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    Evaluation of 2015-2016 MOTAKK HBV DNA and HCV RNA External Quality Assessment National Program Results
    (Ankara Microbiology Soc, 2018) Karatayli, Ersin; Soydemir, Ege; Aksoy, Zeynep Busra; Kizilpinar, Mehtap; Altay Kocak, Aylin; Karatayli, Senem Ceren; Yurdcu, Esra; Yildirim, Umut; Guriz, Haluk; Bozdayi, Gulendam; Yurdaydin, Cihan; Ilhan, Osman; Yildirim, Yasin; Bozdayi, A. Mithat; Oguz, Acelya Yalcintas; Baris, Ahmet; Alp, Alpaslan; Aksozek, Alper; Sayiner, Arzu; Karagul, Aydan; Ordu, Aylin; Istanbullu, Aye; Otlu, Baris; Aridogan, Buket; Aksu, Burak; Buruk, C. Kurtulus; Karahan, Ceren; Guney, Cakir; Toksoz, Devrim; Yildirim, Dilara; Colak, Dilek; Daglar, Duygu Eren; Findik, Duygu; Kas, Elif; Caliskan, Emel; Zeyrek, Fadile Yildiz; Arslan, Fatma; Demir, Feyza; Milletli, Fikriye; Kibar, Filiz; Ozdincer, Furkan; Dundar, Gulnur; Arslan, Hande; Agca, Harun; Aliskan, Hikmet Eda; Guducuoglu, Huseyin; Fidan, Isil; Akyar, Isin; Afsar, Ilhan; Kaleli, Ilknur; Donmez, Ismail; Yanik, Kemalettin; Midilli, Kenan; Cubukcu, Kivanc; Ozdemir, Mehmet; Acar, Melek; Yalinay, Meltem; Kuskucu, Mert Ahmet; Bakici, Mustafa Zahir; Aydin, Neriman; Yilmaz, Neziha; Ceken, Nihan; Ziyade, Nihan; Yilmaz, Nisel; Ozgumus, Osman Birol; Gitmisoglu, Ozlem; Demirgan, Recep; Kesli, Recep; Guckan, Ridvan; Sertoz, Ruchan; Akgun, Sadik; Aksaray, Sebahat; Tezcan, Seda; Kaygusuz, Sedat; Gokahmetoglu, Selma; Mese, Sevim; Bayik, Seyit Ahmet; Akcali, Sinem; Gurcan, Saban; Karsligil, Tekin; Us, Tercan; Ozekinci, Tuncer; Pilgir, Tulin; Aslan, Ugur; Dinc, Ugur; Coskun, Umut Safiye Say; Cetinkol, Yeliz; Keskin, Yusuf; Ayaydin, Zeynep; Toraman, Zulal Asci
    MOTAKK, as a national external quality control program has been launched to evaluate the molecular detection of viral infections including HBV DNA and HCV RNA in molecular microbiology diagnostic laboratories in Turkey. This program is prepared in compliance with ISO 17043:2010 (Conformity assessment general requirements for proficiency testing) standards, and aims to take the place of external quality control programs from abroad, contributing to standardization and accuracy of molecular diagnostic tests in our country. The aim of this study was to evaluate 2015 and 2016 results of the MOTAKK External Quality Control Program for HBV DNA and HCV RNA viral load. The calls were announced on the web page of MOTAKK (www.motakk.org). The quality control samples were sent to participating laboratories in 2015 and 2016. Main stocks were prepared from patients with chronic hepatitis B and C who had viral load detection with reference methods according to WHO reference materials for viral load studies to improve quality control sera. From these main stocks, samples with different viral loads were prepared from dilutions of plasma with HBV, HCV, HAV, HIV, Parvovirus B19 and CMV negative serologic markers. Quality control samples were sent to the participating laboratories along with the negative samples in the cold chain. The laboratories accomplished the related tests within 2-3 weeks and entered their results on the MOTAKK web page. These results were analysed according to ISO 13528 (Statistical methods for use in proficiency testing by interlaboratory comparison) and scoring reports were created by a software developed by MOTAKK and sent to participating labs. Each laboratory evaluated their own results in comparison with the other laboratory results, reassessed the tests via observing the distance from the mean result and the reference values. The number of laboratories participating in the HBV DNA and HCV RNA external quality control program was 70-73 in 2015-2016. Participants were able to comply with the program tools, registering, entering results and receiving the results reports problem. In HBV panel, 72.6-89.1% and 84.7-90.3% of the participant laboratories were in 1 standard deviation (SD) in 2015-2016, respectively. In HCV panel, 70.8-89.1% and 84.7-90.3% of the participant laboratories were in 1 SD in 2015-2016, respectively. A national external quality control program for HBV DNA and HCV RNA in Turkey has been prepared for the first time with this project and implemented successfully. All the data provided in the MOTAKK external quality control program final report, compensate all the data provided by the quality control program final reports from abroad; additionally, the report allows comparison of used technologies and commercial products.
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    Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged less than five years
    (Elsevier Sci Ltd, 2021) Ceyhan, Mehmet; Karadag-Oncel, Eda; Hascelik, Gulsen; Ustundag, Gulnihan; Gurbuz, Venhar; Samlioglu, Pinar; Yilmaz, Nisel
    Purpose: In Turkey, pneumococcal conjugate vaccine (PCV) was introduced to the national immunization program as PCV7 in 2008, and was replaced with PCV13 in 2011. The aim of the study was to demonstrate the pneumococcal carriage rate and the serotype distribution in healthy children under 5 years in Turkey who were vaccinated with PCV13. Methods: We conducted a cross-sectional study including the collection of questionnaire data and nasopharyngeal (NP) specimens among children aged <5 years from five centers from March 2019 to March 2020. Pneumococcal isolates were identified using optochin sensitivity and bile solubility. Serotyping was performed using a latex agglutination kit and Quellung reaction. Results: NP swab samples were collected from 580 healthy children. The observed overall carriage rate was 17.8%. None of the hypothesised predictors of S. pneumoniae carriage, except maternal education level was statistically significant (p = 0.017). High maternal education level appeared to decrease the risk (lower vs. higher maternal education OR: 1.992 [95% CI; 1.089-3.643], p = 0.025). The overall NP S. pneumoniae carriage prevalence for the PCV13-vaccinated children was 17.8% (103/580). The most common serotypes detected were serotype 15B (n = 10, 9.7%), serotype 23F (n = 9, 8.7%), serotype 23A (n = 9, 8.7%), serotype 11A (n = 7, 6.7%), serotype 19F (n = 5, 4.8%) and serotype 15F (n = 5, 4.8%). Of the isolates, 28 (27.2%) were in PCV13 vaccine strains (VSs), and 75 (72.8%) strains were non-VS. The serotype coverage rate was 27.2% for PCV13. Conclusion: The overall S. pneumoniae carriage rate was higher than in earlier studies from Turkey. Post-vaccine era studies from around the world have reported a decrease in VS serotypes and a 'serotype replacement' to non-VS serotypes, as we determined in our study. (C) 2021 Elsevier Ltd. All rights reserved.
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    Prevalence and antimicrobial susceptibility of Escherichia coli in outpatient urinary isolates in Izmir, Turkey
    (Int Scientific Literature, Inc, 2009) Yilmaz, Nisel; Agus, Neval; Yurtsever, Sureyya Gul; Pullukcu, Husnu; Gulay, Zeynep; Coskuner, Ayten; Kose, Sukran; Aydemir, Sohret; Gulenc, Nalan; Ozgenc, Onur
    Background: Knowledge of antimicrobial resistance pattern in Escherichia coli, the predominant pathogen associated with urinary tract infection (UTI), is important as a guide in selecting empirical antimicrobial therapy. The aim of this study was to determine the antibiotic susceptibility patterns of E. coli strains isolated from adult outpatients with UTI, in Izmir, Turkey. Material/Methods: This study was performed with isolates from outpatients with UTI, collected from 5 university and tertiary-care hospitals in Izmir, Turkey. Isolates were analyzed by standard methods and antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Results: A total of 4,534 E. coli strains (3,449 females and 1,085 males) were examined. Antibiotic resistance rates of the isolates for female and male, respectively: Ampicillin (61.8%, 78.7%), amoxicillin-clavulanic acid (36.6%, 59.1%), cefuroxime (22.5%, 41.3%), cefotaxime (18.2%, 35.8%), piperacillin-tazobactam (11.6%, 31.2%), amikacin (8.3%, 13.9%), gentamicin (24.9%, 40%), trimethoprim-sulfamethoxazole (42.1%, 57.3%), and ciprofloxacin/norfloxacin (42.1%, 63.3%). Extended spectrum beta-lactamase rate was found to be 18.3% and 26.1% for females and males, respectively. The isolates were significantly more resistant to all antibiotics in men than in females in this study (p < 0.001). Conclusions: The most important finding of our study is that a considerable proportion of the studied E. coli isolates were resistant to most antibiotics except amikacin. These data provide useful information for clinicians in determining the appropriate empirical antimicrobial regimen, and help authorities to formulate antibiotic prescription policies.
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    Prevalence and antimicrobial susceptibility of Escherichia coli in outpatient urinary isolates in Izmir, Turkey
    (Int Scientific Literature, Inc, 2009) Yilmaz, Nisel; Agus, Neval; Yurtsever, Sureyya Gul; Pullukcu, Husnu; Gulay, Zeynep; Coskuner, Ayten; Kose, Sukran; Aydemir, Sohret; Gulenc, Nalan; Ozgenc, Onur
    Background: Knowledge of antimicrobial resistance pattern in Escherichia coli, the predominant pathogen associated with urinary tract infection (UTI), is important as a guide in selecting empirical antimicrobial therapy. The aim of this study was to determine the antibiotic susceptibility patterns of E. coli strains isolated from adult outpatients with UTI, in Izmir, Turkey. Material/Methods: This study was performed with isolates from outpatients with UTI, collected from 5 university and tertiary-care hospitals in Izmir, Turkey. Isolates were analyzed by standard methods and antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Results: A total of 4,534 E. coli strains (3,449 females and 1,085 males) were examined. Antibiotic resistance rates of the isolates for female and male, respectively: Ampicillin (61.8%, 78.7%), amoxicillin-clavulanic acid (36.6%, 59.1%), cefuroxime (22.5%, 41.3%), cefotaxime (18.2%, 35.8%), piperacillin-tazobactam (11.6%, 31.2%), amikacin (8.3%, 13.9%), gentamicin (24.9%, 40%), trimethoprim-sulfamethoxazole (42.1%, 57.3%), and ciprofloxacin/norfloxacin (42.1%, 63.3%). Extended spectrum beta-lactamase rate was found to be 18.3% and 26.1% for females and males, respectively. The isolates were significantly more resistant to all antibiotics in men than in females in this study (p < 0.001). Conclusions: The most important finding of our study is that a considerable proportion of the studied E. coli isolates were resistant to most antibiotics except amikacin. These data provide useful information for clinicians in determining the appropriate empirical antimicrobial regimen, and help authorities to formulate antibiotic prescription policies.
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    THE RECOVERY OF BACTERIA AN ANTIBIOTIC SUSCEPTIBILITY IN THE SAMPLE COLLECTED WITH TRANSTIMPANIC ASPIRATION FROM PATIENTS WITH SECRETORY OTITIS MEDIA
    (Nobel Ilac, 2009) Yurtsever, Suereyya Guel; Uygur, Murat; Yildiz, Sebnem; Yilmaz, Nisel; Ulusoy, Sercan
    Objective: Secretory otitis media (SOM) is a fluid collection in the middle ear space without general or local signs of acute infections or obvious symptoms. SOM is second common disease of ear after acute otitis media in childhood. Material and Method: In our study we evaluated 74 sample collected from 64 patients with transtimpanic aspiration. The samples were incubated in aerobic bacterial, anaerobic bacterial and fungal cultures. The grow of colonies and susceptibility level of antibiotics were evaluated with convantionel methods. Results: There was growth of (37.8%) of effusions. S. epidermidis (50%), H. influenzae unclassified (15%), M. catarrhalis (10%), P. aeruginosa (10%), S. aureus (5%), S. viridans (5%), Enterobacter spp. (5%), Trichoderma viride (5%) were isolated. We could not isolate any anaerob bacteria. However there is no significant antibiotic resistance. We can not exactly interpretation about antibiotic resistance because of insufficient number of isolated bacteria. Conclusion: SOM is an important health problem in childhood because of its influence over growing healthy of child. The antibiotics remain to be first choise in treatments of otitis media with effusions. Thus there is very important to know agents microbial and antibiotic susceptibility in assessment of treatment choise of SOM.
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    Results of a Multicenter Study Investigating Plasmid Mediated Colistin Resistance Genes (mcr-1 and mcr-2) in Clinical Enterobacteriaceae Isolates from Turkey
    (Ankara Microbiology Soc, 2017) Sari, Ayse Nur; Suzuk, Serap; Karatuna, Onur; Ogunc, Dilara; Karakoc, Ayse Esra; Cizmeci, Zeynep; Aliskan, Hikmet Eda; Comert, Fsun; Bakici, Mustafa Zahir; Akpolat, Nezahat; Cilli, Fatma Feriha; Zer, Yasemin; Karatas, Aysel; Karapinar, Bahar Akgun; Bayramoglu, Gulcin; Ozdamar, Melda; Kalem, Fatma; Delialioglu, Nuran; Aktas, Elif; Yilmaz, Nisel; Gurcan, Saban; Gulay, Zeynep
    Colistin is a polymyxin antibiotic which is considered as one of the last line agents against infections due to multidrug resistant or carbapenem resistant gram-negative pathogens. Colistin resistance is associated with chromosomal alterations which can usually cause mutations in genes coding specific two component regulator systems. The first plasmid-mediated colistin resistance gene, mcr-1 was described in Escherichia coli and Klebsiella pneumoniae isolates in December 2015 and followed by another plasmid-mediated colistin resistance gene mcr-2 in 2016. The rapid and interspecies dissemination of plasmid-mediated resistance mechanisms through horizontal gene transfer, have made these genes considerably threatening. After the first reports, although mcr-1/mcr-2 producing Enterobacteriaceae isolates have been reported from many countries, there have been no reports from Turkey. Thus, the aim of this study was to investigate the presence of mcr-1/mcr-2 in clinical Enterobacteriaceae isolates from different parts of our country. A total of 329 Enterobacteriaceae isolates from 22 laboratories were collected which were isolated between March, 2015 and February, 2016. mcr-1/mcr-2 were investigated by polymerase chain reaction during February-March, 2016. Two hundred and seventeen of Klebsiella pneumoniae (66%), 75 of Salmonella spp. (22.8%), 31 of Esherichia coli (9.4%), 3 of Enterobacter cloacae (0.9%), 2 of Klebsiella oxytoca (0.6%) and 1 of Enterobacter aerogenes (0.3%) isolates were included to the study. Agarose gel electrophoresis results of PCR studies have shown expected band sizes for positive control isolates as 309 bp for mcr-1 and 567 bp for mcr-2. However, the presence of mcr-1/mcr-2 genes was not detected among the tested study isolates of Enterobacteriaceae. Although mcr-1/mcr-2 were not detected in our study isolates, it is highly important to understand the mechanism of resistance dissemination and determine the resistant isolates by considering that colistin is a last-line antibiotic against infections of multidrug or carbapenem resistant gram-negative bacteria. Thus, it is suggested that these mechanisms should be followed-up in both clinical and non-clinical (e.g. isolates from food animals, raw meats and environment) isolates of special populations.