Browsing by Author "Timurkaynak, Funda"

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Bloodstream Infections: Etiologic Agents and Their Antibiotic Resistance Rates
(2016) Aydin, Mehtap; Kasikcioglu, Cemre; Nargiz-Kosucu, Sibel; Timurkaynak, Funda; Arslan, Hande; 0000-0002-5708-7915; ABG-7034-2021
Objective: In this study, we aimed to investigate the etiological agents of bloodstream infections (BSIs) and their antibiotic resistance rates. Methods: The rates of antibiotic resistance of the microorganisms isolated from blood cultures in the microbiology laboratory between 2012 and 2013 were evaluated retrospectively. Blood cultures were performed by using BACTEC (TM) 9120 (Becton Dickinson, Sparks, MD, USA) automated system. Microorganisms that were isolated were identified by routine microbiological methods. Results: In our study, BSIs were most frequently detected in the cardiovascular surgery clinic. Out of 95 bacteria isolated from blood culture, 61 (64.2) were Gram-negative bacteria (46% enteric, 18% nonfermentative), 20 (21%) were Candida spp. and 14 (15%) were Gram-positive bacteria. The most effective antibiotics for enteric bacteria were found as colistin, followed by imipenem, meropenem and amikacin and for nonfermentative Gram-negative bacteria as colistin, cefepime, piperacillin-tazobactam, imipenem and amikacin. Conclusions: When the resistance rates were compared within two years, significant increases in resistance were observed for quinolones and ceftazidime in nonfermentative bacteria, and for carbapenems in enteric bacteria. Regular monitoring of etiological agents of BSIs and their antibiotic resistance rates will guide the selection of empiric therapy.
In vitro Susceptibility of Tigecycline against Multidrug-Resistant Gram-Negative Strains: Etest versus Agar Dilution
(2014) Ozkok, Sezen; Togan, Turhan; Yesilkaya, Aysegul; Timurkaynak, Funda; Azap, Ozlem Kurt; Arslan, Hande; https://orcid.org/0000-0003-0225-6416; https://orcid.org/0000-0002-3171-8926; https://orcid.org/0000-0002-5708-7915; 25791941; A-8902-2013; AAK-4089-2021; ABG-7034-2021
Background and Aim: Tigecycline is a semi-synthetic tetracycline with activity against most multidrug-resistant (MDR) bacteria. Methods: We studied in vitro activity of tigecycline by agar dilution (AD) and Etest methods to evaluate their correlation. The study included 206 isolates of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, Klebsiella pneumoniae and MDR Acinetobacter baumannii recovered from blood cultures of patients of Baskent University between 2008 and 2010. Results: ESBL-producing E. coli had MIC50 /MIC90 values of 0.5/0.5 mu g/ml by AD and 0.25/0.5 mu g/ml by Etest. ESBL-producing K. pneumoniae had MIC50 /MIC90 values of 1/2 mu g/ml by AD and 0.75/2 mu g/ml by Etest, whereas MDR A. baumannii had MIC50 /MIC90 values of 4/4 mu g/ml by AD and 2/4 mu g/ml by Etest. The correlation between AD and Etest was weak for ESBL-producing E. coli and strong for ESBL-producing K. pneumoniae and MDR A. baumannii. Tigecycline MIC values for ESBL-producing E. coli were lower than the tigecycline concentration, while they were higher than the concentrations attainable by treatment doses for A. baumannii. Conclusion: Tigecycline is an appropriate agent in the treatment of E. coli bacteremia, but it is not for treating A. baumannii bacteremia. Tigecycline could be used for K. pneumoniae bacteremia treatment after determining its MIC value. Determining the MIC value by gold-standard methods is more appropriate due to the correlation between Etest and AD at high MIC values. (C) 2015 S. Karger AG, Basel
Kikuchi-Fujimoto Disease in a Patient with Mediastinal Lymphadenopathy
(2014) Turan, Hale; Serefhanoglu, Kivanc; Apiliogullari, Burhan; Aribas, Olgun Kadir; Ekici, Zuhal; Timurkaynak, Funda; Arslan, Hande; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0003-3225-2686; https://orcid.org/0000-0002-5708-7915; ABG-7034-2021; AAV-4737-2021; AAD-5602-2021; ABG-7034-2021
Kikuchi-Fujimoto disease is a benign self-limited syndrome with distinct histopathologic characteristics. Clinical symptoms include cervical lymphadenopathy with tenderness, fever of medium grade, night sweats, nausea, vomiting, and a sore throat. It is a rare disease worldwide. Diagnosis is based on histopathologic findings from an excisional lymph node biopsy. We present the case of a 37-year-old male patient with a fever of 15 days' duration. Clinical examination revealed no other pathologic signs except for oral aphthous lesions and a fever of unknown origin. The patient's fever did not resolve after 15 days' follow-up, and the results of computed tomographic study of the thorax revealed several sites of mediastinal lymphadenopathy. The diagnosis of Kikuchi-Fujimoto disease (histiocytic necrotising lymphadenitis) was based on the results of pathologic examination of the biopsy specimen. The patient's signs and symptoms resolved without antibiotic therapy. This case report of a patient with a fever of unknown origin is presented because of the rare involvement of mediastinal lymphadenopathy without cervical lymphadenopathy. Kikuchi-Fujimoto disease should be considered in the differential diagnosis of the patient who presents with fever and mediastinal lymphadenopathy.
