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Öğe Changes in antimicrobial resistance and outcomes of health care-associated infections(Springer Link, 2021) Aydın, Mehtap; Azak, Emel; Bilgin, Hüseyin; Menekşe, Şirin; Asan, Ali; Elmaslar Mert, Habibe Tülin; Karakoç, Zehra ÇağlaTo describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.Öğe Crusted (Norwegian) scabies in a malnourished geriatric patient with dementia(2020) Karakoç, Zehra Çağla; Başel, Ahmet; Koçak, Yeşim; Pınarbaşı Şimşek, Binnur; Tuğrul, Tolga Simru; Akın, FigenNorwegian scabies, which is a highly contagious variant of scabies, is a common parasitic infestation in elderly persons living in care homes. Clinical symptoms may be different in this patient group (slow onset and insidious progression, often without intense itching) with the addition of comorbid conditions, such as dementia and neurological diseases. Healthcare workers should be aware of this form of scabies, which is more common in elderly and cognitively impaired patients. Early diagnosis can be made easily by a microscopic examination of skin lesions. Isolation precautions are important measures to prevent outbreaks. The treatment includes keratolytic agents besides topical and oral scabicides because of the high mite burden and hyperkeratotic lesions of the crusted scabies. In this study, we reported on a case who had resided in a geriatric care home. The patient was diagnosed with crusted scabies and died in our intensive care unit with pneumonia.Öğe Epidemiology of invasive fungal infections(Aves, 2019) Karakoç, Zehra ÇağlaInvasive fungal infection (IFI) is still one of the leading causes of morbidity and mortality in immunosupressed hosts. Although Candida species are the most common cause of IFIs and Candida albicans still remains the predominant cause of invasive candidiasis, emergence of non-albicans species has increased with the decreasing fluconazole sensitivity in the world. There is also an increase in the incidence of Aspergillus, new species such as Candida auris, and rare moulds. Many factors have likely contributed to this situation including the number of patients with increased immunosuppression and aggressive chemotherapy, increased use of invasive devices and antimicrobial prophylaxis or treatment approaches. Species and resistance distribution of IFI agents can vary between hospitals and even within different units in the same hospital as in the whole world and may vary according to predisposing factors of patients. Due to these reasons, understanding the changing epidemiology of IFIs is important in developing effective therapeutic and prophylactic approaches for these infections expected to increase in the next decade.Öğe First wave in COVID-19 pandemic: a single center experience(AVES, 2020) Karakoç, Zehra Çağla; Pınarbaşı Şimşek, Binnur; Asil, Rıza; Dodurgalı, Recep; Çalışkaner, Filiz; Özsarı, Alev; Tuğrul, Tolga Simru; Ece, FerahAmaç: Çalışmamızda COVID-19 pandemisinin birinci dalgası sırasında Liv Hospital Ulus’ta yatırılarak izlenen COVID-19 tanılı hastaların epidemiyolojik ve klinik özellikleri, laboratuvar ve görüntüleme bulguları ve prognozlarının değerlendirilmesi amaçlanmıştır. Yöntemler: COVID-19 tanısıyla izlenen toplam 124 olgu retrospektif olarak değerlendirildi. Hastanın solunum yolu örneğinde SARS-CoV-2 RT-PCR testi sonucunun pozitif olması, kesin olgu; hastada SARS-CoV-2 RT-PCR testi negatif olmakla birlikte, uygun klinik şikayetlerin olması ve toraks bilgisayarlı tomografisi (BT)’nde viral pnömoniyle uyumlu bulgular saptanması ise olası olgu olarak kabul edildi. Oda havasında SpO2 ?