Cevahir, Nural
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61
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340
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| Journal | Count |
|---|---|
| Mikrobiyoloji Bulteni | 10 |
| Mikrobiyoloji Bülteni | 9 |
| İnfeksiyon Dergisi | 5 |
| American Journal of Infection Control | 2 |
| Biomedical Research (India) | 2 |
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Article Citation - WoS: 2Citation - Scopus: 2Investigation of CTX-M type beta-lactamases in Klebsiella pneumoniae clinical isolates by phenotypic and molecular methods(2009) Tikveşll, S.; Cevahir, N.; Kaleli, I.Rapid spread of CTX-M type extended-spectrum beta-lactamases (ESBL) between the members of Enterobacteriaceae receives attention increasingly all throughout the world. The aim of this study was to investigate the presence of CTX-M type ESBL in Klebsiella pneumoniae clinical strains by phenotypic and molecular methods. A total of 217 non-repetitive K.pneumoniae strains isolated from clinical specimens (152 urine, 20 sputum, 17 wound swabs, 13 blood, 9 tracheal aspirate, 3 CSF and 3 conjunctival swab samples) of inpatients (n= 128) and outpatients (n= 89) admitted to Pamukkale University Medical Faculty Hospital, between January 2006 - January 2007, were included to the study. In vitro antimicrobial susceptibilities were determined by disk diffusion technique in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines, and CT (cefotaxime)/CTL (cefotaxime-clavulanate) containing E-test strips (AB Biodisk, Sweden) were applied for phenotypic detection of cefotaximase production. PCR was performed for the detection of CTX-M genes and the subgroups, while the clonal relatedness of the CTX-M positive isolates was investigated by random amplified polymorphic DNA (RAPD) analysis. While imipenem resistance was not detected in any of the isolates, highest rates of resistance were detected for ampicillin (94%) and cephalothin (64.5%) in 217 K.pneumoniae strains. Using the E-test 39.6% (86/217) of the isolates were found positive, and CTX-M positivity was significantly higher in the strains isolated from inpatients (87.4%) than outpatients (12.6%) (p< 0.001). CTX-M gene was identified in 22.1% (19/86) of the E-test positive isolates. All of the CTX-M positive isolates were identified as CTX-M group-1. The highest resistance rates of CTX-M-1 strains were detected for amoxycillin-clavulanate (94.7%) and netilmicin (89.5%), while the lowest rates were detected for ciprofloxacin (26.3%), trimethoprim/sulphamethoxazole (26.3%) and amikacin (42.1%). RAPD identified 11 different banding patterns among the 19 CTX-M-1 positive isolates, the most frequent clusters being Kp3 (n= 3), Kp4 (n= 3) and Kp5 (n= 3). Five of the 8 isolates from pediatric intensive care unit and 4 of the 5 isolates from other pediatric wards exhibited the same band pattern indicating a possible clonal dissemination. Continuous surveillance of beta-lactamases and the identification of their types in gram-negative enteric bacteria has important clinical impact, since it can often provide valuable information for effective infection control measures and for the choice of appropriate antimicrobial therapy.Article Citation - WoS: 25Citation - Scopus: 33Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets(2006-11) Sacar, Suzan; Turgut, Huseyin; Kaleli, Ilknur; Cevahir, Nural; Asan, Ali; Sacar, Mustafa; Tekin, KorayBackground: Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. Methods: Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. Results: According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. Conclusion: Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them. © 2006 Association for Professionals in Infection Control and Epidemiology, Inc.Article Citation - WoS: 9Citation - Scopus: 12Evaluation of virulence factors in enterococcus species(ANKARA MICROBIOLOGY SOC, 2017-04-15) Mete, Ergun; Kaleli, Ilknur; Cevahir, Nural; Demir, Melek; Akkaya, Yuksel; Kiris Satilmis, OzgunEnterococci have recently become important due to their increased isolation rates in community-based and nosocomial infections and resistance to many antibiotics, including glycopeptides. The aim of this study was to evaluate the antimicrobial susceptible patterns and