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    Antimicrobial Resistance and Molecular Patterns in Community-acquired Complicated Intra-abdominal Infections: A Multicentric Study
    (2020) Oğuz, Vildan Avkan-; Baykam, Nurcan; Korten, Volkan; Abdullayeva, Madina; Yapar, Derya; Mülazımoğlu, Lütfiye; Gülay, Zeynep
    Objective: We aimed to analyze antimicrobial susceptibilities by a molecular evaluation of extended-spectrum beta-lactamase (ESBL) positive of the isolates from communityacquired complicated intra-abdominal infections (CA- IAIs) in Turkey. Method: Clinical samples were obtained during operation. Antimicrobial susceptibilities, inducible beta-lactamase and ESBL status, were determined using Clinical and Laboratory Standards Institute criteria and interpretive standards. ESBL positive and cefoxitin-resistant isolates were evaluated bla genes for CTX-M, TEM, SHV, PER-1 and plasmidic AmpC families with polymerase chain reaction (PCR). We confirmed the results by directly sequencing the bla genes (Macrogen Inc, Korea) with Mega 5.02 and BLAST programs. Results: We isolated 116 pathogens from 81 patients. Clinicians diagnosed 34 (42.1%) patients as acute appendicitis, 15 (18.5%) as cholecystitis, 14 (17.3%) as intra-abdominal abscess, 12 (14.8%) as tumor resection and six (7.3%) acute diverticulitis. Escherichia coli (E. coli) was the most common gram-negative (76%), Enterococcus spp. was the most common gram-positive (13.6%). ESBL production was 12, 3 % in all gram-negative strains; 11, 1% (9/62) in E. coli and 1, 2% (1/9) Klebsiella pneumoniae (K. pneumonia). Quinolone resistance was 22.2% and ceftriaxone resistance was 14.5% in E. coli. We detected CTX-M genes in five of nine ESBL positive isolates. CTX-M-1 group (CTX-M-1, CTX-M-3, and CTX-M-15) was in four and CTX-M-9 group (CTX-M-14) in one ESBL positive E. coli. One isolate had also AmpC, CMY-2 enzyme (1, 6 %). Conclusion: In our study, ESBL positive gram-negative pathogens were >10%. Quinolone resistance was >% 20, so that quinolones should not be the first choice for the treatment of serious IAI's in our country. Cefoxitin resistance was still low in E. coli isolates from CA-IAIs. Regular surveillance data can guide empirical antibiotic therapy in community-acquired intra-abdominal infections. It should emphasize the importance of sampling for culture to surgeons for guiding empirical therapy in the future.
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    Clinical, radiological and prognostic features of influenza cases in the influenza epidemic during years 2016-2017
    (Ankara Üniversitesi, 2018) Erçen Diken, Özlem; Arslan, Sertaç; Akdoğan, Özlem; Yapar, Derya; Ünal, Özgür; Demir, Emre; Baykam, Nurcan
    Introduction: Influenza subtypes vary by clinical, radiological, and prognostic courses and may go along with viral pneumonia. We aimed to identify clinical, radiological, and prognostic aspects of influenza epidemic during years 2016-2017. Materials and Methods: Influenza cases reported to the Public Health Directorate in our city was assessed retrospectively. Clinical, radiological, and prognostic parameters were compared based on influenza subtypes. Results: We analyzed samples from 197 cases with suspected influenza. Mean age of the subjects was 51.17 ± 26.74. We found influenza A/H1N1, influenza A/H3N2, and influenza B in 59 (30.0%), 29 (14.7%), and 3 (1.5%) cases, respectively. Comorbidity was present in 48 (24.4%) cases. Most common radiological finding was interstitial pattern. Seventy-one and 79 per cent of H1N1 and H3N2 cases were influenza pneumonia, respectively. The prevalence of overall mortality was 5.5% with a predominance in H1N1 over H3N2. Influenza vaccination had been performed in 6.8% and 3.4% of H1N1 and H3N2 cases, respectively. We detected no mortality in any vaccinated patient. We identified 6 pregnant women, 2 of which ended up with preterm birth, and another one with abortion. Conclusion: Often manifested as lower respiratory tract infection, influenza may cause epidemics with increased mortality rate. Influenza should be suspected when interstitial pattern was seen on radiological images. H1N1 cases course worse. Since the prognosis is better in vaccinated patients, seasonal influenza vaccination among the community needs to be elevated. In addition, protective measures like vaccination should be taken in pregnancy to avoid preterm delivery or abortion. © 2018, Ankara University. All rights reserved.
