Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Role of Bronchoalveolar Lavage in Diagnosis of Fungal Infections in Liver Transplant Recipients(2015) Tepeoglu, Merih; Atilgan, Alev Ok; Ozdemir, B. Handan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-8595-8880; 0000-0002-7528-3557; 0000-0002-9894-8005; 25894185; AAJ-8097-2021; AAK-3333-2021; X-8540-2019; AAK-5222-2021Objectives: Pulmonary fungal infections remain the most important cause of morbidity and mortality in liver transplant recipients. Fast and accurate causative diagnoses are essential for a good outcome. Bronchoscopy with bronchoalveolar lavage frequently is performed to diagnose pulmonary infections in immunocompromised patients. The aim of this study was to evaluate the diagnostic use of bronchoalveolar lavage in liver transplant recipients with pulmonary infections. Materials and Methods: We retrospectively analyzed the data of 408 patients who underwent liver transplant from January 1990 to December 2012. Patients who underwent bronchoalveolar lavage after transplant were included in this study. Results: There were 18 of 408 liver transplant recipients (4.41%) who underwent bronchoalveolar lavage after transplant. The mean age was 49.5 +/- 18 years. In 5 patients (27.8%), fungal microorganisms were observed in the cytology of bronchoalveolar lavage specimens, including Aspergillus fumigatus in 3 patients and Candida albicans in 2 patients. Death occurred in 4 of 5 patients (80%) with fungal infections. No association was observed between the presence of fungal infection and clinical and radiographic findings of the patients. Conclusions: Bronchoscopy with bronchoalveolar lavage is a useful, noninvasive diagnostic tool for the rapid diagnosis of infections in solid-organ transplant recipients.Item Epidemiology, Species Distribution, Clinical Characteristics and Mortality of Candidaemia in A Tertiary Care University Hospital in Turkey, 2007-2014(2017) Yesilkaya, Aysegul; Azap, Ozlem; Aydin, Mehtap; Ok, Mehtap Akcil; https://orcid.org/0000-0003-0225-6416; https://orcid.org/0000-0002-3171-8926; https://orcid.org/0000-0003-4044-9366; 28338249; A-8902-2013; AAK-4089-2021; HLX-0937-2023; AAZ-8170-2020Candidaemia still continues to be a serious medical concern and the epidemiology of candidaemia varies according to geographical areas. We aim to determine the incidence, local epidemiology, Candida species distribution and crude mortality rates of candidaemia. We retrospectively evaluated candidaemia episodes in between January 2007 and August 2014. We compared demographic, clinical, microbiological findings and mortality rates of episodes caused by Candida albicans and non-albicans Candida species. Overall the candidaemia incidences were 1.23 episodes/1000 admissions. A significant negative slope among candidaemia episodes and years was determined. Overall C. albicans (54.6%) was the most common species followed by Candida glabrata, Candida tropicalis and Candida parapsilosis respectively. Preinfection hospital stay and length of hospital stay were statistically longer in patients with non-albicans Candida candidaemia than in patients with C.albicans candidaemia. The source of candidaemia was unknown in 52.5% of all episodes. Central venous catheters among non-albicans Candida candidaemia episodes and urinary system among C.albicans candidaemia episodes were common source of candidaemia compared to each other. Previous antifungal therapy preceding candidaemia and concomitant bacteraemia were significantly associated with non-albicans Candida candidaemia. Continuous local surveillance will preserve its pivotal importance in formulating empirical antifungal therapy and improving management of candidaemia.Item Biofilm-forming capacity of blood-borne Candida albicans strains and effects of antifungal agents(2018) Demirbilek, Muge; Turan, Hanni; 28988900Infections related to Candida albicans biofilms and subsequent antifungal resistance have become more common with the increased use of indwelling medical devices. Regimens for preventing fungal biofilm formation are needed, particularly in high-risk patients. In this study, we investigated the biofilm formation rate of multiple strains of Candida albicans (n = 162 clinical isolates), their antifungal susceptibility patterns, and the efficacy of certain antifungals for preventing biofilm formation. Biofilm formation was graded using a modified Christensen's 96-well plate method. We further analyzed 30 randomly chosen intense biofilm-forming isolates using the XTT method. Minimum biofilm inhibition concentrations (MBIC) of caspofungin, micafungin, anidulafungin, fluconazole, voriconazole, posaconazole, itraconazole, and amphotericin B were determined using the modified Calgary biofilm method. In addition, the inhibitory effects of antifungal agents on biofilm formation were investigated. Our study showed weak, moderate, and extensive biofilm formation in 29% (n = 47), 38% (n = 61), and 23% (n = 37) of the isolates, respectively. We found that echinocandins had the lowest MBIC values and that itraconazole inhibited biofilm formation in more isolates (26/32; 81.3%) than other tested agents. In conclusion, echinocandins were most effective against formed biofilms, while itraconazole was most effective for preventing biofilm formation. Standardized methods are needed for biofilm antifungal sensitivity tests when determining the treatment and prophylaxis of C. albicans infections. (c) 2017 Asociacion Argentina de Microbiologia. Published by Elsevier Espana, S.L.U.Item Yoğun bakım hastalarında Candida albicans ve Non-albicans kandida türlerine bağlı gelişen kandidemilerde risk faktörlerinin belirlenmesi(Başkent Üniversitesi Tıp Fakültesi, 2009) Çağır, Ünal; Timurkaynak, FundaFungal 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.