Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Acute Respiratory Distress Syndrome Associated with Legionnaires' Disease: Two Case Reports(2018) Erdogan, Haluk; Arslan, Hande; 0000-0002-9033-4236; 0000-0002-5708-7915; O-2247-2015; ABG-7034-2021Introduction: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of illness, bilateral chest radiographic infiltrates consistent with pulmonary edema, and poor systemic oxygenation. ARDS has severe morbidity and mortality. The most common risk factor for the development of community-acquired ARDS is severe sepsis with a pulmonary source of infection. The first step in the therapy of ARDS is identification and treatment of the underlying disease. Here, we report two cases of ARDS associated with Legionnaires disease. Case 1: A 54-year-old male tourist with diabetes mellitus apply to our institution with diarrhea and high fever. At the time of admission, the patient had a temperature of 39.5 degrees C, a blood pressure of 140/70 mmHg, a heart rate of 102 beats/min and a respiratory rate of 24 breaths/min. His oxygen saturation was 93% while breathing room air. Chest examination revealed rales and the chest x-ray showed right-lower zone infiltrates. Legionella urinary antigen was positive on admission day. Treatment with levofloxacin (1000 mg/day) was started in the first 4 hours of admission after taking cultures. The patient had progressive dyspnea and cyanosis was developed. Analysis of arterial blood gas revealed a pH of 7.29, CO2 pressure of 30 mmHg, O-2 pressure of 37 mmHg and oxygen saturation of 62%. Roentgenogram of the chest worsened and showed bilateral infiltration, indicating ARDS. Thirty-two hours after admission, the patient was admitted to intensive care unit for ventilator support. The patient's clinical status continued to deteriorate. He was hypotensive and required dopamine infusions for blood pressure support. Legionella pneumophila serogroup 1 was isolated on sputum culture. Five days after hospitalization, chlarithromycin (1000 mg/day) and ciprofloxacin (1200 mg/day) were substituted for the initial antibiotics. The patient had nosocomial pneumonia caused by methicilline resistant Staphylococcus aureus during subsequent days. Vancomycine 2 gr/days was added to treatment. Clinical status improved and the body temperature fell below 37.5 degrees C on the eleventh day. On the patient's relatives' request, he was flown back to his country by air ambulance. One year later, the patient came back again as a tourist and had fully recovered from the illness. Case 2: A 82-year-old female with diabetes mellitus applied to our institution with high fever, dyspnea and mental change. She had been treated for pulmonary edema without any response to this therapy in a private hospital. She had been hospitalized in another hospital due to gastrointestinal bleeding approximately two weeks prior to her application. Chest examination revealed diffuse rales and the chest x-ray showed bilateral infiltrates. Analysis of arterial blood gas revealed pH of 7.31, CO2 pressure of 41.7 mm Hg, O-2 pressure of 21.9 mmHg and oxygen saturation of 33.6%. The patient was admitted to intensive care unit for ventilator support. Legionella urinary antigen was positive on admission day. Treatment with ciprofloxacin (1200 mg/day) and chlarithromycin (1000 mg/day) was started on admission after taking cultures. Legionella pneumophila serogroup 1 was isolated on endotracheal aspirate culture. The patient died on the 7th day. Conclusions: The clinicians should be aware of Legionnaires disease in etiology of ARDS. Early diagnosis and treatment are important factors in determining prognosis.Item Antimicrobial Resistance of Salmonella Isolates in A Holiday Center on the South of Turkey(2016) Erdogan, Haluk; Erdogan, Askin; Arslan, Hande; 0000-0002-9033-4236; 0000-0002-5708-7915; O-2247-2015; AAD-5420-2020; ABG-7034-2021Objective: Salmonella is an important pathogen that causes food-borne infection in children and adults worldwide. The aim of this study is to evaluate the antimicrobial activity of antimicrobial agents against Salmonella isolates in Alanya, an important holiday center in Turkey. Material and Method: The study was carried out at Baskent University Alanya Research and Teaching Hospital between January 2004 and September 2013. Salmonella spp. were isolated from stool samples and stored at -80 degrees C for antimicrobial susceptibility. Antimicrobial susceptibility was determined according to the Clinical and Laboratory Standards Institute (CLSI) criteria. The antimicrobial agents tested against Salmonella spp. included ampicillin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol, nalidixic acid, ciprofloxacine and ceftriaxone. Quality control was ensured by testing Escherichia coli ATCC 25922. Results: A total of 63 consecutive Salmonella spp. were assessed for their antimicrobial susceptibility patterns, 21 of which were obtained from travellers. Serogroup D1 was the most common serotype (65.1%), followed by B (22.2%), A (7.9%), C1 (1.6%) and C2-C3 (3.2%). The resistances against ampicillin, tetracycline, trimethoprim-sulfamethoxazole and chloramphenicol were found to be 15.9%, 15.9%, 14.3%, and 11.1%, respectively. None of the strains was resistant to ciprofloxacin and ceftriaxone, while 14.3% were nalidixic acid-resistant. Antimicrobial resistance rates of Salmonella isolates obtained from travellers and local residents were not significantly different (p>0.05). Conclusion: This study suggests that ciprofloxacin and ceftriaxone can be used as empirical therapies in patients who are suspected to have salmonellosis with predisposing factors to severe infection and a history of travel to Alanya, Turkey. However, the nalidixic acid resistance of Salmonella isolates may be a cause for concern.Item 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-7034-2021Objective: 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.Item The Effect of Extensively Drug-resistant Infections on Mortality in Surgical Intensive Care Patients(2018) Sahinturk, Helin; Ozdemirkan, Aycan; Kilic, Fatma; Ozalp, Onur; Arslan, Hande; Zeyneoglu, Pinar; Pirat, ArashObjective: The aim of the study was to assess the outcomes of intensive care unit acquired extensively drug-resistant (XDR) bacterial infections in a surgical patient cohort. Materials and Methods: The data of patients with XDR bacteria isolated at Baskent University Hospital, Anesthesia and Surgical Intensive Care Unit between January 2016 and December 2016 were reviewed retrospectively. Adult patients over 18 years of age who had undergone surgery within the first 24 hours and who developed intensive care unit infection 48 hours after admission to intensive care unit were included in the study. Results: All of the 341 patients who admitted to the surgical intensive care unit during the study period were underwent surgery within the first 24 hours. XDR bacterial infections were isolated in 30 out (9%) of these 341 patients. The mean APACHE II score was calculated as 18.5 +/- 5.3, and expected mean mortality rate of 35 +/- 17.1. The mean length of intensive care unit stay was 27.0 +/- 27.4 days, while the mean hospital stay was 49.0 +/- 34.3 days. The hospital mortality rate was found to be 57% (n=7). Conclusion: As a conclusion of our study, we found that XDR bacterial infections were common (9%) among intensive care surgical patients and their mortality rate was higher than their expected mortality rate according to their APACHE II scores calculated during intensive care unit admission (57% vs. 35%, respectively).