Yoğun bakım hastalarında Candida albicans ve Non-albicans kandida türlerine bağlı gelişen kandidemilerde risk faktörlerinin belirlenmesi
(Başkent Üniversitesi Tıp Fakültesi, 2009) Çağır, Ünal; Timurkaynak, Funda
Fungal infeksiyon sıklığı son yıllarda artıs göstermektedir. Hastane kaynaklı fungal infeksiyonların büyük bir kısmı kandida türleri ile olusmaktadır. Kandida türlerine bağlı kan dolasım sistemi infeksiyonları 1980-1990 yılları arasında on kat artıs göstermistir. Günümüzde kronik hastalık ve invaziv islem sıklığındaki artıs ile beraber, yoğun antibakteriyel ve sitotoksik tedavi uygulaması sonucunda kandidemi görülme oranı artmaktadır. Hastane kökenli kan dolasım sistemi infeksiyon etkenleri arasında kandida türleri dördüncü sıklıkta görülmekte ve ciddi mortalite ve morbiditeye neden olmaktadır. Bu çalısmada yoğun bakım ünitesinde izlenen ve C.albicans ve non-albicans türlere bağlı kandidemi gelisen olguların risk faktörleri açısından değerlendirilmesi amaçlandı. Ocak 2004-Aralık 2007 tarihleri arasında dahili ve cerrahi yoğun bakım ünitelerinde yatan ve kandidemi gelisen hastalar çalısmaya alındı. Her hasta için demografik veriler, klinik ve laboratuvar bulguları ve uygulanan girisimleri içeren form dolduruldu. Veriler retrospektif olarak değerlendirildi. Đsatatiksel değerlendirme için chikare ve student T test uygulaması yapıldı. Çalısmaya 120 kandidemi olgusu alındı. Olguların 70’inde (%58.3) C.albicans, 50’sinde (% 41.7) non-albicans kandida türleri ile kandidemi gelisti. Non-albicans türlerin dağılımı; C.tropicalis (%12.5), C.glabrata (%7.5), C.famata (%6.7), C.parapsilosis (%3.3) ve diğer türler (C.keyfr,C.lucitenia,C.humonicola, C.guilliermondi, Candida spp) (%11.7) seklinde idi. Çalısmadaki 120 kandidemi olgusunun 47’si (%39.1) 2007 yılında görüldü. Çalısmamızda tüm yıllarda C.albicans en sık izole edilen tür idi. Tüm nozokomiyal kandidemi olgularının %74’ü yoğun bakım ünitelerinde yatan hastalarda görüldü. Çalısmada; yas, cinsiyet, APACHE- II skoru, uygulanan terapatik islemler (santral venöz kateter, total parenteral nütrisyon, entübasyon, üriner kateter), kulanılan antibiyotikler (karbapenem, glikopeptid, sefalosporin, kinolon. aminoglikozid) ve cerrahi girisimlerin (gastrointestinal sistem ve gastrointestinal sistem dısı) C.albicans ve non-albicans türlere bağlı kandidemi açısından anlamlı fark yaratmadığı saptandı. Uzun süreli yoğun bakımda yatıs, kandidemi öncesi flukonazol tedavisi ve solid organ transplantasyonu, non-albicans türler ile kandidemi gelisimi için risk faktörü olarak bulundu. Her iki grup arasında antifungal tedaviye yanıt açısından anlamlı fark olmamakla birlikte C.albicans olgularının %70.6’sının tedavinin ilk 6-10. günlerinde, non-albicans türlerin ise 11-15. günlerde tedaviye yanıt verdikleri görüldü. Her iki grup arasında mortalite açısından anlamlı fark bulunmadı. Son yıllarda non-albicans türler ile kandidemi sıklığında artıs olmasına karsın bir çok merkezde C.albicans en sık izole edilen tür olarak belirlenmektedir. Çalısmamızda benzer sekilde C.albicans en sık kandidemi etkeni olarak belirlenmistir. Ancak nonalbicans türlerin hızla arttığı gözlenmistir. Çalısmamızda non-albicans türlere bağlı kandidemi gelisimi için solid organ transplantasyonu, kandidemi öncesi flukonazol tedavisi ve uzun süreli yoğun bakımda yatıs risk faktörü olarak belirlenmistir. Erken ve etkin antifungal tedavinin mortalite ve morbidite üzerine olumlu etkisi göz önüne alındığında, her merkezin kendi hasta özelliklerine, risk faktörlerine ve lokal surveyans sonuçlarına göre tedavi planlamasının