreten Klebsiella pneumoniae ve Escherichia coli'nin gastrointestinal kolonizasyonu için risk faktörlerinin araştırılması amaçlanmıştır. Çalışmaya, anesteziyoloji ve reanimasyon YBÜ'de prospektif olarak izlenen erişkin olgular dahil edilmiş; olgulardan rektal sürüntü örnekleri hastaneye yattıkları ilk 48 saat içinde alınmış ve taburcu ya da eks oluncaya kadar geçen sürede her hafta tekrarlanmıştır. Alınan örnekler Stuart besiyeri içerisinde laboratuvara ulaştırılmış ve biri 4 mg/L seftazidim içeren iki EMB besiyerine ekilerek 48 saat inkübe edilmiştir. E.coli ve K.pneumoniae izolatlarının tanımlanması klasik yöntemlerle yapılmış; antibiyotik duyarlılık testleri Mueller Hinton agar kullanılarak disk difüzyon yöntemiyle uygulanmış ve "Clinical and Laboratory Standards Institute (CLSI)" protokollerine göre değerlendirilmiştir. GSBL üretimi çift disk sinerji yöntemiyle doğrulanmıştır. Çalışma
ANKEM Dergisi, 2011
Evaluation of 133 Patients with Acute Pyelonephritis Acute pyelonephritis (APN) is bacterial or f... more Evaluation of 133 Patients with Acute Pyelonephritis Acute pyelonephritis (APN) is bacterial or fungal infection of the urinary tract or renal parenchyma. In this study, patients followed up between January 2003 and March 2011 with pyelonephritis were evaluated for laboratory findings, complicating factors and clinical outcome. During the study period there were 133 patients diagnosed with acute pyelonephritis (38 % male, 62 % female, aged 48.8±18.7 years). Seventy-two patients (54 %) had their first APN attack whereas 61 patients had their second or more episodes. There were no complicating factors in 25 % of patients however 16 % of patients had more than one complicating factor, and urinary catheterisation and obstructive uropathy were the most common complicating factors. In this series, complicating factors were detected by ultrasonography in 45 patients (34 %) who did not have such a medical history. In conclusion, APN is a common clinical entity and cases should be evaluated in terms of complicating factors.
ANKEM Dergisi, 2012
Aspergillus spp., yeryüzünde her yerde yaygın olarak bulunan, önemli bir fırsatçı küf mantarıdır.... more Aspergillus spp., yeryüzünde her yerde yaygın olarak bulunan, önemli bir fırsatçı küf mantarıdır. Aspergillus fumigatus invazif aspergillozun en sık rastlanan etkenidir. Bağışıklık sistemi baskılanmış hastalarda nadir olarak spondilodiskit etkeni olarak saptanabilmektedir. Bu yazıda, amiloidoza bağlı gelişen nefrotik sendrom nedeniyle steroid kullanan ve hemodiyalize giren bir olguda A.fumigatus'un etken olduğu ve vorikonazol ile tedavi edilen bir spondilodiskit olgusu sunulmuştur.
Infectious Diseases in Clinical Practice, 2012
Our study aims to determine the efficacy of infectious disease consultations and the interrelatio... more Our study aims to determine the efficacy of infectious disease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 nonYinfectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have separately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expectation of NIDSs in critical infection cases to start the therapy immediately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely accepted among other clinicians and appears to be of a crucial importance.
Scandinavian Journal of Infectious Diseases, 2011
Background: Linezolid is a bacteriostatic antibiotic with good cerebrospinal fl uid penetration. ... more Background: Linezolid is a bacteriostatic antibiotic with good cerebrospinal fl uid penetration. The aim of this study was to evaluate the effi cacy of linezolid in methicillin-resistant staphylococcal (methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS)) meningitis. Methods: We extracted data and outcomes for all adult patients (age Ͼ 18 y) with culture-proven MRSA or MRCoNS meningitis treated with linezolid between January 2006 and September 2010 in our hospital. Demographic, clinical, and laboratory data and predisposing factors, as well as information on response to treatment and outcome were obtained by regular visits. Results: A total of 17 cases (9 MRCoNS, 7 MRSA, and 1 MRCoNS and MRSA mixed) fulfi lled the inclusion criteria. All patients had hospitalacquired meningitis and had undergone neurosurgery. Cumulative microbiological success on day 5 was 88%. There was 1 staphylococcal meningitis-related death. There were no severe adverse events. Conclusions: Our experience with linezolid suggests that it can be an alternative for the treatment of MRCoNS-and MRSA-related meningitis.
