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    Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice
    (Elsevier, 2022) Anar, Ceyda; Bicmen, Can; Guldaval, Filiz; Atay, Tuba; Gayaf, Mine; Balci, Gunseli; Alici, Ibrahim Onur; Doğan, Betül İkbal; Büyükşirin, Melih; Ayrancı, Aysu; Karadeniz, Gülistan; Polat, Gülru
    Purpose: The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey.Methods: A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report.Results: Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetra-cycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respec-tively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 mu g/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin.Conclusions: Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 mu g/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.
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    Diagnostic value of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in differentiating parapneumonic effusion from tuberculous pleurisy
    (Wolters Kluwer Medknow Publications, 2021) Anar, Ceyda; Yavuz, Melike Yuksel; Alici, Ibrahim Onur; Guldaval, Filiz; Buyuksirin, Melih
    Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P<0.001). The median values of pleural fluid LDH/ADA ratio between TBP and PPE groups were 16.10 (12.53) and 32.90 (34.45), respectively, which was found to be significantly lower in TBP group (P<0.001). Pleural fluid LDH/ADA ratio's sensitivity, specificity, positive predictive value, and negative predictive value were 90, 59.85, 70.4, and 84.9%, respectively, in the diagnosis of TBP for values less than 28 (P<0.001). Conclusion The ratio of pleural fluid LDH/ADA determined from routine biochemical analysis predicts TBP at value of 28. Measurement of this parameter may help clinicians distinguish between TBP and PPE.
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    Machine learning approaches in the interpretation of endobronchial ultrasound images: a comparative analysis
    (Springer, 2023) Koseoglu, Fatos Dilan; Alici, Ibrahim Onur; Er, Orhan
    BackgroundThis study explores the application of machine learning (ML) in analyzing endobronchial ultrasound (EBUS) images for the detection of lymph node (LN) malignancy, aiming to augment diagnostic accuracy and efficiency. We investigated whether ML could outperform conventional classification systems in identifying malignant involvement of LNs, based on eight established sonographic features.MethodsRetrospective data from two tertiary care hospital bronchoscopy units were utilized, encompassing healthcare reports of patients who had undergone EBUS between January 2017 and March 2023. The ML model was trained and tested using MATLAB, with 80% of the data allocated for training/validation, and 20% for testing. Performance was evaluated based on validation and testing accuracy, and receiver operating characteristic curves with comparing trained models and existing classification rules.ResultsThe study analyzed 992 LNs, with 42.3% malignancy prevalence. Malignant LNs showed characteristic features such as larger size and distinct margins. The fine tuned models achieved testing accuracies of 95.9% and 96.4% for fine Gaussian SVM and KNN, respectively. Corresponding AUROC's were 0.955 and 0.963, outperforming other similar studies and conventional analyses.ConclusionFine tuned ML applications like SVM and KNN, can significantly enhance the analysis of EBUS images, improving diagnostic accuracy.