%93 olup oksijen desteği veya mekanik ventilasyon (MV) veya ekstrakorporeal membran oksijenasyonu ihtiyacı uyulduğunda, hastada “ağır hastalık” olduğu kabul edildi. Klinik iyileşme ise 48 saat süreyle ateşin olmaması, lökopeninin düzelmesiyle birlikte lenfosit ve trombosit sayısının artması, oksijen desteği ihtiyacının azalması veya MV’den ayrılma olarak tanımlandı. Bulgular: Toplam 124 olgunun ortanca yaşı 54 (minimum-maksimum 17-98)’tü ve %59.7’si erkek hastalardan oluşmaktaydı. Olguların %58’ine çeşitli komorbiditeler eşlik etmekte olup, en sık hipertansiyon (%33.9) vardı; bunu diabetes mellitus (%16.1) ve kalp hastalıkları (%13.7) izliyordu. Sık rastlanan klinik şikayet grubu, ateş (%73.4), öksürük (%70.2) ve nefes darlığı (%30.7)’ydı. Hastaların 81 (%65.3)’inin SARS-CoV-2 RT-PCR testi pozitifti. Olguların 43 (%34.6)’ünde ağır hastalık vardı ve bu hastaların 18’i yoğun bakım ünitesinde takip edildi. Ağır hastalar, ağır olmayanlarla karşılaştırıldığında ortalama yaşları ve eşlik eden komorbiditeleri daha fazla, yatış süreleri de daha uzundu. Laboratuvar bulguları arasında lökopeniden çok, lökositoz saptandı. Gerek lenfopeni, trombositopeni ve hipoalbüminemi varlığı, gerekse kreatinin, D-dimer ve akut faz göstergelerinin yüksekliği ağır hastalıkta daha belirgindi. Hastaların toraks BT’sinde saptanan tutulumlar, çoğunlukla bilateral (%73), alt ve alt-orta loblarda (%48.7), periferik yerleşimli (%49.6) buzlu cam görünümünde opasiteler (%93.3) şeklindeydi. Sağlık Bakanlığı COVID-19 Rehberleri’ndeki önerilere göre tedavi edilen hastaların hiçbirinde ciddi bir yan etki gelişmedi. Hastalardan 4 (%3.2)’ü kaybedildi. Kaybedilen hastalardan 2 (%2.2)’si kesin olgu tanısı almıştı. Sonuçlar: Kullanımda olan RT-PCR testlerinin duyarlılıkları, COVID19’un tanısında ve tedavisinin yönlendirilmesinde yeterli değildir. Bu nedenle, sürecin yönetilmesinde aynı zamanda görüntüleme yöntemlerinin ve serum antikor testlerinin de kullanılması gerekmektedir. Klimik Dergisi 2020; 33(3): 223-9.Öğe Kardiyak cerrahi sonrası gelişen sağlık bakımı ile ilişkili enfeksiyonların değerlendirilmesi-tek merkez deneyimi(2019) Karakoç, Zehra ÇağlaGiriş: Son yıllarda artan aterosklerotik kalp hastalığı insidansı ile orantılı olarak, dünyada ve ülkemizde kardiyak cerrahi giderek artan sayıda hastaya uygulanmaktadır. Bu ameliyatlar sonrası gelişen sağlık bakımı ile ilişkili enfeksiyon (SBİE)’lar ise ileri yaş ve komorbiditeleri olan bu hasta grubunda mortalitenin önemli bir nedenidir. Literatürde bu enfeksiyonların sıklığı %2,25-24,9 arasında bildirilmektedir. Çalışmamızda kardiyak cerrahi sonrası SBİE gelişen hastaların risk faktörlerinin, mikrobiyolojik özelliklerinin ve mortalite oranlarının retrospektif olarak değerlendirilmesi amaçlandı. Yöntemler: Çalışmamıza Ocak 2013- Eylül 2018 tarihleri arasında açık kalp cerrahisi ameliyatı olan 744 erişkin hastada gelişen 36 SBİE dahil edildi. Olguların demografik bilgileri, olası SBİE risk faktörleri, etken mikroorganizmalar ve antibiyotik duyarlılıkları, mortaliteleri hastane kayıtları ve enfeksiyon kontrol komitesi sürveyans dosyalarından retrospektif olarak değerlendirildi. Üreyen bakteri türleri ve antibiyotik duyarlılıkları VITEK® 2 (bioMérieux, Marcyl’Etoile, Fransa) otomatize sistemi ile tanımlandı. Bulgular: Ortalama SBİE hızı %4,8 (36/744), cerrahi alan enfeksiyon (CAE) hızı %2.9 (22/744) olarak saptandı. Enfeksiyon gelişen 32 hastanın 21’sine (%65,6) koroner arter by-pass cerrahisi uygulandı.Olguların 23 (%71,9)’ü erkek, ortalama yaşları 62.2 (38-80) olup, 22 (%68,8)’sinin ASA skoru ?3 idi. Ortalama vücut kitle indeksi 24,8, 11(%34,4)’i obez hastalardan oluşmaktaydı. Yirmi yedi (%84,3) hastada en az bir komorbidite vardı ve en sık komorbidite %43,7 oranında diyabetti. Enfeksiyonların dağılımı sırası ile; %61,1’i (CAE), %24,9’u pnömoni, %8,2’si kan dolaşımı enfeksiyonu, %5,5’i idrar yolu enfeksiyonu idi. Etyolojiden sorumlu mikroorganizmalar %77,8 (28/36) enfeksiyonda izole edilebildi ve en baskın etken; %55,6 (20/36) ile gram negatif mikroorganizmalar idi. Sağlık bakımı ile ilişkili enfeksiyon gelişenlerde%28,1(9/32)oranında mortalite gelişti. Sonuç: Çalışmamızda tek merkezin kalp ameliyatları sonrasında gelişen SBİE’larını paylaştık. SBİE’ların gelişimi açısından en temel risk faktörleri; ileri yaş, yüksek ASA (AmericanSociety of Anestesiology) skoru, diyabet, obezite, internalmammarian arter kullanımı, uzayan ameliyat süresi, intraoperatif kan ve kan ürünü kullanımı, postoperatifhiperglisemik seyir, uzayan mekanik ventilasyon süresidir. Literatürdeki büyük olgu volümlü çalışma sonuçları da bizim sonuçlarımızı desteklemektedir.Öğe Multidrug-resistant bacterial infections of the libyan civil war victims: what did we learn?