Medical Science Monitor, 2012
The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a ... more The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) meningitis. Material/Methods: Meningitis was induced by intracisternal inoculation of ATCC 43300 strain. After 16 h incubation time and development of meningitis, the vancomycin group received vancomycin 20 mg/kg every 12 h. The linezolid-10 and linezolid-20 groups received linezolid in 10 and 20 mg/kg dosages every 12 h, respectively. The control group did not receive any antibiotics. Cerebrospinal fluid bacterial counts were measured at the end of 16-h incubation time and at the end of 24-h treatment. Results: Bacterial counts were similar in all groups at 16 h. At the end of treatment the decrease in bacterial counts in the vancomycin group was approximately 2 logs higher than the linezolid-20 group (p>0.05) and approximately 4 logs higher than in the linezolid-10 group (p: 0.037) (Vancomycin group:-2.860±4.495 versus Linezolid-20:-0.724±4.360, versus Linezolid-10: 1.39±3.37). Full or partial bacteriological response was higher in vancomycin versus linezolid-10 (p: 0.01), but not vancomycin versus linezolid-20 or linezolid-10 versus-linezolid-20 groups. Conclusions: Our results suggest that linezolid is not statistically inferior to vancomycin in the treatment of MRSA meningitis in an experimental rabbit model in 20 mg/kg q12 h dosage; however, it is inferior in 10 mg/kg q12 h dosage. Additional data should gathered to confirm these findings in advance of clinical trials to assess efficacy in humans.
Journal of Antimicrobial Chemotherapy, 2013
International Journal of Infectious Diseases, 2014
Healthcare-associated/nosocomial infections are increasing and important causes of morbidity afte... more Healthcare-associated/nosocomial infections are increasing and important causes of morbidity after spinal surgery in many countries around the world. 1-3 The efficacy of treatment choices is very limited in multidrug-resistant (MDR) Acinetobacter baumannii. For example, there is currently no universally effective antibiotic against MDR. Hence, treatment regimens are tailored according to antibiotic resistance patterns and available antibiotics. 4-6 Tigecycline is a relatively new glycylcycline antimicrobial, active in vitro against a variety of Gram-positive and Gram-negative organisms, including nosocomial MDR pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL) producers, and carbapenem-resistant A. baumannii. The US Food and Drug Administration (FDA) has approved tigecycline for the treatment of complicated intra-abdominal infections, complicated skin and skin structure infections, and community-acquired pneumonia (CAP). However, its pharmacological and microbiological profiles have encouraged physicians to use the drug in hospitalacquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and meningitis caused by MDR and tigecycline-sensitive pathogens featuring limited therapeutic options. Nevertheless, data regarding
International Journal of Infectious Diseases, 2007
Objectives: Infectious diseases (ID) trainees should be familiar with duties relevant to consulta... more Objectives: Infectious diseases (ID) trainees should be familiar with duties relevant to consultation practice. In this study we aimed to analyze the ID trainee night/weekend shift consultation process in terms of consultant characteristics, types of recommendations, and compliance with recommendations. Methods: All consultations performed by ID trainees on the night shift and at the weekends between 10 June and 10 August 2004 were recorded prospectively on standardized forms. Infectious diseases specialists assessed the appropriateness of recommendations the day after each consultation. Recommendations were considered complied with if they were carried out within 72 hours of the consultation. Results: Of 440 consultations, 163 were for a clinically diagnosed infection (without specific antibiotic request) and 79 were for treatment continuation. Overall, 152 consultations were for requesting specific antibiotic(s), and 327 antibiotics were recommended or approved in 270 consultations. Eight of these recommendations were inappropriate. Overall compliance to ID recommendations was 75.3% (418/555). In univariate analysis, the compliance rate to nontreatment recommendations (microbiologic cultures, radiology, biochemistry, etc.) was found to be lower than the rate of compliance to antibiotic recommendations (186/308 vs. 232/247, p < 0.05). In addition, compliance to recommendations made by the first-year trainees was lower than to the recommendations made by the other trainees. In logistic regression analysis only