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    Cytokine response in crimean-congo hemorrhagic fever virus infection
    (John Wiley and Sons Inc., 2017) Ergönül, Önder; Şeref, Ceren; Eren, Şebnem; Çelikbaş, Aysel; Baykam, Nurcan; Dokuzoğuz, Başak; Gönen, Mehmet; Can, Füsun
    We described the predictive role of cytokines in fatality of Crimean Congo Hemorrhagic Fever Virus (CCHFV) infection by using daily clinical sera samples. Consequent serum samples of the selected patients in different severity groups and healthy controls were examined by using human cytokine 17-plex assay. We included 12 (23%) mild, 30 (58%) moderate, 10 (19%) severe patients, and 10 healthy volunteers. The mean age of the patients was 52 (sd 15), 52% were female. Forty-six patients (88%) received ribavirin. During disease course, the median levels of IL-6, IL-8, IL-10, IL-10/12, IFN-?, MCP-1, and MIP-1b were found to be significantly higher among CCHF patients than the healthy controls. Within the first 5 days after onset of disease, among the fatal cases, the median levels of IL-6 and IL-8 were found to be significantly higher than the survived ones (Fig. 3), and MCP-1 was elevated among fatal cases, but statistical significance was not detected. In receiver operating characteristic (ROC) analysis, IL-8 (92%), IL-6 (92%), MCP-1 (79%) were found to be the most significant cytokines in predicting the fatality rates in the early period of the disease (5 days). IL-6 and IL-8 can predict the poor outcome, within the first 5 days of disease course. Elevated IL-6 and IL-8 levels within first 5 days could be used as prognostic markers. © 2017 Wiley Periodicals, Inc.
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    Epidemiology of viral hepatitis changes in our country
    (Viral Hepatitis Society, 2018) Baykam, Nurcan; Güner, Rahmet
    The most important interventions in our country that significantly affect the epidemiology of viral hepatitis are the introduction of hepatitis B vaccine into the routine vaccination program for newborns since 1998 and the introduction of catch up vaccination strategies and screening for high-risk groups. In addition, the development of our surveillance system, the introduction of hepatitis A vaccine into the routine vaccination program, and the addition of studying nucleic acid testing to serological screening in blood donors are other important interventions
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    Hitit Index to distinguish patients with and without Crimean-Congo hemorrhagic fever
    (Elsevier Gmbh, 2019) Kayadibi, Hüseyin; Yapar, Derya; Akdoğan, Özlem; Ulusu, Nuray N.; Baykam, Nurcan
    Crimean-Congo hemorrhagic fever (CCHF) is fatal. Therefore, it is very important to use an inexpensive, easily accessible, quick and accurate screening index based on clinical signs and laboratory parameters to identify patients suspected of having CCHF. Laboratory test results on the day of hospitalization for 268 inpatients suspected of having CCHF were used to calculate the laboratory section of the Hitit Index, while 65 of these were also monitored daily during their hospital stay to develop the clinical section of the Hitit Index. Two-hundred CCHF-negative outpatients were also evaluated. One-hundred and forty-nine inpatients were CCHF-positive and 119 inpatients were CCHF-negative. The Hitit Index is 5.6 - (5.3*lymphocyte) - (0.02*fibrinogen) - (12*direct bilirubin) + (0.04*AST) + (0.32*hematocrit) - (0.5*neutrophil) - (0.07*CKD-EPI) - (0.001*CK) +/- conjunctival hyperemia (+1.5 in conjunctival hyperemia presence and -1.5 in conjunctival hyperemia absence). In 65 inpatients monitored daily, Hitit Index results for CCHF-positive and negative inpatients were 6.10(1.90-12.30) and -5.35(-8.83- -1.95), while CCHF-negative outpatients were -10.99(-15.64- -6.95) (P < 0.001), respectively. On hospitalization day, just one inpatient was false-negative in 27 CCHF-positive inpatients, while four were false-positive among 38 CCHF-negative inpatients using the Hitit Index. After 24 h, just one inpatient was diagnosed falsely among 27 CCHF-positive and 38 CCHF-negative inpatients, and there was no change after 48 h. Management of patients living in endemic regions suspected of having CCHF could be achieved within minutes using the Hitit Index. Patients with Hitit Index less than zero can be monitored as outpatients, while patients with Hitit Index results above zero must be hospitalized in infectious diseases wards. This study was not registered since it was retrospective.
