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Yayın Blood Culture Positivity: Is It Pathogen or Contaminant?(ANKARA MICROBIOLOGY SOC, 2013) Balikci, Ahmet; Belas, Zeliha; Eren Topkaya, AynurBlood culture is the gold standard for diagnosis of bloodstream infections. Many studies have shown that rapid isolation and identification of the microorganisms in blood culture and initiation of early antimicrobial therapy are critically important to reduce the mortality rate. It was found that the rate of contamination in blood cultures is increasing with automated systems developed to facilitate the growth of microorganism and tracking positivity. It is more difficult to interpret a positive blood culture result especially in the case of having only one sample bottle. In this study the effect of growth time observed in the automated blood culture systems was evaluated in terms of interpretation of blood culture results as being pathogens or contaminants. A total of 1201 blood cultures tested in BACTEC 9120 (Becton Dickinson, USA) system in Maltepe University Hospital Medical Microbiology Laboratory, Istanbul, Turkey during one-year period were included in the study and growth times were recorded for positive bottles. The decision about the growth as being a pathogen or contamination was made by considering the clinical condition of the patient, the number of positive blood cultures and the results of inflammation markers (white blood cell counts, procalsitonin and CRP levels). Of the blood cultures 290 (24%) yielded positive results and 73% (212/290) of them were evaluated as pathogens, while 27% (78/290) were identified as contaminants. The mean detection time for clinically significant isolates was 17.87 hours and for contaminants was 40.56 hours. The difference between the growth time of pathogens and contaminants was found statistically significant (p< 0.0001). With regard to all positive results, it was detected that 66% of the bacteria grew within the first 24 hours. While 29.6% of the pathogens grew within 12 hours, none of the contaminants grew during that time. The evaluation of growth time among staphylococci in terms of methicillin resistance revealed that methicillin- resistant staphylococci grew later (26 hours) than the susceptible ones (11 hours) both in the pathogen group and the contaminant group (p< 0.01). The data of our study emphasized that, the growth time detected in blood culture systems had a critical role in estimating whether the isolated microorganism is a pathogen or a contaminant, especially in case of lack of more than one blood samples. It was concluded that, the bacterial growth detected within the first 24 hours most probably indicated the microorganism as pathogen, while blood culture positivity detected after 48 hours strongly pointed out that it was contaminant. However, it should be considered that methicillin-resistant staphylococci needed much longer time than 24 hour for growth, both as pathogens or contaminants.Yayın A case of urinary tract infection caused by Flavimonas oryzihabitans [Flavimonas oryzihabitans'in etken oldugu bi·r üri·ner si·stem enfeksi·yonu olgusu](2007) Eren Topkaya, Aynur; Özakkaş, Fatma; Benli Aksungar, Fehime; Tülbek, YaşarFlavimonas oryzihabitans is an uncommon bacterial species isolated from clinical specimens. In this report, a 53 years old female patient who had been followed up with the diagnosis of rectum cancer and renal failure for five and two years, respectively, was presented. F.oryzihabitans was isolated from the urine culture of the patient, and the clinical response to ofloxacin therapy was excellent even the urinary catheter has not been removed. Although this pathogen is mostly community aquired, it was found resistant to most of the antimicrobial agents tested. Since it was susceptible to fluoroquinolones and carbapenems, these antibiotics could be the drug of choice for the treatment of infections caused by F.oryzihabitans. The aim of this presentation was to withdraw attention to this bacterium which is thought to be the first urine isolate in our country.Yayın A grubu beta-hemolitik streptokokların antibiyotik duyarlılıkları(Antibiyotik ve Kemoterapi Derneği, 2007) Özakkaş, Fatma; Aksungar, Fehime B.; Eren Topkaya, AynurA grubu beta-hemolitik streptokoklar (Streptococcus pyogenes) bakteriyel