Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item The Turkish Clinical Microbiology and Infectious Diseases Society (KLIMIK) Evidence-Based Guideline for the Diagnosis and Treatment of Brucellosis, 2023(2023) Simsek-Yavuz, Serap; Ozger, Selcuk; Benli, Aysun; Ates, Can; Aydin, Mehtap; Aygun, Gokhan; Azap, Alpay; Azap, Ozlem; Basaran, Seniha; Demirturk, Nese; Ergonul, Onder; Kocagul-Celikbas, Aysel; Kuscu, Ferit; Saricaoglu, Elif Mukime; Sayin-Kutlu, Selda; Turker, Nesrin; Turkoglu-Yilmaz, EmineAlthough brucellosis is very common in the world and Turkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBIM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies.Item Risk Factors for Occupational Brucellosis Among Veterinary Personnel in Turkey(2014) Kutlu, Murat; Ergonul, Onder; Sayin-Kutlu, Selda; Guven, Tumer; Ustun, Cemal; Alp-Cavus, Sema; Ozturk, Serife Baron; Acicbe, Ozlem; Akalin, Serife; Tekin, Recep; Tekin-Koruk, Suda; Demiroglu, Yusuf Ziya; Keskiner, Ramazan; Gonen, Ibak; Sapmaz-Karabag, Sevil; Bosnak, Vuslat; Kazak, Esra; https://orcid.org/0000-0002-9866-2197; 25132061; AAZ-9711-2021Veterinarians and veterinary technicians are at risk for occupational brucellosis. We described the risk factors of occupational brucellosis among veterinary personnel in Turkey. A multicenter retrospective survey was performed among veterinary personnel who were actively working in the field. Of 712 veterinary personnel, 84(11.8%) had occupational brucellosis. The median number of years since graduation was 7 (interquartile ranges [IQR], 4-11) years in the occupational brucellosis group, whereas this number was 9 (IQR, 4-16) years in the non-brucellosis group (p < 0.001). In multivariable analysis, working in the private sector (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.55-5.28, p = 0.001), being male (OR, 4.5; 95% CI, 1.05-18.84, p = 0.041), number of performed deliveries (OR, 1.01; 95% CI, 1.002-1.02, p = 0.014), and injury during Brucella vaccine administration (OR, 5.4; 95% CI, 3.16-9.3, p < 0.001) were found to be risk factors for occupational brucellosis. We suggest that all veterinary personnel should be trained on brucellosis and the importance of using personal protective equipment in order to avoid this infection. (C) 2014 Elsevier B.V. All rights reserved.Item European Society of Clinical Microbiology and Infectious Diseases Guidelines for Coronavirus Disease 2019: An Update on Treatment of Patients with Mild/Moderate Disease(2022) Bartoletti, Michele; Azap, Ozlem; Barac, Aleksandra; Bussini, Linda; Ergonul, Onder; Krause, Robert; Martin-Quiros, Alejandro; Pano-Pardo, Jose Ramon; Power, Nicholas; Sibani, Marcella; Szabo, Balint Gergely; Tsiodras, Sotirios; Zollner-Schwetz, Ines; Rodriguez-Bano, Jesus; 36028088Scope: Despite the large availability of vaccines, coronavirus disease 2019 (COVID-19), induced by severe acute respiratory syndrome coronavirus 2, continues to be a major threat for health-care providers and fragile people. A number of options are now available for outpatients with mild-to-moderate COVID-19 at the risk of disease progression for the prevention of deaths or hospitalization. Methods: A European Society of Clinical Microbiology and Infectious Diseases COVID-19 guidelines task force was established by the European Society of Clinical Microbiology and Infectious Diseases Executive Committee. A small group was established, half appointed by the chair and the remaining selected based on an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the population, intervention, comparison, outcome format was developed at the beginning of the process. For each population, intervention, comparison, outcome, two panel members performed a literature search, with a third panelist involved in case of inconsistent results. Voting was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations: In this update, we focus on anti-viral agents, monoclonal antibodies (mAbs) and other treatment options proposed for patients with mild or moderate COVID-19 who are at the risk of hospitalization or death. Although the use of anti-virals is recommended, especially nirmatrelvir/ritonavir and remdesivir or, alternatively, molnupirarvir, the administration of mAbs against the spike protein strictly depends on circulating variants or the ability to test timely for variants and sub-variants. At the time of writing (AprileJune 2022), the only active mAb was tixagevimab/cilgavimab given the predominance of the Omicron BA.2, BA.3, BA.4 and BA.5 sub-lineages in Europe. However, considering that the epidemiological scenario is extremely dynamic, constant monitoring of variants of concern is mandatory. Michele Bartoletti, Clin Microbiol Infect 2022;28:1578Item In Memoriam: Prof. Dr. Kenan Midilli (1963-2022)(2022) Aygun, Gokhan; Aygun, Pakize; Azap, Alpay; Benzonana, Nur; Can, Fusun; Ergonul, Onder; Kurt-Azap, Ozlem; Kuskucu, Mert Ahmet; Simsek-Yavuz, Serap; Turan, Ayfer; 0000-0002-3171-8926; AAK-4089-2021Item Promoters of Colistin Resistance in Acinetobacter Baumannii Infections(2019) Nurtop, Elif; Bilman, Fulya Bayindir; Menekse, Sirin; Azap, Ozlem Kurt; Gonen, Mehmet; Ergonul, Onder; Can, Fusun; https://orcid.org/0000-0002-3171-8926; 30964377; AAK-4089-2021Objectives: We aimed to describe the mechanisms of colistin resistance in Acinetobacter baumannii. Materials and Methods: Twenty-nine patients diagnosed with colistin-resistant A. baumannii infection were included to the study. The mutations in pmrCAB, lpxA, lpxC, and lpxD genes, expression of pmrCAB, carbapenemases, and mcr-1 positivity were studied. Results: Twenty-seven (93%) of the patients received IV colistin therapy during their stay, and the case fatality rate was 45%. All mutations in pmrC and pmrB were found to be accompanied with a mutation in lpxD. The most common mutations were I42V and L150F in pmrC (65%), E117K in lpxD (65%), and A138T in pmrB (58.6%). The colistin minimum inhibitory concentrations (MICs) of the isolates having any of these four mutations were higher than the isolates with no mutations (p < 0.001). The two most common mutations in pmrC (I42V and L150F) were found to be associated with higher expressions of pmrA and pmrC and higher colistin MIC values (p = 0.010 and 0.031). All isolates were bla(OXA-23) positive. Conclusion: Coexistence of the lpxD mutation along with mutations in pmrCAB indicates synergistic function of these genes in development of colistin resistance in A. baumannii.Item The Clinical Impact of ST131 H30-Rx Subclone in Urinary Tract Infections Due To Multidrug-Resistant Escherichia Coli(2016) Can, Fusun; Kurt-Azap, Ozlem; Ispir, Pelin; Nurtop, Elif; Seref, Ceren; Loclar, Ilayda; Aktas, Ozge Nur; Orhan, Yelda Ceren; Ergonul, Onder; 27436393In this study, risk factors for ST131 H30 and H30-Rx subclones among urinary tract infections (UTIs) caused by multidrug-resistant (MDR) Escherichia coli were described. Urine samples were collected from consecutive outpatients registered to the outpatient clinics of Bas, kent University Hospital (Ankara, Turkey) with complaints of acute cystitis in 2011. A total of 107 MDR E. coli isolates were included in the study. Of the 107 isolates studied, 26 (24.3%) were typed as ST131 clone. Extended-spectrum beta-lactamase (ESBL)-producers accounted for 59 (55.1%) of the 107 isolates. Among the 59 ESBL-positive isolates, 18 (31%) were found to belong to the ST131 clone. Of the 18 ESBL-positive ST131 isolates, 17 (94%) were defined as H30 subclone, among which 16 (94%) represented the H30-Rx subclone. Among the 48 ESBL-negative isolates, 8 (17%) ST131 isolates were detected, 7 (88%) of which belonged to H30 subclone; 5 (71%) of the H30 subclone isolates were