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Öğe 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, GülruPurpose: 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.Öğe Clinical differences between elderly and non-elderly patients with COVID-19(Aves, 2022) Ucsular, Fatma Demirci; Karadeniz, Gulistan; Polat, Gulru; Ayrancı, Aysu; Yalniz, Enver; Kazankaya, Fatmanur; Guldaval, FilizOBJECTIVE: Comorbidity frequency and mortality rates are higher in elderly patients with COVID-19. The disease is also more severe in elderly patients. This study aims to examine the characteristics of the COVID-19 disease, severity, comorbidities, and mortality rates in elderly patients by comparing them with nonelderly patients. MATERIAL AND METHODS: This study was designed as a retrospective study. 469 patients who were followed up in outpatient, inpatient, and intensive care units with the diagnosis of COVID-19 between March 11, 2020, and June 01, 2020, were retrospectively included in the study. Patients were divided into two groups who were >= 65 years named as the elderly group and <65 years referred to as nonelderly. Survival data was generated from the death notification system on August 02, 2020. RESULTS: A total of 469 patients including elderly(n=101) and nonelderly(n=368) were included in the study retrospectively. The incidence of severe pneumonia(31%/12.6%) and critical illness(16%/5.8%), comorbidity (85%/37.2%) and hospitalization time(8/5 days) were significantly higher in the elderly group(p<0.05). 23 (22.8%) of elderly patients and 27(7.3%) of nonelderly patients died (p=0.000). Mortality was found to be 3.5 times higher than in the non-elderly group. The expected survival time was 145.85 days(CI 95%:133-158.66) in the elderly patients and 170.36 days(CI 95%:166-174.6) in the nonelderly patients (p<0.000). In ROC analysis, the sensitivity of age was 86%(73.3-94.2), specificity was 66.83%(62.1-71.3), and the cut-off>56 (AUC:0.775; p <0.001) in predicting mortality. CONCLUSION: Mortality is high, comorbidities are more frequent, and the disease is more severe in elderly patients with COVID-19. Age above 56 can be used as a cut-off to predict mortality.Öğe 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, MelihObjective 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.Öğe Evaluation of whether smoking cessation among advanced lung cancer patients has a significant effect on anxiety and depressive symptoms(Kare Publ, 2023) Guldaval, Filiz; Polat, Gulru; Anar, Ceyda; Ayranci, Aysu; Karadeniz, Gulistan; Gayaf, Mine; Turk, Merve AyikBACKGROUND AND AIM: Continued smoking has a detrimental effect on lung cancer patients, which may already be associated with anxiety and depression. There is a belief among some that smoking cessation will further increase anxiety and depression in these patients, reducing their quality of life. In this study, we aimed to determine whether there was a difference in anxiety, depression, and quality of life scores between ex-smokers after the diagnosis of lung cancer and current smokers.METHODS: One hundred patients with advanced lung cancer were included in the study. Demographic characteristics were recorded, and the smoking status of patients was questioned. The Hospital Anxiety and Depression Scale and European Organization for Research and Treatment of Cancer Quality of Life tests were performed to evaluate anxiety, depression, and quality of life.RESULTS: The mean age was 61 & PLUSMN;8 years. Adenocarcinoma was the most common type of cancer, and 64% of the cases were at stage 4. Of the total 100 patients, 8 had never smoked, 23 were smokers, and 69 were ex-smokers. After the diagnosis of lung cancer, 17 patients quit smoking. No statistically significant difference was found between smoking status and anxiety or depression and quality of life scores (p>0.05). There was no difference between anxiety or depression and quality of life scores between patients who quit smoking after the diagnosis and those who continued (p>0.05).CONCLUSIONS: Patients with lung cancer should not be abstained from smoking cessation because of the possibility of increased anxiety or depression; rather, patients should be supported for smoking cessation at any stage.