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Öğe Annual trends in antibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations(Luigi Ponzio E Figlio, 2004) Tatman-Otkun, M; Gürcan, S; Özer, B; Shokrylanbaran, NAcinetobacter baumannii is becoming increasingly resistant to antibiotics often requiring combination therapy. Annual changes of resistance to selected antimicrobials of 150 A. baumannii strains, isolated as nosocomial pathogens between 1994 and 2000 were investigated. The synergistic effects of antimicrobials were studied using a microdilution checkerboard technique in eight selected isolates resistant to third-generation cephalosporins and beta-lactam/beta-lactamase inhibitor combinations and to at least one aminoglycoside. Rates of resistance of cefepime, ceftazidime, ampicillin/sulbactam, amikacin and ciprofloxacin (before 1996 and between 1996-2000) were 29.7% - 72.6, 37.8% - 81.4%, 35.1% - 72.6%, 8.1% - 56.6%, 5.4% - 46.0% respectively (p<0.001 for each one). Synergy was observed in at least one of the combinations of antibiotics from seven of eight isolates (87%), no antagonism was detected with any combination. Ceftazidime-amikacin (50%) and ampicillin/sulbactam-tobramycin (50%) were the most effective combinations. Due to the effectiveness of sulbactams to Acinetobacter, ampicillin/sulbactam-tobramycin combination is recommended as the first line of choice.Öğe Antibiotic resistance patterns and plasmid profiles of Salmonella typhimurium isolates in Turkey(Springer-Verlag, 2001) Otkun, M; Erdem, B; Akata, F; Tatman-Otkun, M; Gerceker, D; Yagci, S; Ozkan, ETo understand the resistance mechanisms present in 75 isolates of Salmonella typhimurium derived from clinical infections in Turkey, antimicrobial resistance patterns and associated plasmids were investigated. Among the 22 strains that produced extended-spectrum beta -lactamase (ESBL), 20 were resistant to aminoglycosides and 12 to trimethoprim-sulfamethoxazole, Strains that did not produce ESBL did not express aminoglycoside or trimethoprim-sulfamethoxazole resistance, although 27 of them were ampicillin resistant. None of the strains were resistant to imipenem or fluoroquinolones. Nineteen strains producing ESBL carried a plasmid of >100 MDa, Seven ESBL-producing strains conjugally transferred their ESBLs and trimethoprim-sulfamethoxazole resistance. No correlation was found between the resistance patterns and plasmids in non-ESBL-producing strains.Öğe The antimicrobial susceptibility of Stenotrophomonas maltophilia isolates using three different methods and their genetic relatedness -: art. no. 24(Bmc, 2005) Tatman-Otkun, M; Gürcan, S; Özer, B; Aydoslu, B; Bukavaz, SBackground: Stenotrophomonas maltophilia is inherently resistant to many antimicrobials. So far, antimicrobial susceptibility tests for S. maltophilia have not been fully standardized. The purpose of the study was to compare the susceptibility of S. maltophilia isolates against seven different antimicrobials using three different methods and to investigate their genetic relatedness. Results: Although trimethoprim/sulfamethoxazole (SXT) and ciprofloxacin have the lowest MIC values, SXT (98.1%) and ticarcillin/clavulanate (TLc) (73.1%) were found to be the most effective antimicrobials by agar dilution method, which was in accordance with the breakpoints established by NCCLS. Disc diffusion and E-test was in agreement with agar dilution method for SXT. When the isolation dates, clinics, antibiotyping, and AP-PCR data were investigated, two small outbreaks consisting of five and three cases were determined. Conclusion: By using the NCCLS criteria, disc diffusion and E-test were unreliable alternative methods for S. maltophilia, except for SXT. However, the significance of these data should be confirmed by further experimental and clinical studies.Öğe The epidemiology of hepatitis a virus infection in children, in Edirne, Turkey(Springer, 2004) Erdogan, MS; Otkun, M; Tatman-Otkun, M; Akata, F; Türe, MTurkey is a middle endemic area with respect to Hepatitis A virus (HAV) infection. However, the frequency of this infection varies due to socioeconomic differences in various regions. The aim of this study was to detect the most likely age of exposure to HAV and factors affecting infection rates among children living in Edirne. A sample of 645 children between the ages of 0-19 living in Edirne were tested for total anti-HAV levels using ELISA method. A questionnaire on socio-economic status (SES), possible risk factors, and place of residence was completed for each child. Anti-HAV seropositivity was found to be 4.4, 25, 37.3 and 43.2%, in 2-5, 6-10, 11-14 and 15-19 age groups, respectively. Seropositivity was found to be increasing with age (p < 0.05). According to logistic regression analysis results; mother's education, SES of family, history of hepatitis in primary family members and the number of brothers or sisters were determined as factors increasing the seropositivity of HAV. Furthermore, HAV infection risk was found to be a decreasing function of income that is higher the income less likely the infection. These results showed that HAV infection rate in Edirne is in middle endemicity and the most likely way of exposure is transmission from family members. Although it requires further cost-effectiveness studies, our results indicate that applying the HAV vaccination in early childhood would be beneficial to decrease the prevalence of the infection and prevent HAV epidemics.Öğe Exposure time to hepatitis B virus and associated risk factors among children in Edirne, Turkey(Cambridge Univ Press, 2005) Otkun, M; Erdogan, MS; Tatman-Otkun, M; Akata, FHepatitis B virus (HBV) infection is endemic in Turkey, but the main routes of transmission were not well established. This study aims to detect the exposure time to HBV and associated risk factors among children. In a sampling group of children aged 0-19 years living in Edirne, antiHBc, antiHBs and HBsAg were screened by the microELISA method. A questionnaire was also completed for each child. In 717 children that were included in the study, the total antiHBc seropositivity was 5.4% and was 1.8, 0.8, 1.7, 6.8, 11.8% in 0-1, 2-5, 6-10, 11-14, 15-19 years age groups respectively. The overall HBsAg seropositivity was 1.7%. The risk of HBV infection increased after the age of 10 years (OR 7.79, 95% CI 3.01-20.16). Collective circumcision was the only independent factor according to regression analysis. Children living in Edirne should be vaccinated against HBV before reaching 11 years of age.Öğe First case report of empyema caused by Beauveria bassiana(Blackwell Publishing, 2006) Gürcan, S; Tugrul, HM; Yörük, Y; Özer, B; Tatman-Otkun, M; Otkun, MInfections with Beauveria bassiana are extremely rare in humans. A 51-year-old man was admitted to hospital with the diagnosis of lung adenocarcinoma. Thoracic wall resection with lobectomy was applied and empyema has developed after prolonged air leakage. B. bassiana was isolated in pleural fluid. The patient improved without antifungal therapy after thoracotomy with securing of air leakage.Öğe A food-borne outbreak caused by salmonella enteritidis(Yonsei Univ Coll Medicine, 2003) Tansel, Ö; Ekuklu, G; Otkun, M; Tatman-Otkun, M; Akata, F; Tugrul, MThis study was designed to define the epidemiology of a food-borne outbreak caused by Salmonella enteritidis that affected only one squadron of a military battalion located in the vicinity of the city of Edirne in Turkey. The outbreak was analyzed by a standard surveillance form of the Centers for Disease Control and Prevention. The relationship between the eaten foods and cases was analyzed by Fisher's exact chi-square test, and odds ratios were calculated by a case-control study. The outbreak affected 60 of 168 soldiers in the squadron, 16 of whom were hospitalized. S.enteritidis was cultured in stools from 13 of the hospitalized soldiers and from 3 soldiers who had prepared the food. All strains were completely susceptible to antibiotics; their plasmid profiles were also identical. The highest attack rate detected was 55.7% in an omelet eaten 24 hours before (p<0.001). Furthermore, it was the riskiest food according to the case-control study (OR=7.88; 95% CI=3.68-16.89). The food samples were unobtainable because they had been discarded. All of the hospitalized cases recovered, and none of the control cultures of stools yielded the pathogen after three weeks. In conclusion, although our results didn't indicate the exact source of the outbreak microbiologically, the omelet was considered to be the source based on the epidemiological proofs.Öğe Nebulized surfactant as a treatment choice for otitis media with effusion: an experimental study in the rabbit(Cambridge Univ Press, 2001) Koten, M; Uzun, C; Yagiz, R; Kemal, M; Adali, K; Karasalihoglu, AR; Tatman-Otkun, MExogenous surfactant can improve eustachian tube function in experimentally induced otitis media with effusion (OME). Performing tympanometric recordings, the efficacy of inhaled nebulized surfactant, as compared with inhaled nebulized physiological saline was investigated, for the treatment of OME experimentally induced in the rabbit by intrabullar inoculation of heat-killed Streptococcus pneumoniae. In addition, the histological changes in middle ears after the treatment were investigated in order to establish whether the pathological findings correlated with the results. Middle-ear pressure values before, and after, treatment were analyzed by the Wilcoxon statistical method, and the Mann-Whitney U test was used to compare the post-treatment values between groups. In all ears with OME in the affected animals, which were treated with nebulized surfactant inhalation, a positively significant (p <0.05) increase of pressure more than 20 daPa was recorded. In the control group, after inhalation of nebulized physiological saline, there was no positive increase in the affected middle-ear pressures; on the contrary, more negative pressure changes were recorded. In the histological evaluation, middle-ear epithelia and sub-epithelial space were normal in surfactant-treated ears with OME, whereas mucosal thickening with an oedematous sub-epithelial space containing occasional inflammatory cells and increases in connective tissue and vascularity, and effusions on the epithelial surface were present in the ears with OME in the control group. The significant improvement in the negative middle-ear pressure after nebulized surfactant treatment and the histological findings shown in our study can support the theory that surface-active agents are of importance in eustachian tube function even under pathologic conditions, such as OME.Öğe An outbreak of tularemia in western Black Sea Region of Turkey(Yonsei Univ College Medicine, 2004) Gürcan, S; Tatman-Otkun, M; Otkun, M; Arikan, OK; Ozer, BThe aim of this study was to investigate the source and the size of a tularemia outbreak in a village located in a non-endemic area. Five patients from the same village were admitted to hospital with the same complaints all within one week of September 2001. Tularemia was suspected and a diagnosis was made after physical and anamnesis examinations. The village was visited the same week that the patients were admitted to the hospital, in the January and April 2002. The villagers were examined and screened serologically by microagglutination method and the water sources were investigated bacteriologically. A total of 14 people were found to be infected from the outbreak and the oropharyngeal form was the only clinical presentation. Antibody titers ranged between 1 : 80 and 1 : 640. The patients responded well to the aminoglycoside plus tetracycline therapy. Examination of the pipewater and three springs revealed that all the water sources were contaminated by coliforrns, however, Francisella tularensis could not be isolated in glucose-cystine. medium. Antibody levels stayed stable or decreased seven months after. Tularemia had not been reported in this area before, so the first patients were misdiagnosed. In conclusion tularemia should be considered in differential diagnosis of patients with fever, sore throat and cervical lymphadenopaties.Öğe Prevalence of extended-spectrum beta-lactamases produced by nosocomial isolates of Enterobacteriaceae in Trakya University Hospital, Turkey(Luigi Ponzio E Figlio, 2003) Akata, F; Tatman-Otkun, M; Özkan, E; Tansel, Ö; Otkun, M; Tugrul, MThe prevalence of extended-spectrum beta-lactamase (ESBL) production by 194 nosocomial isolates of Enterobacteriacea recovered from 1995 to 1999 was investigated. The ESBL production was determined by the double-disk synergy test and was confirmed by the E-test ESBL strip. Twenty-three isolates (21 Klebsiella pneumoniae, one Escherichia coli, one Providencia rettgeri) were found as ES-BL-producers (11.8%). These isolates were also usually resistant to non-betalactam antibiotics. Most of them contained a beta-lactamase with a pI of 7.6. All the strains conjugally transferred their ESBLs to recipient E.coli. Contrary to others, ESBL-producing K.pneumoniae strains isolated in 1999 were resistant to ciprofloxacin, and had the identical plasmid profiles suggestive of an outbreak. Ciprofloxacin resistance in these strains could not be transferred. In conclusion, K. pneumoniae was the main ESBL-producing species among nosocomial isolates of Enterobacteriacae in our hospital.Öğe Resistance to macrolides in Group A streptococci from the European section of Turkey(Elsevier Science Bv, 2002) Akata, F; Öztürk, D; Tansel, Ö; Tatman-Otkun, M; Otkun, M; Fitoussi, F; Bingen, EThe aim of this study was to determine the susceptibilities to macrolides of Group A streptococcal isolates from the European section of Turkey. In the case of resistant isolates, the patterns and genetic mechanisms of erythromycin resistance were studied. Seven (2.7%) of the 260 isolates were resistant to erythromycin. Four of them showed the M phenotype and harboured mefA genes whereas three isolates showed the inducible macrolide, lincosamide and streptogramin B resistance phenotype and harboured ermTR genes. In the European section of Turkey, the current resistance rate of Group A streptococci to macrolides remains low. (C) 2002 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.