virulence factors of various clinical specimens; urine (n= 149), blood (n= 38), wound (n= 17), stool (n= 13), and other (n= 12) with a total of 229 enterococci including 138 E. faecalis and 91 E. faecium isolates. Aggregation factor (AF), enterococcus surface protein (esp), cytolysins and gelatinase encoding genes (asa1, esp, cylM, cylBcyl A, cylll, cylls, gelE, respectively) were investigated by molecular methods. Haemolysin production and gelatinase were studied phenotypically. A total of 30 isolates, 29 of E. faecium and one of E. faecalis isolates were resistant to vancomycin. High-level gentamicin and high-level streptomycin resistance in E. faecalis were 40.7% and 63.7% however, they were 47.1% and 55.8% in E. faecalis isolates. All strains were susceptible to linezolid. Ampicillin, penicillin and vancomycin resistance in E. faecium isolates were found to be higher than E. faecalis isolates (p= 0.001, p= 0.008 and p< 0.001). Asa1 (p< 0.001), cylll (p= 0.002) and cylls (p< 0.001) as well as gelatinase activity in isolates of E. faecalis were significantly higher than the isolates of E. faecium (p< 0.001). The most common virulence genes in our study were asa1 gene (45%), cyLs gene (33.2%) and esp gene (32.3%). Ciprofloxacin resistance in cylLL and cyLs gene positive isolates of E. faecalis were significantly higher compared to isolates that do not contain these genes (p= 0.035 and p= 0.047). Likewise, haemolysin producing E. faecium isolates were significantly more resistant to vancomycin compared to isolates that do not produce hemolysin (p< 0.001). When the virulence factors of vancomycin resistant and susceptible isolates were compared, the esp gene level in VRE E. faecium isolates was found to be 24.1%, while no esp gene was found in VRE E. faecalis isolates. The existence of asa1was negative in both VRE E. faecium and VRE E. faecalis isolates. The activity of hemolysin was found 42.3% for E. faecalis and 19.3% for E. faecium. In vancomycin-sensitive enterococcus (VSE) species, esp gene activity was 35.1% for E. faecalis, 29.4% for E. faecium, asa1 gene activity was 60.8% for E. faecalis and 47.1% for E. faecium, hemolysin activity was 52.8% for E. faecalis and 23.5% for E. faecium. In our study, it was found that VSE isolates have more virulence genes than VRE isolates. It should be kept in mind that VRE can causeinfections which are difficult-to-treat especially in hospitalized patients and VSE have significant virulence factors that can cause severe infections.Conference Object Comparison of antimicrobial agents in the treatment of experimental endocarditis due to methicillin-resistant Staphylococcus aureus(JOHN WILEY & SONS LTD, 2010) Sacar, M.; Sacar, S.; Cevahir, N.; Onem, G.; Teke, Z.; Asan, A.; Turgut, HAbstract Not AvailableArticle Investigation of Beta-Lactamases in carbapenem-resistant A. Baumannii isolates(Kuwait Medical Association, 2015) Cevahir, Nural; Gürbüz, Melahat; Demir, Melek; Kaleli, İlknurObjectives: To investigate the prevalence of PER-1, PER-2, GES, IMP-1, VIM-2, OXA-23, and OXA-24 type beta-lactamases in carbapenem-resistant Acinetobacter baumannii isolates, in view of the fact that Beta-lactamase production is the most important mechanism of acquired beta-lactam resistance in Gram-negative pathogens. Design: Experimental study Setting: Department of Medical Microbiology, School of Medicine, Pamukkale University, Denizli, Turkey Subjects: From January 2009 to December 2009, a total of 98 carbapenem-resistant A. baumannii bacteria were isolated from patients. Intervention: In-house PCR was performed for the detection of PER-1, PER-2, GES, IMP-1, VIM-2, OXA-23, and OXA-24 beta-lactamase genes in those clinical carbapenem-resistant A. baumannii isolates. Main Outcome Measure: Prevalence rate of beta-lactamase genes in carbapenem-resistant A. baumannii isolates Results: GES beta-lactamase was found in 59 isolates (60.20%). PER-1 was found in eight isolates (8.16%). IMP-1 was found in five isolates (5.10%). OXA-24 was detected in two isolates (2.04%). No isolate possessed VIM-2, PER-2, or OXA-23 beta-lactamase genes. Conclusion: This study indicates that the GES type beta-lactamases are the most prevalent among carbapenem-resistant A. baumannii isolates in our hospital. Screening for beta-lactamases and strict