(Istanbul Univ, Fac Medicine, Publ Off, 2020) Karakoç, Zehra Çağla; Bekmezci, Taner; Başel, Ahmet; Pınarbaşı Şimşek, BinnurObjective: Complicated by nosocomial infections and wide spectrum antibiotherapy, combat related injuries (CRI) are associated with resistant gram-negative microorganisms, especially at the later stage. The aim of this study is to retrospectively investigate demographic, clinical and microbiologic characteristics of 45 CRI patients transferred from Libya and hospitalized in a private clinic. Material and Method: Surveillance cultures (nasal, rectal, wound swabs, trakeal aspirates, urine and blood cultures) were obtained and isolated bacteria and their antibiotic susceptibility were identified using VITEK (R) 2 system (bioMerieux, Marcy l'Etoile, France). Results: The median age of 45 patients (44 [97.8%] male) was 30.7 +/- 12.9 years. The majority of the injuries were due to firearms (66.7%) and 22 (48.9%) patients were injured on the lower extremities. Open bone fractures were present in 30 (66.6%) patients. Primary wound site infection was present in 28 (62.2%) patients. Surveillance cultures revealed 40 microorganisms from the samples of 29 patients, which were gram-negative rods in 22 (55%), gram-positive cocci in 17 (42.5%) and fungus in 1 (2.5%) patients). Of the 40 isolated microorganisms, 13 (32.5%) were non-resistant, 10 (22.2%) were MDR, and 13 (28.9%) were XDR. None of the patients died in the study period. Conclusion: Despite the limited number of cases, this study presents the characteristics of the Libyan combat victims treated by a multidisciplinary team at a single center. Surveillance cultures revealed many victims to be infected or colonised by MDR/XDR bacteria. Early surgical wound debridement, early initiation of antibiotic therapy in the proper dose and spectrum, and obtaining wound site cultures whenever necessary may help to provide more favorable outcomes in CRI victims.Öğe Non-albicans species: main actors of candidemia? seven-year experience from a single centre(ISTANBUL UNIV, 2020) Karakoç, Zehra ÇağlaObjective: Candidemia is a major cause of mortality among healthcare-associated infections. Considering the increase in non-albicans species in recent years, it is important to define the treatment approach by identifying Candida at the species level. The aim of this study was to evaluate the epidemiological characteristics, risk factors and mortality of patients with candidemia in our hospital. Material and Method: Forty-four patients with Candida species isolated from at least one bottle of blood culture taken during hospitalization between January 2013 and October 2019 were included in the study. Patients' demographic information, comorbidities, duration of hospitalization and ward, neutropenia, total parenteral nutrition (TPN), steroid administration and invasive device use, antimicrobial treatments used in the last month, source of candidemia, acute phase indicators, Candida species and antifungal resistance, antifungal treatment, clinical response and mortality were evaluated retrospectively. Candida species and antifungal susceptibilities were identified using the automated system VITEK (R) 2 (bioMerieux, Marcy l'Etoile, France). Results: A total of 44 patients with candidemia participated; the median age was 57, and 27 (61.3%) were male. The median length of stay was 33.5 days. Forty-two (95.4%) of the cases were accompanied by multiple comorbidities, and the most common aetiology was malignancy (59%). Most (97.7%) of the patients had received broad-spectrum antibiotic treatment in the last month. Central venous catheters (CVCs) were used in 35 (79.5%) of the cases and 50% of them were treated with TPN. Candida albicans (54.6%) was the most common species, followed by Candida tropicalis (18.2%). Non-albicans species were observed to increase over time. Thirty-day mortality was 36.3%. Conclusion: Non-albicans candidemia was found to have increased over the years in our study. The main risk factors for candidemia were determined as the presence of comorbidities, especially malignancy, prior broad-spectrum antibiotherapy use, TPN treatment and the presence of CVC. The mortality rate in this study was also consistent with the literature.