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    Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi’nde lenfadenopati ön tanılı olguların toksoplazmoz açısından irdelenmesi
    (Refik Saydam Hıfzıssıhha Merkezi Başkanlığı, 2017) Güreser, Ayşe Semra; Yapar, Derya; Taşçı, Leyla; Boyacıoğlu, Zehra İlkay; Turgal, Ebru; Baykam, Nurcan; Taylan Özkan, Hikmet Ayşegül
    Amaç: Sağlıklı insanlarda genellikle asemptomatik seyreden toksoplazmozun en sık görülen semptomatik formu lokalize lenfadenopati (LAP)'dir. Bu çalışmada LAP ön tanısı ile başvuran hastaların toksoplazmoz açısından irdelenmesi amaçlanmıştır. Yöntem:01.08.2013-31.07.2015 tarihleri arasında Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği'ne LAP ön tanısı ile başvuran 239 (%57,70 kadın, %42,30 erkek) hastaya ait demografik, serolojik, radyolojik ve patolojik veriler hastane bilgi sisteminden (HBS) elde edilmiştir. Anti-Toxoplasma IgG ve IgM testleri Architect (Abbott Diagnostics) veya Cobas E 601 (Roche Diagnostics) cihazlarıyla kemilüminesan yöntemiyle çalışılmıştır.mikropartikül enzimimmünassay Bulgular: Hiçbirinde immunsupresyon hikayesi olmayan hastalardan 138 kadının 51 (%36,96)'inde, 101 erkeğin 13 (%12,87)'ünde IgG ve/veya IgM antikoru pozitifti. Hem erkeklerde (%3,76) hem de kadınlarda (%10,46) en yüksek antikor pozitiflik oranı 39 yaş altındadır. Hastaların 48 (%20,10)'inde yalnızca anti-Toxoplasma IgG, 12 (%5)'sinde ise IgG ve IgM birlikte ve dört (%1,70)'ünde ise tek başına IgM pozitifliği belirlenmiştir. Anti-Toxoplasma IgM'i pozitif 16 hastadan 7 (%2,93)'si 39 yaş altı kadın olup yalnızca ikisinde çalışılan IgG avidite testi yüksek avidite olarak bulunmuştur. IgM pozitif olan hastaların ultrasonografisine ulaşılan 12'sinde, altısında çoklu tutulum olmak üzere LAP'ların dağılımı şöyledir: yedi bilateral servikal, beş submandibular, üç parotis, 3 oksipital, bir submental, bir retroaurikular. LAP'ların en küçüğü 6x5 mm, en büyüğü ise 24x12 mm ebatlarındadır. Toksoplazmoz IgM pozitif hastalardan üçüne ince iğne aspirasyon biyopsisi yapılmış, birinde reaktif lenfoid hiperplazi, ikisinde kronik nonspesifik lenfadenit tespit edilmiştir. LAP ve IgM pozitif olan altı hastaya tedavi verildiği ve LAP'larında gerileme olduğu belirlenmiştir.Sonuç: Sonuç olarak çalışmamızda belirlediğimiz %6,70'lik IgM pozitifliği klinisyenlerin LAP etiyolojisinde toksoplazmozu akılda tutması gerekliliğini ortaya koymaktadır. Bu amaçla LAP incelemesinde yer alan hekimlere ayırıcı tanı ve toksoplazmozda serolojik tanının yeri konusunda eğitim verilmesi önerilir.
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    Nadir Görülen Olgu: Skabiese Bağlı Lökositoklastik Vaskülit
    (2020) Yapar, Derya; Akdoğan, Özlem; Baykam, Nurcan
    Skabies, Sarcoptes scabiei’nin neden olduğu kaşıntılı bir kutanöz parazitozdur. Lökositoklastik vaskülit (LCV) erişkinlerde sık görülen vaskülit olup sıklıkla idiopatiktir ancak enfeksiyon, otoimmün hastalıklar, malinite veya ilaçlara bağlı gelişebilir. Literatürde skabiese bağlı LCV ile ilgili az sayıda olgu bildirilmiştir. Skabiese bağlı olduğunu düşündüğümüz LCV olgumuzu literatür incelemesi eşliğinde tartışmayı istedik. Altmış iki yaşında erkek hasta iki gündür olan öksürük, balgam, ateş ve bacaklarında bir buçuk aydır olan kaşıntılı döküntü şikayetleri ile başvurdu. Pnömoniye yönelik tedavi başlandı. Kaşıntılı makülopapüler ve purpurik döküntüleri olan hastaya skabies tanısı konuldu. Hastanın eşinde de kaşıntılı cilt lezyonlarının olduğunu öğrendik. Topikal permetrin tedavisi başlandı. Vaskülitik lezyonlarından alınan cilt biyopsisinde lökositoklastik vaskülit tespit edildi. Kitlesel malinite, otoimmün hastalıklar, infeksiyöz nedenler ekarte edildi. Topikal tedavi ile vaskülitik lezyonların iyileştiği görüldü. Hastamızda topikal permetrin tedavisi ile vaskülitik lezyonların iyileşmesi, diğer nedenlerin ekarte edilmesi ve eşinde benzer şikayetlerin olması ile skabies ve skabiese sekonder gelişen LCV tanısını düşündük. Özellikle kaşıntılı lezyonlarda skabiese bağlı LCV gibi nadir görülen komplike bir olguda iyi alınan anamnezin tanıyı kolaylaştıracağını düşündük.