infection control for these isolates will help prevent further spread of resistance. © 2015, kuwait Medical Association. All rights reserved.Article Pamukkale Üniversitesi Hastanesi Dermatoloji Polikliniği'ne başvuran hastalarda dermatofitoz etkenleri(2004) Ergin, Çağrı; Ergin, Şeniz; Kaleli, İlknur; Erdoğan, Şanlı Berna; Cevahir, Nural; Kaçar, NidaBu çalışmanın amacı, Denizli'deki dermatofitoz etkenlerini saptamak idi. Pamukkale Üniversitesi Hastanesi'nde dermatomikoz öntanılı 753 hastadan 1160 klinik örnek alındı ve 248'inden (%21.4) dermatofit izole edildi. Bu kökenlerin 171'i (%68.95) Trichophyton rubrum, 50'si (%20.16) T. mentagrophytes, 10'u (%4.03) Epidermophyton floccosum, dokuzu (%3.63) T. tonsurans, yedisi (%2.82) Microsporum canis ve bir tanesi (%0,41) T. verrucosum olarak tanındı. Saçsız deri ve tırnak infeksiyonlarında en yaygın etkenin T. rubrum olduğu görüldü.Article Citation - WoS: 1The alteration of the antibiotic sensitivity of pseudomonas aeruginosa strains isolated from nosocomial infections by year(2012) Saçar, S.; Asan, A.; Cenger, D.H.; Cevahir, Nural; Çaylak, S.D.; Turgut, HüseyinObjective: Antibiotic resistance is an important problem for the treatment of P. aeruginosa infections. The aim of this study is to determine the alteration of the infection rates and antibiotic sensitivity of hospital-acquired P. auruginosa strains throughout the years and to evaluate the empirical treatment options. Material and Method: This study was performed in all patients hospitalized between 2004 and 2006. The antibiotic sensitivity of P. aeruginosa isolated by classical methods was determined according to the criteria of the Clinical and Laboratory Standards Institute. Results: In the study period, 228 P. aeruginosa strains were evaluated. The hospital infection rate of P. aeruginosa was found to be 0.3%, 0.9% and 0.9% among the years of 2004, 2005 and 2006, respectively. Amikacin was found the most sensitive aminoglycoside, and betalactam antibiotic sensitivity decreased between the years. Multidrug resistance for P. aeruginosa was increased from 9.3% to 15.3%. Conclusions: We suggest that amikacin, piperacillintazobactam and imipenem should be the first antibiotics choices for empirical treatment of pseudomonas infections due to the fact, multidrug resistance is a increasing by years and can be eliminated by the restriction of inappropriate antibiotic treatment.Other İdrar örneklerinin piyüri, bakteriyüri ve kültür yönünden değerlendirilmesi(2001) Demir, Melek; Cevahir, Nural; Kaleli, İlknur; Zencir, MehmetBu çalışmada, idrar yolu infeksiyonu tanısında idrar mikroskobisi ile kültür sonuçlarının karşılaştırılması amaçlanmıştır. Laboratuvara idrar kültürü amacı ile gönderilmiş 146'sı çocuk yaş grubundan ve 490'nı erişkin yaş grubundan toplam 636 idrar örneği çalışma kapsamına alındı. Santrifüj edilmemiş idrar örneğinde Thoma lamında mm3 de 10 ve üzerinde lökosit varlığı piyüri, Gram boyamada mikroskopta immersiyonla incelenen her alanda en az bir mikroorganizmanın varlığı bakteriyüri yönünden pozitif kabul edildi. Piyüri ve bakteriyürinin kültürdeki anlamlı üreme ile ilişkileri değerlendirildi. Örneklerin %55.8 (355)'inde üreme saptanmazken %13.8 (88)'inde anlamlı üreme, %30.3 (193)'ünde kontaminasyon saptandı. Anlamlı üreme görülen 88 örnekte en sık izole edilen mikroorganizma Escherichia coli idi. Çalışma kapsamına alınan 636 örnekten 199 (%31.3)'unda bakteriyüri, 128 (%20)'inde piyüri saptanmıştır. Anlamlı üreme olarak değerlendirilen 88 örneğin 49'unda piyüri, 58'inde bakteriyüri pozitif olarak belirlendi. Kültürdeki anlamlı üreme ile karşılaştırıldığında; piyüri için duyarlılık %55.7, özgüllük %92.6, bakteriyüri için duyarlılık %65.9, özgüllük %88.0 olarak bulunmuştur.Article Citation - WoS: 5Citation - Scopus: 5Comparison of the Therapeutic Efficacy of Linezolid and Vancomycin and Correlation of Serum and Tissue Malondialdehyde and Myeloperoxidase in an Experimental Mediastinitis Model(2009-03) Sacar, Suzan; Sacar, Mustafa; Aybek, Hulya; Turgut, Huseyin; Onem, Gokhan; Cevahir, Nural; Teke, ZaferBackground: We aimed to investigate the therapeutic efficacy of linezolid in an experimental mediastinitis model and to compare it with vancomycin, which is commonly used. The objective of this study was also to evaluate the role of the immune system in mediastinitis. Materials and methods: Fifty adult Wistar rats were randomly divided into five groups: an uncontaminated and contaminated untreated control groups; a group that received sefazolin prophylaxis; and two groups treated with vancomycin or linezolid. Median sternotomy without access to pleural spaces was performed on all rats. All groups, except the uncontaminated one, were inoculated with 0.5 mL 108 colony-forming units/mL methicillin-resistant Staphylococcus aureus in the mediastinal and sternal layers. Postoperatively, vancomycin and linezolid groups were given antibiotic treatment for 7 d, starting 24 h after the end of the procedure. After 7-d treatment tissue samples from the upper ends of the sternotomy line and mediastinum were obtained and evaluated microbiologically. Additionally, serum, heart, lung, liver, kidney, and mediastinal tissues samples were obtained to determine malondialdehyde (MDA) and myeloperoxidase (MPO). Results: The study showed that either vancomycin or linezolid successfully reduced bacterial counts in mediastinum and sternotomy line. MDA and MPO levels were found to be decreased in the treated groups. There was a positive correlation between serum and tissues MDA and MPO in all of the groups. Conclusions: Our study showed that linezolid appears to be a promising option for treating mediastinitis due to methicillin-resistant S. aureus. Additionally, it was demonstrated that a wide inflammatory process occurred after mediastinitis. © 2009 Elsevier Inc. All rights reserved.Article Klebsiella pneumoniae klinik izolatlarında CTX-M tipi beta-laktamazların fenotipik ve moleküler yöntemlerle araştırılması(2009) Tikveşli, Soner; Cevahir, Nural; Kaleli, İlknurSon zamanlarda CTX-M tipi genişlemiş spektrumlu beta-laktamaz (GSBL)'ların Enterobacteriaceae üyeleri arasında hızla yayıldığı dikkati çekmektedir. Bu çalışmada, Klebsiella pneumoniae klinik izolatlarında CTX-M varlığının fenotipik ve moleküler yöntemlerle araştırılması amaçlanmıştır. Çalışmaya, Pamukkale Üniversitesi Tıp Fakültesi Hastanesinde Ocak 2006-Ocak 2007 tarihleri arasında hastanede yatan (n= 128) ve poliklinik hastalarının (n= 89) çeşitli klinik örneklerinden (152 idrar, 20 balgam, 17 yara yeri sürüntüsü, 13 kan, 9 tra-keal aspirat sıvısı, 3 beyin omurilik sıvısı, 3 göz sürüntüsü) izole edilen 217 K.pneumoniae susu alınmıştır. Suş-ların in vitro antimikrobiyal duyarlılıkları "Clinical and Laboratory Standards Institute (CLSI)" önerileri doğrultusunda disk difüzyon metodu ile, sefotaksimaz üretimi ise CT (sefotaksim)/CTL (sefotaksim-klavulanik asit) şeritleri kullanılarak E-test (AB Biodisk, isveç) yöntemiyle belirlenmiştir. CTX-M gen varlığı ve alt gruplarının belirlenmesinde polimeraz zincir reaksiyonu (PCR) kullanılmış, CTX-M gen pozitifliği saptanan suşlar arasındaki klonal ilişki RAPD (Random Amplified Polymorphic DNA)-PCR yöntemiyle araştırılmıştır. Çalışılan tüm suşlar arasında en yüksek direnç ampisilin (%94) ve sefalotine (%64.5) karşı belirlenmiş, imipeneme karşı direnç saptanmamıştır. E-test ile izolatların %39.6'sında (86/217) pozitiflik tespit edilmiş; yatan hastalara ait izolatların pozitiflik oranı (%87.4), poliklinik hastalarına ait izolatlardan (%12.6) anlamlı olarak yüksek bulunmuştur (p< 0.001). PCR yöntemiyle sefotaksimaz pozitif suşların %22.1'inde (19/86) CTX-M gen varlığı belirlenmiş, bunların tümünün CTX-M grup-1 olduğu görülmüştür. CTX-M-1 olarak belirlenen suşlarda en yüksek direnç amoksisilin-klavulanik asit (%94.7) ve netilmisine (%89.5), en düşük direnç ise siprofloksasin (%26.3), trimetoprim/sülfametoksazol (%26.3) ve amikasine (%42.1) karşı saptanmıştır. RAPD sonucuna göre 19 CTX-M-1 izolatında 11 farklı patern tespit edilmiş, en sık rastlanan kümelerin Kp 3 (n= 3), Kp 4 (n= 3) ve Kp 5 (n= 3) olduğu izlenmiştir. Çocuk yoğun bakım ünitesindeki hastalardan izole edilen sekiz sustan beşinin ve çocuk servisindeki beş sustan dördünün aynı bant paternlerini göstermesi, bu birimlerde klonal yaytlım olduğunu düşündürmüştür. Sonuç olarak; nozokomiyal K.pneumoniae suşlarında beta-laktamaz üretim oranlarının izlenmesi ve enzim tiplerinin belirlenmesinin, gerekli enfeksiyon kontrol önlemlerinin alınması ve uygun antibiyotik seçiminde klinisyenleri yönlendirmesi açısından önemli olacağı düşünülmüştür.