Öğe Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections(W B Saunders Co Ltd, 2018) Aydın, M.; Ergönül, O.; Azap, A.; Bilgin, H.; Aydın, G.; Çavuş, S. A.; Demiroğlu, Y. Z.; Alışkan, H. E.; Memikoğlu, O.; Menekşe, S.; Kaya, S.; Demir, N. A.; Karaoğlan, I.; Başaran, S.; Hatipoğlu, C.; Erdinç, S.; Yılmaz, E.; Tümtürk, A.; Tezer, Y.; Demirkaya, H.; Çakar, S. E.; Keşke, S.; Tekin, S.; Yardımcı, C.; Karakoç, Zehra Çağla; Ergen, P.; Azap, O.; Mülazimoğlu, L.; Ural, O.; Can, F.; Akalın, H.This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.Öğe Seasonal influenza vaccination coverage: a multicenter cross-sectional study among healthcareworkers(Meditagem, 2020) Tümtürk, Ayhanım; Tosun, Sema; Yıldız, İlknur Esen; Köksal Alay, Handan; Mıstanoğlu Özatay, Duru; Karakoç, Zehra ÇağlaAim: The aim of this study is to evaluate the attitudes of healthcare workers against seasonal influenza vaccine and the reasons for vaccine avoidance. Materials and Methods: This national survey was conducted from April 1st to June 30th in 2017. The study was carried out among health care workers working in primary, secondary and tertiary care settings. A total of 12 questions were sent to 5046 health care professionals from 55 different cities who agreed to participate in the survey. Results: 7% of the participants stated that they get vaccinated regularly every year. 65.8% of the participants stated that they don’t get vaccinated at all. The most important reason for those who did not receive influenza vaccination was their disbelief in the necessity of the vaccination (51.9%). The most common reason for the seasonal influenza vaccination was the prevention of influenza infection (56.7%). Conclusion: The results of the study showed that HCWs influenza vaccination rates are very low. Doctors have been found to have slightly better rates than other HCWs. The high level of education and the increase in professional experience had a positive effect on the vaccination rate. It is important to know the HCWs attitudes and behaviors towards the vaccination to increase the rates.Öğe Sharps injuries: a single-center experience(Aves, 2018) Karakoç, Zehra Çağla; Koçak, Yeşim; Pınarbaşı Şimşek, BinnurObjective: This research evaluates the sharps injuries (SIs) of health care workers in a private hospital and the effect of education on injury rate. Methods: Data were analyzed retrospectively from records of 112 injuries that occurred in 103 health care workers between January 2013 and December 2016. Training was conducted once a year and on entry for new staff members. In case of increase in injury rates despite training, PDCA (plan-do-check-act) cycle study was also applied with the decision of the infection control committee. Training was provided for problem areas (such as disposing of sharps immediately after use in patient room, and verbal warning when passing sharps hand to hand between team members in operating room, etc.). Results: During four years of follow-up, 1162 health care workers were trained for SIs. Hepatitis B immune globulin and vaccination were administered to three and HIV postexposure prophylaxis was prescribed for two employees. No blood-borne diseases were encountered in follow-ups. Between the years 2013 and 2016, the rates of SIs were 4.3%, 9.6%, 4.4%, and 8.6%, respectively. The distribution of injured persons according to occupational groups are 47.3% nurses, 20.5% assistant health care workers, 17% cleaning personnel, 8.9% laboratory technicians, 6.3% doctors. The most common type of exposure is the needlestick injury (% 73). Operating room unit was the leading location with 43% frequency. As the SI rate was high in the first six months of 2014, The PDCA program was initiated in the second half of the year and the injury rate was reduced to 4.4% in 2015. In 2016, training was also started in the second half of the year because of high SIs rates. Conclusions: This study has shown that problem-oriented continuous training programs are effective in reducing SIs.