Öğe Risk Factors for Presence of Resistant Microorganisms in Sputum Cultures of Patients with Infectious Exacerbations of Chronic Obstructive Lung Disease(Bilimsel Tip Yayinevi, 2022) Buyuksirin, Melih; Senol, Gunes; Polat, Gulru; Ayranci, Aysu; Guldaval, Filiz; Serce Unat, DamlaIntroduction: Antibiotics reduce the risk of short-term mortality. Certain bacteria may be resistant to initial regimens which is related to mortality. The aim of this study was to find risk factors for the presence of resistant bacteria during exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: Ethics committee approval was obtained for the study. The patients hospitalized with an exacerbation of COPD between 2015 and 2020 were retrospectively ieviewed. The patients with a sputum culture result were divided into: Group A with conventional microorganisms (susceptible to initial antibiotic regimen) and Group B with non-conventional microorganisms (resistant to initial antibiotic regimen). The risk factors for Group B microorganisms were investigated. Results: One hundred and nineteen patients were included in the study. Median age was 68 (40-88) years. There were 22 patients in Group A and 97 in Group B. Most common microorganism in Group A was Haemophilus influenza (12.6%). Most encountered microorganisms in Group B were Pseudomonas aeruginosa (49.6%). Male sex (HR= 2.9; 95% CI= 0.9-9.5; p= 0.073), age >61 (HR=4.8; 95% CI= 1.7-13.6; p= 0.003), and >5 hospitalizations last year (HR= 8.2; 95% CI= 0.9-67.7; p= 0.051) were found to be independent risk factors for resistant microorganisms. Conclusion: Proposed risk factors for the isolation of multidrug resistant microorganism in patients hospitalized with COPD exacerbations should be considered when choosing the initial antibiotic regimen.Öğe Sociodemographic and clinical risk factors associated with in-hospital tuberculosis mortality in Turkiye, 2008-2018(Turkish Assoc Tuberculosis & Thorax, 2024) Gayaf, Mine; Ayik Turk, Merve; Ozdemir, Ozer; Polat, Gulru; Karaman, Onur; Guldaval, Filiz; Ari, GulsumIntroduction: Tuberculosis (TB) is an infectious disease that can be fatal if left untreated or poorly treated, and it is associated with many morbidities. Deaths may provide better understanding of the associated factors and help guide interventions to reduce mortality. In this study, it was aimed to reveal some of the features that predict hospital mortality in patients with TB and to present some alarming findings for clinicians. Materials and Methods: Patients who had been hospitalized with the diagnosis of TB between January 2008 and December 2018 were included and analyzed retrospectively. In -hospital mortality because of any TB disease after the initiation of treatment in patients admitted to the TB Ward and the primary cause of mortality were taken as endpoint. Results: A total of 1321 patients with a mean age of 50.1 years were examined. Total mortality was 39.4% (521 deaths) and 13.1% were in -hospital deaths (173 deaths). Of the deaths, 61.8% (n= 107) occurred during the first month after TB treatment were started. On univariate analysis, age over 48.5 years, Charlson comorbidity index, extension of radiological involvement, hypoalbuminemia and lymphopenia were most predictive variables with higher odds ratios (respectively, p< 0.001 for all). Conclusion: In -hospital tuberculosis disease mortality is related with older age, cavitary or extensive pulmonary involvement, low albumin levels, unemployment, cigarette smoking and especially those with concomitant malignancy and chronic pulmonary disease.Öğe Surgical and Non-surgical Treatments in Pleural Empyema Plevral Ampiyemde Cerrahi ve Cerrahi Olmayan Tedaviler(Galenos Publ House, 2025) Deniz, Sami; Aksel, Nimet; Ozdemir, Ozer; Vayisoglu Sahin, Gorkem; Cimen Celik, Ezgi; Gucsav, Mutlu Onur; Guldaval, FilizObjective: Increasing number of patients are developing complicated pleural infection. We aimed at revealing the differences of treatment modalities performed in patients with empyema. Methods: Patients those had been diagnosed and treated for empyema were assessed in a retrospective design. For the definitive diagnosis of empyema, thoracentesis was made. We categorized the patients in two groups as therapeutic drainage (group 1) and open Results: A total of 360 patients, 57 of whom were women, were included. Tube drainage was applied to the patients in group 1, and therapeutic thoracentesis was applied to those not suitable for drainage. Patients who did not provide adequate drainage due to loculation were deloculated with fibrinolytic agent or video-assisted thoracoscopic surgery. In patients with advanced empyema with multiloculation and