classified under H30-Rx subclone. In multivariate analysis, hospitalisation within last year was the only host risk factor associated with MDR E. coli ST131 H30-Rx subclone UTI (OR = 3.5, 95% CI 1.04-12.17; P = 0.042). CTX-M-15 production was found to be highly associated with the presence of ST131 H30-Rx subclone (OR = 4.8, 95% CI 1.54-15.32; P = 0.007). In conclusion, urinary MDR E. coli ST131 H30-Rx subclone was found to be important in the dissemination of MDR UTIs in the community. Approximately 20% of the MDR isolates were H30-Rx subclone. Infection with this subclone was found to be healthcare-associated. (C) 2015 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.Item Antifungal Stewardship(2017) Azap, Ozlem K.; Ergonul, Onder; https://orcid.org/0000-0002-3171-8926; AAK-4089-2021Item Inappropriate use of ivermectin during the COVID-19 pandemic: primum non nocere!(2022) Barac, Aleksandra; Bartoletti, Michele; Azap, Ozlem; Bussini, Linda; Ergonul, Onder; Krause, Robert; Ramon Pano-Pardo, Jose; Power, Nicholas R.; Rodriguez-Bano, Jesus; Sibani, Marcella; Szabo, Balint Gergely; Tsiodras, Sotirios; Verweij, Paul E.; Martin Quiros, Alejandro; Zollner-Schwetz, Ines; 35337977Item Comparison Of Ceftazidime-Avibactam Susceptibility Testing Methods Against OXA-48-Like Carrying Klebsiella Blood Stream Isolates(2022) Isler, Burcu; Vatansever, Cansel; Ozer, Berna; Cinar, Gule; Aslan, Abdullah Tarik; Stewart, Adam; Simos, Peter; Falconer, Caitlin; Bauer, Michelle J.; Forde, Brian; Harris, Patrick; Simsek, Funda; Tulek, Necla; Demirkaya, Hamiyet; Menekse, Sirin; Akalinj, Halis; Balkan, Ilker Inanc; Aydin, Mehtap; Tigen, Elif Tukenmez; Demir, Safiye Koculu; Kapmaz, Mahir; Keske, Siran; Dogan, Ozlem; Arabaci, Cigdem; Yagci, Serap; Hazirolan, Gulsen; Bakir, Veli Oguzalp; Gonen, Mehmet; Saltoglu, Nese; Azap, Alpay; Azap, Ozlem; Akova, Murat; Ergonul, Onder; Paterson, David L.; Can, Fusun; 35843111Ceftazidime-avibactam exhibits good in vitro activity against carbapenem resistant Klebsiella carrying OXA-48-like enzymes. We tested two hundred unique carbapenem resistant Klebsiella blood stream isolates (71% with single OXA-48-like carbapenemases, including OXA-48, n = 62; OXA-232, n = 57; OXA-244, n = 17; OXA-181, n = 5) that were collected as part of a multicentre study against ceftazidime-avibactam using Etest (bioMerieux, Marcyl'Etoile, France), 10/4 mg disc (Thermo Fisher) and Sensititre Gram Negative EURGNCOL Plates (Lyophilized panels, Sensititre, Thermo Fisher) with the aim of comparing the performances of the Etest and disc to that of Sensititre. Ceftazidime-avibactam MIC50/90 was 2/> 16 mg/L for the entire collection and was 2/4 mg/L for single OXA-48-like producers. Categorical and essential agreements between the Etest and Sensititre were 100% and 97%, respectively. Categorical agreement between the disc and Sensititre was 100%. Etest and 10/4 mg discs are suitable alternatives to Sensititre for ceftazidime-avibactam sensitivity testing for OXA-48-like producers. (C) 2022 Elsevier Inc. All rights reserved.Item Characteristics And Outcomes Of Carbapenemase Harbouring Carbapenem-Resistant Klebsiella Spp. Bloodstream Infections: A Multicentre Prospective Cohort Study In An OXA-48 Endemic Setting(2022) Isler, Burcu; Ozer, Berna; Cinar, Gule; Aslan, Abdullah Tarik; Vatansever, Cansel; Falconer, Caitlin; Dolapci, Istar; Simsek, Funda; Tulek, Necla; Demirkaya, Hamiyet; Menekse, Sirin; Akalin, Halis; Balkan, Ilker Inanc; Aydin, Mehtap; Tigen, Elif Tukenmez; Demir, Safiye Koculu; Kapmaz, Mahir; Keske, Siran; Dogan, Ozlem; Arabaci, Cigdem; Yagci, Serap; Hazirolan, Gulsen; Bakir, Veli Oguzalp; Gonen, Mehmet; Chatfield, Mark D.; Forde, Brian; Saltoglu, Nese; Azap, Alpay; Azap, Ozlem; Akova, Murat; Paterson, David L.; Can, Fusun; Ergonul, Onder; 35301623A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam.