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    Antifungal Prophylaxis in Solid Organ Transplant Recipients
    (Galenos Yayincilik, 2015) Senol, Sebnem; Kutsoylu, Oya Eren; Kaya, Onur; Avci, Meltem; Tasbakan, Meltem Isikgoz; Oguz, Vildan Avkan; Baysan, Betil Ozhak; Cavus, Sema Alp; Cetin, Cigdem Banu; Ergin, Cagri; Ertugrul, Bulent; Kutlu, Selda Sayin; Kutlu, Murat; Mermut, Gulsen; Metin, Dilek Yesim; Ozturk, Barcin; Pullukcu, Husnu; Turhan, Ozge; Yapar, Nur
    Solid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed.
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    A CASE OF CEREBRAL ABSCESS DUE TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS WHICH IS TREATED WITH LINEZOLID plus RIFAMPIN COMBINATION
    (Ankara Microbiology Soc, 2010) Sipahi, Oguz Resat; Cagiran, Inanc; Yurtseven, Taskin; Tasbakan, Meltem Isikgoz; Arda, Bilgin; Tunger, Alper; Ulusoy, Sercan
    Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of cerebral abscesses, however it is a relatively more common etiologic agent in post-neurosurgical abscesses and the main antibacterial therapy option is vancomycin. In this report, a case of brain abscess due to MRSA which did not respond neither to moxifloxacin + vancomycin nor vancomycin + rifampin combination therapies, and merely treated by linezolid + rifampin combination, has been presented. Fifty-one years old female patient who was operated 40 days ago for subarachnoid bleeding and aneurysm in middle cerebral artery bifurcation, was hospitalized due to purulent leakage from the operation area. She did not have fever and her physical examination, including the neurologic system, was normal. Computerized tomography revealed an approximately 1 cm lesion compatible with subdural empyema and cerebral abscess in the right frontoparietal area in supratentorial sections. The patient was operated for wound revision and moxifloxacin was initiated. Since the operation materials revealed MRSA growth, vancomycin (4 x 500 mg, IV) was added to the treatment. The isolate was identified by conventional methods, and antibiotic susceptibility test performed by disk diffusion method showed that it was susceptible to levofloxacin, linezolid, rifampin, vancomycin and teicoplanin. Since no clinical response was obtained in two weeks, moxifloxacin was switched to rifampin (300 mg 1 x 2). On the 10(th) day of vancomycin + rifampin therapy, radiological findings showed development of cerebritis and therefore vancomycin was changed with linezolid (2 x 600 mg, IV). The control CT of the patient revealed regression of the brain lesion and linezolid + rifampin treatment continued for six weeks. The patient did not develop any hematological, liver or renal toxicity during the therapy and the radiological findings regressed. No relapse were detected in the one year follow-up period. This case suggested that linezolid might be a treatment alternative in the therapy of vancomycin-refractory MRSA brain abscess.
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    A Case of Polymicrobial Brain Abscess Caused By a Rare Bacterium: Granulicatella elegans
    (Galenos Yayincilik, 2018) Akyol, Deniz; Yildirim, Cigdem; Tasbakan, Meltem Isikgoz; Yamazhan, Tansu; Tunger, Alper; Eraslan, Cenk; Sipahi, Oguz Resat
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    Clinical Evaluation of Fifteen Cases of Hydatid Disease
    (Galenos Yayincilik, 2015) Uysal, Serhat; Uyan, Ayse; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Yamazhan, Tansu; Pullukcu, Husun; Mermut, Gulsen; Ertem, Ekin; Ulusoy, Sercan
    Introduction: Hydatid disease is a zoonotic infection caused by the cestode Echinococcus spp. It is transmitted by ingestion of infectious cestode eggs, especially through dog feces. The two organs most commonly affected are the liver and the lung. In this paper, a series of 15 cases with symptomatic hydatid cysts hospitalized in our clinic and evaluated via consultations are presented. Materials and Methods: Patients, who were treated with hydatid disease between April 2006 and June 2015, were included in the study. Demographic characteristics, symptoms (fever, abdominal pain, pruritus, weakness, icterus, cough, sputum, nausea-vomiting), signs (hepatomegaly, splenomegaly), radiological-laboratory findings, complications, involvements of other body parts and treatment modalities were evaluated retrospectively. Results: Ten (66.7%) of the patients were female. The mean age of the patients was 52.3 +/- 18.3 year. Twelve (80%) patients had at least one cystic lesion in the liver. Four cases were complicated with a lung cyst, three with spondylodiscitis, three with splenic cyst, two with renal cyst, two with amoebic liver abscess, one with intraabdominal dissemination and one case was complicated with anaphylactic shock. Seven patients (46.7%) had leukocytosis and three (20%) had eosinophilia. All patients received treatment with albendazole p.o 2x400 mg tablets. The mean duration of treatment was 27.4 +/- 18.5 weeks. Conclusion: Hydatid cyst is an infectious disease that may cause severe organ involvement. Patients with hydatid cyst in any part of the body should be checked carefully for other system involvement, including the liver, abdominal and/ or retroperitoneal organs.
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    Comparison of an in house and a commercial real-time polymerase chain reaction targeting Toxoplasma gondii RE gene using various samples collected from patients in Turkey
    (Bmc, 2019) Doskaya, Mert; Pullukcu, Husnu; Karakavuk, Muhammet; Sahar, Esra Atalay; Tasbakan, Mehmet Sezai; Tasbakan, Meltem Isikgoz; Guruz, Adnan Yuksel
    Background: Toxoplasma gondii is an opportunistic protozoan parasite that can infect all warm-blooded animals including humans and cause serious clinical manifestations. Toxoplasmosis can be diagnosed using histological, serological, and molecular methods. in this study, we aimed to detect T. gondii RE gene in various human samples by in house and commercial real time polymerase chain reactions. Methods: A total of 38 suspected cases of toxoplasmosis [peripheral blood (n:12), amnion fluid (n:11), tissue (n:9), cerebrospinal fluid (n:5), and intraocular fluid (n:1)] were included to the study. An in house and a commercial RT-PCR were applied to investigate the T. gondii RE gene in these samples. Results: the compatibility rate of the two tests was 94.7% (37/38). When the commercial RT-PCR kit was taken as reference, the sensitivity and specificity of in house RT-PCR test was 87.5 and 100%. When the in house RT-PCR test was taken as reference, the commercial RT-PCR kit has 100% sensitivity and 96.8% specificity. Incompatibility was detected in only in a buffy coat sample with high protein content. Conclusions: Both the commercial and in house RT-PCR tests can be used to investigate T. gondii RE gene in various clinical specimens with their high sensitivity and specificity. in house RT-PCR assay can be favorable due to cost savings compared to using the commercial test.
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    Comparison of quality of life in hepatitis B virus carriers versus chronic hepatitis B virus carriers versus the normal population
    (Tubitak Scientific & Technical Research Council Turkey, 2010) Tasbakan, Meltem Isikgoz; Sertoz, Ozen Onen; Pullukcu, Husnu; Calik, Sebnem Ozkoren; Sipahi, Oguz Resat; Yamazhan, Tansu
    Aim: To compare health related quality of life (HRQOL) in hepatitis B virus (HBV) carriers versus chronic HBV disease carriers versus the normal population Materials and methods: The study sample consisted of 2 groups. HBV carriers were recruited from individuals who were regularly followed-up at the Infectious Diseases and Clinical Microbiology outpatient clinic of our setting due to inactivity in HBV infection The control group was recruited from the same outpatient clinic among patients who had a diagnosis of chronic HBV infection and who were not undergoing active treatment yet Both groups were requested to fill in the short form 36 questionnaire on HRQOL (HRQOL-SF-36) and a form to gather data about age, gender, and education. We also compared the mean values of the SF-36 domain scores of these 2 groups with published scores of healthy controls derived from the Turkish population Results: QOL in HBV carriers was greatly similar to that of patients with chronic HBV disease except for physical role limitation scores and both HBV carriers and patients with chronic disease had lower HRQOL. than the normal Turkish population Conclusion: When compared with the normal Turkish population, QOL is affected negatively both in chronic HBV infection patients and in HBV carriers.
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    Delayed Diagnosis of HIV Infection in a Patient with Non-Hodgkin Lymphoma: Are Physician Still Not Aware?
    (Bilimsel Tip Yayinevi, 2020) Baskol, Dilsah; Mermut, Gulsen; Yamazhan, Tansu; Tasbakan, Meltem Isikgoz; Pullukcu, Husnu
    Malignancy risk is increased in patients infected with the human immunodeficiency virus (HIV). Non-Hodgkin lymphomas, Kaposi's sarcoma and cervical cancer are among the AIDS-defining diseases. Diffuse large B cell lymphoma is the most common non-Hodgkin lymphoma. Taking combined antiretroviral therapy is associated with good prognosis in the treatment of AIDS-related non-Hodgkin lymphoma. Therefore, HIV screening test should be requested in patient groups with the above-mentioned diagnoses. If evaluated from a different perspective, HIV-infected patients can apply to many departments with different clinics. For this reason, all physicians should have knowledge and awareness in terms of AIDS-defining diseases. the awareness of physicians is of great importance in this disease, which has a high success rate with early diagnosis and treatment. Unfortunately, cases with late diagnosis are still encountered. in this article, a patient treated with chemotherapy for four months with the diagnosis of diffuse large B cell lymphoma, who consulted us as febrile neutropenia and was diagnosed with late HIV infection is presented.
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    Depression and anxiety disorders during pegylated interferon treatment in patients with chronic hepatitis B
    (Taylor & Francis Ltd, 2017) Sertoz, Ozen Onen; Tuncel, Ozlem Kuman; Tasbakan, Meltem Isikgoz; Pullukcu, Husnu; Onmus, Isabel Raika Durusoy; Yamazhan, Tansu; Elbi, Hayriye
    Objectives: Interferon (IFN) treatment has many neuropsychiatric side effects such as depression and anxiety disorder. Although untreated depression is a major contributor to dosage reduction or premature discontinuation of the IFN treatment, it is found that depressive symptoms among patients undergoing hepatitis C virus (HCV) treatment are commonly overlooked during routine clinical interviews. Besides depression, anxiety disorders are shown to affect adherence to pegylated IFN (Peg-IFN) treatment in patients with hepatitis C. Despite the occurrence of neuropsychiatric side effects of IFN treatment being widely reported in patients with hepatitis C, there are few studies studying patients infected with hepatitis B virus (HBV). The aim of this prospective study was to evaluate the incidence and risk factors of depressive and anxiety disorders that occur during Peg-IFN treatment of patients with HBV. Methods: The sample consisted of volunteer patients who were diagnosed with HBV infection and who were decided to receive IFN treatment. During the study period, all consecutive patients with HBV infection and who would have IFN treatment were informed about the study and invited to participate. Thirty-seven chronic hepatitis B (CHB) patients were recruited for the study, but four of them were excluded due to psychiatric diagnosis at the initiation of the treatment. Therefore, the sample consisted of 33 patients with CHB, meeting the inclusion criteria. The participants had psychiatric assessment before the treatment and at 1st, 3rd, 6th, and 12th months. At each visit, the subjects were assessed with Clinical Global Impressions Scale, Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Rating Scale (HAM-A). Results: Among the 33 patients with HBV, 22 (66.7%) were men. Mean age was 35.97 +/- 10.73 years. While follow-up, 6 patients dropped out from the study. Also, 13 patients were excluded from the study as they developed depression and/or anxiety disorder. Mean baseline HRSD and HAM-A scores were smaller than the following visits' scores. The difference was not statistically significant only for the 12th month assessments. Totally 14 (42.4%) patients developed depression/anxiety disorder during 1 year follow-up. Six (42.86%) of them received the diagnosis at the 1st month, 3 (21.43%) at the 3rd, 4 (28.57%), at 6th months, and 1 (7.14%) at the 12th month. When we compared the patients who developed depression/anxiety disorder with the patients who did not develop any psychiatric disorder, we found that the mean baseline HRSD score (t = 2.303, p =.028) and female percentage (p =.017) were statistically significantly higher in the depression/anxiety disorder group. Conclusions: There is an incidence of 42.4% for depression and/or anxiety disorders during Peg-IFN treatment. Females and patients with subsyndromal depressive symptoms should be referred to a psychiatrist and closely monitored especially for the first three months of the IFN treatment.
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    Evaluation of Knowledge Level on Sexually Transmitted Diseases of Medical School Students Who Received HPV Vaccination
    (Bilimsel Tip Yayinevi, 2022) Erdem, Huseyin Aytac; Vahabi, Merve Mert; Tasbakan, Selin Ece; Tanrikulu, Yaren; Tasbakan, Meltem Isikgoz
    Introduction: Sexually transmitted diseases (STDs) can adversely affect sexual and reproductive health, especially starting from ado- lescence, in addition to the mortality and morbidity they cause. Of these, human papilloma virus (HPV) is of great importance because it is very common and can be prevented by vaccination. More widespread vaccination can be achieved by increasing awareness and knowledge, both in society and among physicians. In this study, it was aimed to evaluate the knowledge level of med school students, who had HPV vaccine, about sexually transmitted diseases.Materials and Methods: Socio-demographic characteristics and knowledge levels about sexually transmitted diseases were evaluated by filling out a questionnaire for med school students who were vaccinated in 2022 in our hospital. The dataset were put in Microsoft Office Excel program.Results: Total of 212 participants (169 females 79.7%; 43 males 20.3%, mean age 22.18 +/- 2.15 years) were included in the study. Participants stated that they heard about HPV vaccine; through classes 74.5% (n= 158), friends/family 43.4% (n= 92), and social media/TV 41% (n= 87). They defined the safest contraceptive method for STD as using condoms 68.9%, not having sexual intercourse 18.4%, and monogamy 12.7%. Question about causative relation with cancer development of listed agents answered as: HPV (99.1%), hepatitis B (70.8%), syphilis (6.6%), and Gonorrhea (3.8%).Conclusion: Increasing level of knowledge of young physicians and physician candidates about sexually transmitted diseases will certainly contribute to the awareness and vaccination of society. We believe that being aware of our shortcomings in this regard and reducing sexual health education to a much earlier age, will help solve this issue.
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    Favipiravir for the treatment of COVID-19 pneumonia: Can we predict the response to treatment?
    (J Infection Developing Countries, 2022) Sayiner, Abdullah; Erdem, Huseyin Aytac; Ekren, Pervin Korkmaz; Tasbakan, Sezai; Basoglu, Ozen K.; Tasbakan, Meltem Isikgoz; Yamazhan, Tansu
    Introduction: Early experience with favipiravir in the treatment of COVID-19 is promising, but no clinical data have been published in medical journals. This study aimed to review the experience with favipiravir treatment for COVID-19 pneumonia and to examine whether there are any predictors of treatment response. Methodology: Fifty-six patients with severe or progressive pneumonia associated with COVID-19 who were treated with favipiravir monotherapy for at least five days were included in this retrospective study. Treatment response was defined as clinical recovery without any need for admission into the intensive care unit and/or anti-cytokine therapy. The demographic, clinical, laboratory and radiographic features of the patients were compared between favipiravir-responders and non-responders. Results: Of the 56 patients, 34 patients (60.7%) responded to treatment and recovered. There was no difference in the demographic, clinical, and radiographic findings between the responders and non-responders. The inflammatory biomarkers were also similar except for the CRP levels on the day favipiravir was started [74 (36-111) vs. 118.5 (46.5-203) mg/L, respectively, p = 0.043]. There was also a significant difference in the median time to defervescence [1 (1-2) vs. 3.5 (1.75-9.25) days, respectively]. Of clinical interest, 27 (79.4%) and 31 (91.2%) of the responders became afebrile within two and four days, respectively. The response rate was lower in patients who presented severe pneumonia associated with respiratory failure. Conclusions: Patients with non-severe pneumonia at admission and whose fever resolved within two days of treatment are more likely to improve with favipiravir.
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    Hospital-acquired urinary tract infection point prevalence in Turkey: Differences in risk factors among patient groups
    (Bmc, 2013) Tasbakan, Meltem Isikgoz; Durusoy, Raika; Pullukcu, Husnu; Sipahi, Oguz Resat; Ulusoy, Sercan
    Background: The aim of this study was to determine the point prevalence of nosocomial urinary tract infections (UTIs) and to investigate risk factors for pathogen type (E. coli vs. others) and extended-spectrum beta-lactamase (ESBL) positivity among nosocomial UTI patients. Methods: A questionnaire consisting of 44 questions on demographic data and risk factors of UTI cases was sent to 51 tertiary care hospitals. Univariate and multivariate analyses were conducted. Results: The overall prevalence of UTI was 1.82% (483/26534). The prevalence of UTI was higher in intensive care units (ICUs) with 6.77% versus 1.45% outside ICUs. Hospitals of the Ministry of Health (compared to university hospitals), hospitals in less developed provinces and hospitals with bed capacity < 500 had higher UTI prevalence. Patients without a urinary catheter were more likely to have received immunosuppressive therapy, current corticosteroid use, renal transplantation and uterine prolapsus and less likely to have another infection outside the urinary tract, as compared to catheterized patients. Among the 422 culture-positive patients, the most common pathogen was E. coli (45.5%). The risk factors increasing the likelihood of E. coli in urine culture were being female, history of urinary tract operation, no use of antibiotics in the preceding three months and infection outside the urinary tract. There were 247 patients with E. coli or Klebsiella spp. positive in culture. Among these, 61% (n=151) were ESBL-positive. Among patients having E. coli/Klebsiella positive in culture, antibiotic use in the preceding three months and history of urinary tract operation were the independent risk factors significantly increasing the risk of ESBL. Conclusions: The reasons underlying the high prevalence of nosocomial UTIs, and a better understanding of the risk factors might lead to improved control of these infections.
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    Impact of Direct Acting Antiviral Agents on Psychiatric and Sexual Health of Patients with Hepatitis C Virus
    (Galenos Yayincilik, 2019) Tuncel, Ozlem Kuman; Akyol, Deniz; Pullukcu, Husnu; Yamazhan, Tansu; Tasbakan, Meltem Isikgoz; Sertoz, Ozen Onen
    Objectives: Data about the psychosocial side effects of direct-acting antiviral agents (DAA) used for the treatment of hepatitis C virus (HCV) infection is scarce. In this study, it is aimed to assess the psychiatric and sexual effects of ledipasvir/sofosbuvir (L/S) combination and paritaprevir-ritonavir-ombitasvir-dasabuvir (PROD) combination in patients with HCV infection. Materials and Methods: The sample of this retrospective study consisted of patients who were diagnosed with HCV infection and received PROD or L/S treatment. The patients were assessed by the Hospital Anxiety and Depression (HAD) scale and Arizona Sexual Experiences (ASEX) scale at baseline and first-, third- and sixth-month visits. Besides these, demographic data and data about the liver disease were collected. Results: During the studied period, 42 patients were started DAA treatment. The average age of the sample was 56.64 +/- 12.04 years. Thirty-five (83.3%) patients achieved sustained viral response. Data of the patients who filled HAD or ASEX at baseline and at least in one of the following visits within six months were used. Anxiety, depression and sexual measures did not differ between baseline and following assessments. Conclusion: L/S and PROD do not seem to have a significant effect on anxiety and depression levels and sexual experiences of the patients while they made an improvement in viral load.
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    Is there a rise in resistance rates to fosfomycin and other commonly used antibiotics in Escherichia coli-mediated urinary tract infections? A perspective for 2004-2011
    (Tubitak Scientific & Technical Research Council Turkey, 2013) Pullukcu, Husnu; Aydemir, Sohret; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Hall, Feriha Cilli, Jr.; Tunger, Alper
    Aim: Resistance patterns of Escherichia coli to fosfomycin, ciprofloxacin, amikacin, and cotrimoxazole were evaluated in 2 different studies held in 2004 and 2005. In this study, it was aimed to compare the changes in the susceptibility patterns of uropathogenic E. coli strains to the above-mentioned antibiotics after 6 years. Materials and methods: Between February and April 2011, E. coli strains isolated from urine samples were included prospectively in the study. Results: A total of 502 E. coli strains (358 from outpatients and 144 from inpatients) were isolated from urine specimens between February and April 2011. Extended spectrum beta-lactamase (ESBL)-producer E. coli rate was 35%. Resistances to cotrimoxazole, ciprofloxacin, amikacin, and fosfomycin were 54.5%, 49.8%, 22.7%, and 1.4%, respectively. When we compared ESBL-producer E. coli strains isolated in 2005 and 2011, amikacin resistance increased (11% to 22.7%, P = 0.0001), whereas cotrimoxazole resistance decreased significantly (74% to 62.9%, P = 0.0063). When we compared resistance patterns of non-ESBL-producer E. coli in relation to 2004 and 2011, there was no significant change in the resistance to fosfomycin, cotrimoxazole, ciprofloxacin, and amikacin. Pooled analysis of fosfomycin studies from Turkey revealed 1.6% fosfomycin resistance in a total of 6439 strains. Conclusion: Our results suggest that despite common usage, there is not an increase in the resistance to fosfomycin. We conclude that fosfomycin can be used as one of the primary choices in the empirical therapy of urinary tract infections.
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    Is there a rise in resistance rates to fosfomycin and other commonly used antibiotics in Escherichia coli-mediated urinary tract infections? A perspective for 2004-2011
    (Tubitak Scientific & Technical Research Council Turkey, 2013) Pullukcu, Husnu; Aydemir, Sohret; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Hall, Feriha Cilli, Jr.; Tunger, Alper
    Aim: Resistance patterns of Escherichia coli to fosfomycin, ciprofloxacin, amikacin, and cotrimoxazole were evaluated in 2 different studies held in 2004 and 2005. In this study, it was aimed to compare the changes in the susceptibility patterns of uropathogenic E. coli strains to the above-mentioned antibiotics after 6 years. Materials and methods: Between February and April 2011, E. coli strains isolated from urine samples were included prospectively in the study. Results: A total of 502 E. coli strains (358 from outpatients and 144 from inpatients) were isolated from urine specimens between February and April 2011. Extended spectrum beta-lactamase (ESBL)-producer E. coli rate was 35%. Resistances to cotrimoxazole, ciprofloxacin, amikacin, and fosfomycin were 54.5%, 49.8%, 22.7%, and 1.4%, respectively. When we compared ESBL-producer E. coli strains isolated in 2005 and 2011, amikacin resistance increased (11% to 22.7%, P = 0.0001), whereas cotrimoxazole resistance decreased significantly (74% to 62.9%, P = 0.0063). When we compared resistance patterns of non-ESBL-producer E. coli in relation to 2004 and 2011, there was no significant change in the resistance to fosfomycin, cotrimoxazole, ciprofloxacin, and amikacin. Pooled analysis of fosfomycin studies from Turkey revealed 1.6% fosfomycin resistance in a total of 6439 strains. Conclusion: Our results suggest that despite common usage, there is not an increase in the resistance to fosfomycin. We conclude that fosfomycin can be used as one of the primary choices in the empirical therapy of urinary tract infections.
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    Mucormycosis: Retrospective Evaluation of 12 Cases
    (Ankara Microbiology Soc, 2011) Arda, Bilgin; Erdem, Aytac; Sipahi, Oguz Resat; Tasbakan, Meltem Isikgoz; Pullukcu, Husnu; Tasbakan, Mehmet Sezai; Ceylan, Naim; Metin, Dilek Yesim; Midilli, Rasit; Yamazhan, Tansu; Ulusoy, Sercan
    Mucormycosis is a rare and often fatal invasive fungal infection. Disseminated or pulmonary forms are common in patients with immune deficiency while rhinocerebral form is common in diabetes mellitus. The aim of this study was to evaluate retrospectively the adult mucormycosis cases which were followed up in our hospital between 2007-2010. The cases were evaluated in terms of demographic characteristics, underlying diseases, laboratory, clinical and treatment results. A total of 12 mucormycosis cases (6 were male; age range: 18-74 years; mean age: 50.83 +/- 18.27 years) were evaluated. Ten of the 12 cases had definitive diagnosis of invasive fungal infection according to EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria whereas two had possible mucormycosis. Six cases had rhinoorbital, four had rhinocerabral, one had pulmonary and one had rhinocerebral and pulmonary mucormycosis. Fever (n= 10; 83%), edema in face (n= 8; 67%) and eyes (n= 6; 50%) were the most common symptoms and findings. Mycologic culture was performed in ten cases and was found positive in five cases (four cases had Rhizopus spp. one case had Mucor). In two cases direct microscopy revealed mycelium but culture did not yield any pathogen. Two cases had concomitant Aspergillus spp. growth. Overall mortality rate was determined as 50% (6/12). All of the cases received antifungal therapy (liposomal amphotericin B and posaconazole or itraconazole), however, surgical intervention was applied to five cases. Mean duration of antifungal treatment was 60.8 +/- 47.4 days. Mortality rate was lower in cases who received concomitant surgical therapy, but the difference was not found statistically significant (2/5 vs. 4/7, p> 0.05). Hematologic diseases (n= 6) and diabetes mellitus (n= 3) were the most common underlying diseases in mucormycosis cases. Voriconazole prophylaxis applied to three cases with hematologic diseases was detected as a risk factor. Development of mucormycosis in those cases who were under voriconazole prophylaxis, deserves attention. Since this is the largest 3-years series of adult mucormycosis cases reported from a single center and includes the first cases treated with posaconazole, the results of this evaluation may aid to the management of patients with mucormycosis.
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    Necrotising Fasciitis: Clinical Evaluation and Treatment Results of 18 Patients
    (Galenos Yayincilik, 2019) Ozturk, Anil Murat; Akyol, Deniz; Suer, Onur; Erdem, Huseyin Aytac; Simsir, Ilgin Yildirim; Akar, Sebnem Senol; Tasbakan, Meltem Isikgoz
    Introduction: Necrotizing fasciitis (NF) is a complicated and rapidly spreading soft tissue infection that affects the superficial fascia, skin, and subcutaneous tissue. in this study, we evaluated patients who were diagnosed with NF and treated in two tertiary-care educational university hospitals. Materials and Methods: Patients diagnosed with NF in three centers (Ege University Department of Orthopedics and Traumatology and Department of Infectious Diseases and Clinical Microbiology and Celal Bayar University Department of Infectious Diseases and Clinical Microbiology) between November 2016 and December 2018 were retrospectively analyzed. the patients' demographic characteristics, significant risk factors for infection, sites of infection, models of surgical treatment, department(s) that performed the surgery, causative infectious agents, empirical and agent-specific treatment regimens and their duration, length of hospital stay, need for intensive care, and one month survival were evaluated. Results: Eighteen patients (10 females, mean age 53.7 [19-86 years]) who were diagnosed with NF were included in the study. Diabetes mellitus, trauma/surgery history, and decubitus wound were the most common predisposing factors. the most common anatomic site was lower extremity (n=10, 55.5%). All patients underwent surgical debridement. the most commonly isolated microorganisms were Escherichio coli (n=4), Klebsiella pneumoniae, Proteus mirabilis, and Acinetobacter boumannii (each n=3). Empirical treatment was initiated with meropenem in eight patients (32%) and tigecycline in four patients (12.5%), and the antibiotic was changed in five patients based on culture results. the mean duration of antibiotic therapy was 35.5 (9-68) days. the average hospital stay was 55 (11-186) days. Six patients (33.3%) required intensive care during follow-up. the mortality rate was 16.6%. Conclusion: NF is a fulminant disease, and early diagnosis and effective multidisciplinary treatment are crucial for reducing mortality rates. When the diagnosis is suspected, early surgical debridement should be performed and empirical antibiotherapy should be started immediately.
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    A neglected causative agent in diabetic foot infection: a retrospective evaluation of 13 patients with fungal etiology
    (Tubitak Scientific & Technical Research Council Turkey, 2019) Ozturk, Anil Murat; Tasbakan, Meltem Isikgoz; Metin, Dilek Yesim; Yener, Can; Uysal, Serhat; Yildirim Simsir, Ilgin; Ertam, Ilgen; Pullukcu, Husnu; Arda, Bilgin; Cetinkalp, Sevki
    Background/aim: Clinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature. Materials and methods: The patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features. Results: A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 +/- 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery. Conclusion: Invasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.
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    Nitrofurantoin in the treatment of extended-spectrum beta-lactamase-producing Escherichia coli-related lower urinary tract infection
    (Elsevier Science Bv, 2012) Tasbakan, Meltem Isikgoz; Pullukcu, Husnu; Sipahi, Oguz Resat; Yamazhan, Tansu; Ulusoy, Sercan
    The aim of this study was to evaluate the effect of nitrofurantoin (NFT) in the treatment of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli-related lower urinary tract infection (LUTI). The hospital records of all patients aged >18 years with dysuria or problems with frequency or urgency in passing urine, >20 leukocytes/mm(3) in urine microscopy and culture-proven ESBL-producing NFT-sensitive E. coli in the urine (>10(5) CFU/mm(3)), no leukocytosis or fever and who were treated with NFT between January 2006 and May 2011 in our outpatient clinic or in the hospital were evaluated. All patients had received a NFT 50 mg capsule every 6 h for 14 days and had a control urine culture taken 7-9 days after therapy. Clinical success was defined as resolution of symptoms at the control visit, and microbiological success was defined as a sterile control urine culture. A total of 75 patients (mean +/- standard deviation age, 54 +/- 17 years; 45 females, 30 males, all but 14 with complicated LUTI) fulfilled the study inclusion criteria. Overall clinical and microbiological success rates were 69% (52/75) and 68% (51/75), respectively. Control urine culture performed 28-31 days after the end of therapy was available in 31/51 patients (61%) with microbiological success. Re-infection and relapse rates were 6.5% (2/31) and 3.2% (1/31), respectively. In conclusion, these results suggest that NFT may be an alternative in the treatment of ESBL-producing E. coli-related LUTI. This is the first study in which NFT was used in the treatment of LUTI due to ESBL-producing E. coli as well as in patients with complicated UTI. (C) 2012 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.
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    Not So Innocent: Thrombocytopenia After One Dose of Rifampicin
    (Galenos Yayincilik, 2017) Nagiyeva, Tarana; Tasbakan, Meltem Isikgoz; Pullukcu, Husnu; Sipahi, Oguz Resat; Yamazhan, Tansu
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    Pegylated interferon in HBeAg-positive and -negative chronic hepatitis B patients: post-treatment 1-year results of three Turkish centres
    (Taylor & Francis Ltd, 2014) Yamazhan, Tansu; Kurtaran, Behice; Pullukcu, Husnu; Yuksel, Esma; Ozkaya, Deniz; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Durusoy, Raika; Aksu, Hasan Salih Zeki
    In this study, we aimed to evaluate the 1-year post-treatment follow-up results of 112 patients who received pegylated interferon (PEG-IFN) for 52 weeks. HBeAg negativity/seroconversion and/or negative HBV-DNA at the end of the treatment were considered as response. Patients who had response at the end of treatment but had HBV-DNA breakthrough during 1-year follow-up were considered as relapse. The study group comprised 112 cases (34 HBeAg-positive, 78 HBeAg-negative). In HBeAg-positive and -negative cases, end-of-treatment response rates were 2.9% and 60.2%, whereas 1-year sustained virological response rates were 0 and 33.3%, respectively. When we compared relapse cases versus cases with response at the end of 1-year follow-up, being female and having low viral load were the two parameters associated with higher response rates (Chi-square, P=0.028; Mann-Whitney U test, P=0.023). Overall non-response rates to PEG-IFN were high (57.1%). Results in HBeAg-positive cases were disappointing.