farenjitlerin en sık saptanan etkenidir. Penisilin ve diğer beta-laktam antibiyotiklere henüz direnç bildirilmemiştir. Ancak, penisilin allerjisi olan veya tolerans varlığında hastaların tedavisinde alternatif olan makrolidlere karşı giderek artan oranlarda direnç bildirilmiştir. Bu çalışmada, Ocak 2006-Haziran 2006 tarihlerinde boğaz kültürlerinden izole edilen, 100 S.pyogenes suşunun ampisilin, seftriakson, azitromisin, tetrasiklin, kloramfenikol ve siprofloksasine duyarlılıkları araştırılmıştır. Suşların tümü ampisilin, seftriakson ve azitromisine duyarlı bulunmuştur. En yüksek direnç oranı kloramfenikol için saptanırken (% 19), bunu sırasıyla tetrasiklin (% 14) ve siprofloksasin (% 12) dirençleri izlemiştir. Test ettiğimiz makrolid grubu antibiyotik olan azitromisine karşı direnç olmaması, penisilin allerjisi ya da tolerans varlığında, bu gruptaki antibiyotiklerin üst solunum yolu infeksiyonlarının tedavisinde alternatif olabileceğini düşündürmektedir.Yayın An infectious mononucleosis case(ORTADOGU AD PRES & PUBL CO, 2007) Eren Topkaya, Aynur; Benli Aksungar, Fehime; Oezakkas, Fatma; Capan Akinci, NurverEpstein-Barr virus (EBV) is transmitted through intimate contact and the portal of entry is usually the lympho-epithelial cells lining the oral cavity where a persistent infection is established. The virus-host interaction is usually sub-clinical in young children. A 20-month-old male presented with long-lasting high fever of unknown origin. Generalized lymphadenopathy and an exantematous rash on the back of the patient were detected on physical examination. Antibodies against EBV, rubella, CMV and HSV were detected in the initial blood samples and the avidity of IgG class antibodies was evaluated. Low avidity of EBV-VCA IgG was detected and, other serological tests for EBV were performed. Infectious mononucleosis was diagnosed upon positive test results. Previous studies reporte that, during infections by viruses that may cause latent infections, polyclonal B lymphocytes are activated, producing antibodies against other viruses. As a result, in patients with exanthematous rash, IgM and IgG class antibodies along with avidity tests should be evaluated for differential diagnosis.Yayın Isolation ratio and T- serotyping of group A streptococci from pediatric upper respiratory tract infections in Turkey(2005) Eren Topkaya, Aynur; Yıldırım, Tekin; Arsan, SinanAmaç: Akut romatizmal ateş, A grubu streptokokların neden olduğu tonsillofarenjitlerden sonra gelişen non-süpüratif bir sekeldir. A grubu streptokokların M1, M3, M5, M6, M14, M18, M19, M24 gibi belirli M serotipleri bu tür sekellere yol açmaktadır. M proteinlere karşı oluşan antikorlar streptokoklara karşı bağışıklığı sağlarken, romatizmal ateşe de neden olurlar. Anti-M serumları ticari olarak elde edilemediğinden, birçok laboratuvarda A grupları, T agglütinasyon paterni ve opasite faktörü ile serotiplenmektedir. Ülkemizde, son zamanlarda yaygın olan serotipleri belirlemek amacıyla, 930 çocuktan alınan boğaz sürüntülerinden izole edilen 120 streptokok kökeninin, T protein tipi ve opasite faktörü araştırılmıştır.Yöntemler: T protein tipini belirlemek üzere, A grubu streptokok kökenlerinin homojen süspansiyonları, polivalan antiserumlarla (T, U, W, X, Y) lam agglütinasyon yöntemi ile karşılaştırılmıştır. Opasite faktörünü belirlemek için mikroplak yöntemi kullanılmıştır.Bulgular: Serotiplenebilen kökenler arasında en sık saptanan, T-protein agglütinasyon paterni U (2, 4, 6, 28) olmuştur (%30). Bunu T-protein agglütinasyon paterni olarak %20 ile T (1, 3, 13, B3264) ve % 18 ile X (8, 14, 25, Imp.19) izlemiştir. Sonuç: Romatizmal ateş ve romatizmal kalp hastalıklarını genel olarak değerlendirebilmek için, ülkemizde daha fazla epidemiyolojik ve serotip çalışmalarına ihtiyaç vardır.Yayın Klinik örneklerden izole edilen pseudomonas aeruginosa suşlarının antibiyotik duyarlılıkları(Maltepe Üniversitesi, 2013) Akduman Alaşehir, Elçin; Karadeniz, Aslı; Balıkçı, Ahmet; Eren Topkaya, AynurAmaç: Pseudomonas aeruginosa hastane enfeksiyonlarının sık rastlanan etkenleri arasında yer alan fırsatçı patojendir. Yüksek morbidite ve mortalite ile seyreden enfeksiyonlara sebep olmaları nedeni ile antibiyotik dirençlerinin belirlenmesi etkin tedavi için önemlidir. Bu çalışmada hastanemiz mikrobiyoloji laboratuvarına gönderilen örneklerden izole edilen