Öğe Vajinitlerde etiyoloji değişiyor mu? tek merkez verilerinin paylaşımı(DergiPark, 2021) Karakoç, Zehra ÇağlaVajinitler jinekoloji polikliniklerinde en sık karşılaşılan tanılardan biri olup, çoğunlukla enfeksiyöz kaynaklıdır. Çalışmamızda; jinekoloji polikliniklerine vajinal akıntı şikayeti ile başvuran hastalardan alınan vajinal sürüntü örneklerinin, mikrobiyolojik değerlendirme sonuçlarının ve etiyolojide rol alan mikroorganizmaların değerlendirilmesi amaçlanmıştır. Ocak-Haziran 2019 tarihleri arasında hastanemiz jinekoloji polikliniklerinde vajinit ön tanısı konulan 290 hastadan alınan 305 vajinal sürüntü örneği çalışmaya dahil edildi. Örneklerin mikroskobik inceleme ve kültür sonuçları klinik mikrobiyoloji laboratuvar kayıtlarından retrospektif olarak değerlendirildi. Vaginal sürüntü kültürleri; %5 koyun kanlı agar, Çikolata agar, MacConcey agar, Sabouraud Dextroz agar besiyerlerine ekilerek, gram boyamaları ve direkt mikroskobik incelemeleri yapıldı. Plaklar 48-72 saat süre ile 37°C’de inkübe edildi. Üreyen mikroorganizmaların identifikasyonu ve antibiyogramı için VITEK 2 Compact® (bioMeriéux, Marcy l’Etoile, Fransa) otomatize sistemi kullanıldı. Hastaların ortalama yaşı 35.1±10.3 (18-84) olup, mikroorganizma üremesi saptanan örnek sayısı 131 (%42.9)’di ve bunların 84(%64.1)’ünde Candida albicans’ın etken olduğu belirlendi. Hastalar premenopozal ve postmenopozal (<45 yaş ve ?45 yaş) olarak gruplandırıldı. Premenopozal grupta vajinal sürüntü örneği kültüründe üreme oranı (118/131), C. albicans üreme oranı (81/131) bakteriyel vajinoz ile ilişkili bulgular (25/262) daha fazla oranda belirlendi. Mikroskopik incelemede Trichomonas vaginalis saptanan hastaların tamamı premenopozal gruptaydı. Buna mukabil postmenopozal grupta ise, bakteriyel üreme oranı (10/13) daha fazlaydı. İzole edilen gram-pozitif bakterilerde ampisilin, penisilin ve gentamisin direnci saptanmadı. Gram-negatif bakterilerde ise karbapenemler ve gentamisine karşı direnç saptanmazken, diğer antibiyotiklere olan duyarlılık %47.2-97.2 arasında değişti. Çalışmamızda tüm hasta popülasyonu değerlendirildiğinde izole edilen en sık etken C. albicans’tır. Ancak postmenopozal grupta bakteriyel etkenlerin ön plana geçtiği, premenopozal grupta ise; literatürle uyumlu olarak Candida’ların daha sık vajinit etkeni olduğu belirlenmiştirÖğe Zero surgical site infection in primary knee arthroplasty with multidisciplinary intervention: Is it possible?(EDIMES Edizioni Medico Scientifiche, 2018) Karakoç, Zehra Çağla; Haklar U.Surgical site infections (SSI) are among the most important complications in knee arthroplasty. In this article we aim to retrospectively evaluate effects of preoperative multidisciplinary assessment and treatment of focal infections in primary knee arthroplasty patients operated by a single surgeon in a single center. A total of 93 patients undergoing 120 primary knee arthroplasty operations were included in the study. In the preoperative assessment all patients were consulted by infectious diseases, otorhinolaryngology (ENT) and dentistry departments, and female patients additionally by gynecology departments to evaluate and treat possible focal infections. Decolonization protocols were implemented for the bacterial growths detected in nasal and urine cultures. Patients received one of four surgical interventions, namely unilateral total knee arthroplasty (TKA), unilateral robotic-assisted unicompartmental knee arthroplasty (RUKA), bilateral RUKA or unilat- eral TKA and unilateral RUKA. No patients received bilateral TKA in a single session. Out of 93 patients 70 (75.3%) were female, mean age was 67.7±9.9 years, and American Society of Anesthesiologists (ASA) scores were <3 for 93.5% of the study group. Fifty-two (55.9%) of the patients received RUKA. Mean value for the duration of operations was 150.7±67 minutes, for hospitalization it was 5.9±2.8 days, and postoperative follow-up was 25.7±8.8 months. None of the patients developed SSI in the follow-up period. Many factors are associated with SSI after knee arthroplasty. Total absence of SSI in our study group may be attributable to meticulous patient selection, multidisciplinary preoperative assessment, and the performance of RUKA by a single surgeon in a single center. © 2018, EDIMES Edizioni Medico Scientifiche. All rights reserved.