önemi ortaya çıkmaktadır. Fungal infections have been increasing in frequency over the past years. The majority of nosocomial fungal infections are caused by Candida species. Bloodstream infections due to Candida species. have increased 10 fold between 1980 and 1990. Nowadays the rate of candidemia has raised with excessive antibacterial and cytotoxic treatment applications associated with an increase in chronic diseases and invasive process frequencies. Among the agents that cause nosocomial bloodstream infections, Candida spp. are the fourth most common agent, and associated with serious morbidity and mortality. This study aimed to evaluate the risk factors in intensive care unit patients with candidemia caused by C.albicans and non-albicans Candida species. The patients with candidemia, followedup in internal and surgical intensive care units, were enrolled in the study between January 2004 and December 2007. Structured forms, including demographic data, clinical and laboratory findings and applications, were fulfilled for each patient. The data were evaluated retrospectively. Chi-square and student-t test were used for statistical analysis. A hundred and twenty patients were enrolled in the study. Candidemia caused by C.albicans and non-albicans Candida species developed in 70 (58.3%) and 50 (41.7%) patients, respectively. The distribution of non-albicans Candida species was as follow: C.tropicalis (12.5%), C.glabrata (7.5%), C.famata (6.7%), C.parapsilosis (3.3%) and other species (C.kefyr,C.lusitaniae,C.humonicola, C.guilliermondi, Candida spp) (11.7%). Forty seven (39.1%) of 120 patients in the study were hospitalized in 2007. C.albicans was the most common isolated pathogen in all years of our study. Seventy four percent of all nosocomial candidemia cases were detected in intensive care units. In this study age, gender, APACHE- II score, therapeutic procedures (central venous catheter, total parenteral nutrition, intubation, urinary catheter), antibiotics (carbapenem, glicopeptide, cephalosporin, quinolone. aminoglycoside) and surgical procedures (gastrointestinal system or other systems) did not cause any significant difference on candidemia caused by C.albicans and non-albicans Candida species. Long term hospitalization in intensive care unit, fluconazole treatment before the onset of candidemia, and solid organ transplantation were found to be risk factors in the development of candidemia with non-albicans Candida species. While there was no statistically difference between two groups in response to antifungal therapy, %70.6 of C.albicans cases responded to therapy within 6-10 days compared to non-albicans Candida cases who responded within 11-15 days. No significant difference in mortality was observed between two groups. Although the frequency of candidemia due to non-albicans species of Candida has increased in recent years, C.albicans is the most common isolated pathogen in many centers. Likewise C.albicans was the most common cause of candidemia in our study. However non-albicans species are increasingly detected. In our study solid organ transplantation, fluconazole treatment before the onset of candidemia and long term hospitalization in intensive care unit were found to be risk factors in the development of candidemia with non-albicans Candida species. Each center should have an empirical treatment modality according to patients’ characteristics, risk factors and local surveillance results by considering the benefical effects of early and effective treatment on mortality and morbidity.