P. aeruginosa suşlarının antibiyotik direnç dağılımının retrospektif olarak saptanması amaçlanmıştır. Metod: Hastanemizde Haziran 2011 - Haziran 2013 tarihleri arasında kültür antibiyogram testi için gönderilen çeşitli klinik örneklerden izole edilen toplam 122 P. aeruginosa suşu retrospektif olarak incelenmiştir. Suşlar standart biyokimyasal yöntemler ve Api 20 NE (Bio-Merieux, France) sistemi kullanılarak tanımlanmış ve antibiyotik duyarlılığı Clinical and Laboratory Standards Institute (CLSI) kriterleri doğrultusunda Mueller-Hinton agarda disk diffüzyon yöntemi ile araştırılmıştır. Bulgular: Toplam 122 suşun %47.5'i solunum yolu , %26.2'si idrar, %16.4'ü yara ve %9,8'i kan örneklerinden izole edilmiştir. İzole edilen suşlarda amikasin, gentamisin, siprofloksasin, levofloksasin, piperasilin-tazobaktam, sefaperazon-sulbaktam, seftazidim, sefepim ve imipenem direnci sırasıyla %9.8, %17.2, %19.7, %23.8, %23, %13.9, %23.8, %24.6 ve %23.8 olarak bulunmuştur. Sonuç: Hastanelerde P. aeruginosa suşlarının direnç paterninin izlenmesi ampirik tedavide uygun antimikrobiyal ajanın seçiminde önemlidir.Yayın Plasma BNP and homocysteine levels in patients with or without congestive heart failure(Turkish Society of Cardiovascular Surgery, 2007) Sekban, Ahmet; Benli Aksungar, Fehime; Şahin, Müslüm; Eren Topkaya, Aynur; Akyıldız, MahmutBackground: We investigated the relationship between brain natriuretic peptide (BNP), a marker for congestive heart failure, and plasma homocysteine levels. Methods: The study included seven patients (3 females, 4 males) with congestive heart failure and 36 patients (17 females, 19 males) without a history of previous myocardial infarction or congestive heart failure. Plasma BNP and homocysteine levels were measured. All the patients were assessed by transthoracic echocardiography.Results: In 19 patients (44%) plasma BNP and homocysteine levels were lower than 15 pg/ml and 7.91 mol/l, respectively, whereas in 24 patients, the corresponding levels were higher than 68.4 pg/ml and 8.84 mol/l. There was a significant positive correlation between plasma BNP and homocysteine levels (r=0.92, p<0.001, 95% confidence interval 0.86-0.95). No significant differences existed between male and female patients with respect to plasma BNP and homocysteine levels. The mean BNP and homocysteine levels were 369.9±75.4 pg/ml and 13.6±4.6 mol/l in patients with congestive heart failure; and 78.3±24.3 pg/ml and 8.9±2.5 mol/l in patients without a history of previous myocardial infarction or congestive heart failure, respectively. The two groups exhibited significantly different plasma BNP and homocysteine levels. Echocardiographic assessments showed left ventricular diastolic dysfunction in 11 patients without congestive heart failure, having a BNP level above 100 pg/ml. These patients also had higher homocysteine levels.Conclusion: Our results demonstrate that the risk for congestive heart failure may be more reliably assessed if BNP and homocysteine levels are incorporated into diagnostic screening of patients with myocardial infarction and of high-risk patients such as those with diabetes or hypertension.Yayın Primary lymphoepithelioma-like carcinoma of the lung: Report of a rare case and review of the literature(2012) Yener, Neşe Arzu; Balıkçı, Ahmet; Çubuk, Rahmi; Midi, Ahmet; Örki, Alpay; Eren Topkaya, AynurPrimary lymphoepithelioma-like carcinoma of the lung is a rare type of non-small cell lung carcinoma. In this study, we aimed to present a 62-year-old smoker male with a primary lymphoepithelioma-like carcinoma of the hilar region of the left lung. The patient underwent left pneumonectomy and no adjuvant therapy was given. There were no other abnormalities on whole body PET/CT scan including the nasopharyngeal region. The patient showed seropositivity for EBV IgG but immunohistochemistry and PCR amplification studied on paraffin-embedded tissue sections of the tumor failed to show any sign of EBV infection within the tumor cells. He is alive and disease-free four months after the operation. Although primary lymphoepithelioma-like carcinoma of the lung is usually reported in young females with no history of tobacco use and the tumor cells are infected with EBV, it may rarely be seen in elderly males with a history of tobacco use and the tumor cells not infected with EBV.