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    Nedeni Bilinmeyen Ateş Nedeni: Supskapular Apse
    (2020) Yapar, Derya; Akdoğan, Özlem; Baykam, Nurcan
    Subskapular apse literatürde az sayıda olgu olması ve erken dönemde tanı konulup acil cerrahi müdahale gerektirmesi nedeniyle nadir ama ciddi klinik bir durumdur. Bu yazıda travma ya da cerrahi girişim olmaksızın metisiline dirençli Staphylococcus aureus septisemisine neden olan, erken dönemde tanısı konulan ve tedavi edilen spontan subskapular apse olgusu sunulmuştur
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    Predicting tularemia with clinical, laboratory and demographical findings in the ED
    (W.B. Saunders, 2016) Yapar, Derya; Erenler, Ali Kemal; Terzi, Özlem; Akdoğan, Özlem; Ece, Yasemin; Baykam, Nurcan
    Introduction We aimed to determine clinical, laboratory and demographical characteristics of tularemia on admission to Emergency Department (ED). Material and Methods Medical data of 317 patients admitted to ED and subsequently hospitalized with suspected tularemia between January 1, 2011, and May 31, 2015, were collected. Patients were divided into 2 groups according to microagglutination test results, as tularemia (+) and tularemia (-). Results Of the 317 patients involved, 49 were found to be tularemia (+) and 268 were tularemia (-). Mean age of the tularemia (+) patients was found to be higher than that of tularemia (-) patients. When compared to tularemia (-) patients, a significant portion of patients in tularemia (+) patients were elderly, living in rural areas and had contact with rodents. When clinical and laboratory findings of the 2 groups were compared, any statistical significance could not be determined. Conclusion Tularemia is a disease of elderly people living in rural areas. Contact with rodents also increases risk of tularemia in suspected patients. © 2015 Elsevier Inc.
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    Recommendations for intra-abdominal infections consensus report
    (Turkish Surgical Association, 2016) Oğuz Avkan, Vildan; Baykam, Nurcan; Sökmen, Selman; Güner, Rahmet; Ağalar, Fatih; Alp, Emine; Doğrul, Ahmet; Turhan, Özge; Ağalar, Canan; Kurtaran, Behice; Geçim, İbrahim Ethem; Özaras, Reşat; Yılmaz, Gürdal; Akbulut, Ayhan; Koksal, İftihar
    Guidelines include the recommendations of experts from various specialties within a topic in consideration of data specific to each country. However, to date there has not been a guideline standardizing the nomenclature and offering recommendations for intra-abdominal infections (IAIs) in Turkey. This is mainly due to the paucity of laboratory studies regarding the clinical diagnosis and treatment of IAIs or the sensitivity of microorganisms isolated from patients with IAIs. However, due to the diversification of host characteristics and advancements in technological treatment methods, it has become imperative to 'speak a common language'. For this purpose May 2015, a group of 15 experts in intra-abdominal infections, under the leadership of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey (EKMUD) and with representatives from the Turkish Surgical Association, Turkish Society of Colon and Rectal Surgery, Hernia Society, Turkish Society of Hepato-pancreato-biliary Surgery, and the Turkish Society of Hospital Infections and Control, was formed to analyze relevant studies in the literature. Ultimately, the suggestions for adults found in this consensus report were developed using available data from Turkey, referring predominantly to the 2010 guidelines for diagnosing and managing complicated IAIs in adults and children by the Infectious Diseases Society of America (IDSA) and the Surgical Infection Society. The recommendations are presented in two sections, from the initial diagnostic evaluation of patients to the treatment approach for IAI. This Consensus Report was presented at the EKMUD 2016 Congress in Antalya and was subsequently opened for suggestions on the official websites of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey and Turkish Surgical Association for one month. The manuscript was revised according to the feedback received. © Copyright 2016 by Turkish Surgical Association.
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    The role of T reg population in pathogenesis of Crimean Congo hemorrhagic fever
    (Elsevier B.V., 2018) Gazi, Umut; Yapar, Derya; Karasartova, Djursun; Güreser, Ayşe Semra; Akdoğan, Özlem; Ünal, Özgür; Baykam, Nurcan; Taylan Özkan, Hikmet Ayşegül
    Crimean-Congo hemorrhagic fever (CCHF) is a severe human infection caused by CCHF virus (CCHFV). Today, although the literature on CCHF pathogenesis is still limited, it is thought to be associated with immunosuppression in the early phase of infection followed by pro-inflammatory immune response that may lead to fatal outcomes. The aim of this study is to investigate the role of regulatory T-cells (T reg cells) in the pathogenesis of CCHFV. Peripheral blood mononuclear cell samples collected from 14 acute CCHF patients with mild disease course and 13 healthy subjects were included in this study. T reg expression and functional levels were analyzed by flow cytometry. T reg cells were identified as CD4+CD25 + CD127dim cells, and their functional levels were compared by measuring their ability to suppress CD69 and CD154 expression by activated T-cells. The flow cytometry analysis revealed that total T-cell and helper T-cell levels did not vary between the two groups. In contrast, CCHF patients displayed higher T reg cell levels but lower T reg suppressive activities when compared with control subjects. This is the first study on the involvement of T reg cells in CCHF pathogenesis. Our results indicate that even though T reg cell levels are elevated during acute phase of CCHF infection, not all generated T reg cells has immunosuppressive capacity, and therefore may not represent ‘true’ T reg cell population. Future studies on the intrinsic mechanisms responsible for the reduced T reg inhibitory activities are required for further enlightening the CCHF pathogenesis, especially in the acute phase of the disease. © 2018 Elsevier B.V.
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    Ülseratif Koliti Olan Bir Hastada Sitomegalovirus Koliti
    (Aves, 2020) Akdoğan, Özlem; Yapar, Derya; Düzenli, Tolga; Kaplan, Gülcan; Tunçel Öztürk, Pınar; Özçerezci, Tuğba; Baykam, Nurcan; Kocagül Çelikbaş, Aysel
    Sitomegalovirus (CMV), immünosüprese bireylerde, gastrointestinal sistem de dahil olmak üzere ağır, kalıcı ve yaşamı tehdit eden hastalıklara neden olabilir. Yedi yıldan beri ülseratif kolit tanısıyla Gastroenteroloji Polikliniği’nde takip edilen 71 yaşında kadın hastanın, karın ağrısı ve kanlı ishal şikayetlerinin alevlenmesi nedeniyle yapılan kolonoskopisinde yer yer mukoza ülserasyonları ve psödopolipler gözlendi. Histomorfolojik bulgular CMV kolitiyle uyumluydu. İmmünohistokimyasal boyamada CMV antijen-pozitif hücreler görüldü. Polimeraz zincir reaksiyonu testiyle CMV DNA doku biyopsi örneklerinde 257 000 kopya/ mg, serumda ise 137 kopya/ml olarak saptandı. Bir ay süreyle gansiklovir 2×5 mg/kg İV uygulandıktan sonra serumda ve doku biyopsisi örneklerinde CMV DNA sonuçlarının negatifleştiği saptandı. Klinik tablosu kısmi bir düzelme gösteren hasta, tedavisi üç aya tamamlanmak üzere oral valgansiklovire geçilerek taburcu edildi. Başlanan tedaviye devam etmemesi üzerine, hasta üç ay sonra yineleyen karın ağrısı ve kanlı ishal şikayetleriyle yeniden yatırıldı. Kolon biyopsisi materyalinde CMV DNA 814 kopya/mg bulunması üzerine başlanan metilprednizolon ve gansiklovir tedavisine yanıt alınamayınca, tedavi rejimine infliksimab da eklendi. Bu tedaviyle hastanın doku ve serum CMV DNA negatif oldu ve klinik tablosunda düzelme oldu. Gansiklovir kesilerek hasta IFX tedavisine devam edilmek üzere taburcu edildi. Hastanın altı aylık takibinde yeni bir atak gelişmedi. Bu olgu da göstermektedir ki, ülseratif kolit hastalarında, benzer bulguları olabilen CMV koliti akılda bulundurulması bir fırsatçı infeksiyondur.
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    Which one should be prefered: liver biopsy or non-invasive procedures?
    (Galenos Yayınevi, 2017) Güner, Rahmet; Baykam, Nurcan
    In this recent issue of Journal of Viral Hepatitis, Karacaer et al. (1) aimed to evaluate the percutan liver biopsy safety. Liver biopsy has currently some major roles that are diagnosis, assesment of prognosis (especially staging of parenchymal liver diseases) and deciding of therapy. It is seen as the gold standard according to current clinical practice. Because of its some restrictive and limiting features and some complications, several non-invasive methods have been developed (2)