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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 Can the progression of COVID-19 pneumonia be predicted?(2022) Üçsular, Fatma Demirci; Ayrancı, Aysu; Polat, Gülru; Yalnız, Enver; Güldaval, Filiz; Karadeniz, Gülistan; Unat, Damla SerçeBackground: Coronavirus disease-2019 (COVID-19) remains a major cause of morbidity and mortality. There are many parameters affecting the progression of the disease. The purpose of the present study was to evaluate and compare the initial data of patients hospitalized with the diagnosis of COVID-19 pneumonia, who progressed during the hospitalization period, with other patients who recovered or remained stable, and to investigate the risk factors that can be used to predict the disease progression. Materials and Methods: Patients, who received inpatient treatment with the diagnosis of COVID-19 pneumonia, were included in the study retrospectively. Two groups were created from all patients according to their progression in hospital follow-ups: Group 1: Progression group and group 2: Recovery/stabilization group. If patients had clinical, laboratory and/or radiological deterioration or died during follow-up, these patients were included in the progression group. If patients recovered or remained stable, these patients were also included in the recovery/stabilization group. The demographic data, initial hemogram, biochemical parameters and radiological data of the patients were recorded. Results: It was determined in the univariate analysis that the age, smoking status, comorbidity, heart disease, chronic obstructive pulmonary disease, cancer, dyspnea, fever, leukocytosis, lymphopenia, elevated neutrophil-lymphocyte ratio (NLR), C-reactive protein, albumin, lactate dehydrogenase, ferritin, D-dimer, troponin-T, pro-B-type natriuretic peptide (pro-BNP) were risk factors predicting disease progression all p-values<0.05. In the multivariate logistic regression analysis, it was found that fever, NLR, and D-dimer could be used to predict the disease progression (p<0.05). In the ROC analysis, the sensitivity of NLR was 83.3%, specificity 57.5%, and cut-off >3.545 [area under curve (AUC)=0.752; p<0.001]; the sensitivity of pro-BNP was 71.8%, specificity 73.8%, and cut-off >332.8 (AUC=0.752; p<0.001), the sensitivity of troponin-T was 81.2%, specificity was 60.6%, and cut-off was >4.58 (AUC=0.730; p<0.001) in predicting progression. Conclusion: The identification of risk factors predicting progression is important in reducing morbidity and mortality rates. Fever, NLR, D-dimer troponin-T and pro-BNP are important parameters that can be used to predict progression.Öğe Clinical characteristics and transmission routes of COVID-19 in the early period of the pandemic in a non-covid ward of chest diseases hospital(2021) Karadeniz, Gülistan; Gayaf, Mine; Güldaval, Filiz; Ayrancı, Aysu; Batum, Özgür; Polat, Gülru; Tatar, DursunObjective: In the early stages of the outbreak, Covid patients were followed-up in isolated Covid Wards, and the examinations of other pulmonary diseases continued in Non-Covid wards. Differential diagnosis between COVID-19 and infections caused by other pathogens is not adequately recognized. For this reason, it is even more difficult to identify patients who are infected with SARS-CoV2 or other pathogens. In the present study, the clinical characteristics and transmission routes of the Covid-19 cases in Non-Covid Wards within approximately 2 months’ time after the onset of the pandemic were analyzed speculatively. Method: In the early periods of the pandemic, quarantine wards were created for Covid patients in Chest Diseases Hospital, but there were also changes in Non-Covid patients and new Non-Covid hospitalizations. The clinical characteristics and transmission routes of the Covid cases in Non-Covid Ward were examined retrospectively and observationally between 10.03.2020 and 30.04.2020. Results: During this period, a total of 35 Covid cases were detected as a patient, companion and healthcare employees. The median age of the patients was 50 years (min-max 25-85). There were 17 patients (48.6%) who were not severe, and 18 severe patients (51.4%), and 10 (28.6%) patients died. A total of 25 (71,4%) of infected cases were verified with the SARS-CoV-2 Nucleic Acid Test, and 10 (28,6%) were diagnosed clinically and radiologically as possible COVID-19 cases. Being 65 years old or over, having comorbid diseases, especially COPD, the presence of dyspnea as a symptom and involvement on chest radiography were found to be significantly associated with survival (p0.027, 0.009, 0.038, 0.000 and 0.033, respectively). Lymphopenia, increase in neutrophil count, CRP and NLR value were found to be statistically related to survival (p 0.005, 0.001, 0.014 and 0.000, respectively). We found 4 super spreaders, one of whom was a companion, and 3 patients. Conclusion: Potential “super spreaders” can be the source of infection before the quarantine conditions are applied and comprehensive protection is implemented. For this reason, quarantine, use of personal protective equipment, application of social distancing, and the implementation of comprehensive preventive measures, such as disinfection, are crucial in controlling nosocomial infection.Öğe Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?(2021) Büyükşirin, Melih; Tatar, Dursun; Karadeniz, Gülistan; Polat, Gülru; Aksel, Nimet; Güldaval, Filiz; Üçsular, Fatma DemirciINTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival. METHODS: We retrospectively included cases of MPE with a tissue diagnosis. RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, ORCID: 0000-0002-8939-336X respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000). DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival.Öğe Effect of host risk factors in identifying mortality in COVID-19 pneumonia and a new COVID-19 mortality index: Co-AMSCA(Kare Publ, 2022) Gayaf, Mine; Anar, Ceyda; Polat, Gülru; Ayrancı, Aysu; Güldaval, Filiz; Karadeniz, Gülistan; Batum, ÖzgürBACKGROUND AND AIM: The purpose of the study was to examine the host risk factors related to mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia and to find a COVID-19 mortality score based on these factors. METHODS: Subjects hospitalized with COVID-19 pneumonia between March 11, 2020, and October 1, 2020, were retrospectively analyzed. The age, gender, smoking status, body mass index, blood group, severity of pneumonia, comorbidity, reverse transcriptase-polymerase chain reaction positivity, use of angiotensin-converting enzyme (ACE) inhibitors, radiological changes, and mortality rates of the patients who had proven COVID-19 pneumonia were recorded. Patients were divided into two groups according to mortality status, and the two groups were compared. The cutoff values, sensitivity and specificity values, and odds ratios were calculated to predict mortality of the new scoring system. RESULTS: A total of 422 patients (51 mortal and 371 nonmortal) participated in the study. The univariate regression analysis showed that age, male gender, smoking, comorbidity, and using ACE inhibitors were prognostic host risk factors for COVID-19-related mortality. A new scoring model with the combination of risk factors named Co-AMSCA was created in the study. The cutoff value of the system was found to be 3.5 with 88.4% sensitivity and 65.5% specificity. The mortality risk in patients with a Co-AMSCA mortality score above 3.5 points was 7.8 times higher than that in patients whose score was lower than 3.5 points. In multivariate logistic regression analysis, older age and smoking were significant risk factors for mortality. CONCLUSIONS: A mortality score was created based on host risk factors, which are easy to calculate and do not need laboratory tests and do not waste the time of the clinicians. This study showed that by using Co-AMSCA scoring model, it is possible to achieve a mortality prediction in COVID-19 patients who are hospitalized due to pneumonia.Öğe Is chronic respiratory disease a possible risk factor in acute pulmonary thromboembolism?(2022) Karadeniz, Gülistan; Erikci, İsmail; Güçsav, Mutlu Onur; Ayrancı, Aysu; Polat, Gülru; Vayısoğlu, GörkemObjective: Although we frequently encounter pulmonary thromboembolism (PTE) in patients with chronic respiratory disease in our daily practice, only the presence of respiratory failure is stated as a risk factor in the guideline. In our study, it was aimed to investigate the frequency of acquired risk factors, especially chronic respiratory diseases, in acute PTE. Material and Methods: Our study was designed as a single-center observational descriptive study. Patients hospitalized with the diagnosis of acute PTE in our hospital were evaluated between August 01, 2016 and August 01, 2020. Results: A total of 157 patients were included in our study. The most common acquired risk factors were; being 65 years and older (n=80, 51%), arterial hypertension (n=65, 42.4%), obesity (n=35, 22.3%) and chronic respiratory disease (n=30, %19.1). No ac quired risk factor was found in 31 patients (19.2%). Chronic obstructive lung disease (n=22, 73.3%) was the most common disease among chronic respiratory diseases. Other respiratory diseases were interstitial lung disease (n=5, 16.7%), obstructive sleep apnea syndrome (n=2, 6.7%), and asthma (n=1, 3.3%). The presence of chronic respi ratory disease was significantly higher in men, patients aged 65 and over, and smokers. Conclusion: The frequency of PTE risk factors varies according to countries and socioe conomic level. Our data showed that chronic respiratory disease is more common in PTE patients than many diseases or conditions that are currently considered as risk factors.Öğe Prognostic effects of neutrophil-lymphocyte rates in serum and pleural fluids in malignant pleural fluids(2021) Ayrancı, Aysu; Yavuz, Melike Yüksel; Anar, Ceyda; Karadeniz, Gülistan; Polat, Gülru; Büyükşirin, Melih; Güldaval, FilizObjective: Various studies have reported that the neutrophil-to-lymphocyte ratio in the serum (sNLR) may serve as a cost-effective and useful prognostic factor in patients with various cancer types. We investigated the clinical impact of NLR as a prognostic factor in malign pleural effusion (MPE) and sNLR on prognosis in MPE. Method: We retrospectively reviewed all of the patients who were diagnosed MPE. The relationship between sNLR and neutrophil-to-lymphocyte ratio in the malign pleural effusion (mNLR) value, age, Eastern Cooperative Oncology Group (ECOG), histopathologic type, serum albumin and lactate dehydrogenase (LDH) with survival were investigated. Results: A total of 222 patients with a mean age of 65.7±11.5 were included in the study. Patients with a mNLR value ?0.42 and a serum NLR value ?4.75 had a shorter survival (p: 0.000). Multivariate analysis, which showed that survival was significantly related mNLR value > 0.42 and/or sNLR value > 4.75 (Odds Ratio (OR): 2.66, %95 CI, 1,65-4,3 p: 0.001), serum LDH > 210 (OR = 1.8, %95 CI, 1,33-2,46 p: 0.001) and age > 65 (OR = 1.9, %95 CI, 1,41-2,55 p = 0.001). Conclusion: sNLR and mNLR may act as a simple, useful, and cost-effective prognostic factor in patients with MPE. Furthermore, these results may serve as the cornerstone of further research into the mNLR in the future. Although further studies are required to generalize our results, this information will benefit clinicians and patients in determining the most appropriate therapy for patients with MPE.Öğe Pulmoner emboli klinik, laboratuvar bulguları, prognoz ve mortalite açısından cinsiyetler arasında farklılık gösterir mi?(2020) Unat, Damla Serçe; Ayrancı, Aysu; Polat, Gülru; Karadeniz, Gülistan; Üçsular, Fatma Demirci; Unat, Ömer Selim; Yalnız, EnverAmaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır.Öğe What are the differences between smoker and non-smoker COPD cases? is it a different phenotype?(2021) Güldaval, Filiz; Polat, Gülru; Doruk, Sibel; Karadeniz, Gülistan; Ayrancı, Aysu; Türk, Merve; Anar, CeydaOBJECTIVE: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers.MATERIAL AND METHODS: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them.RESULTS: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers.CONCLUSION: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype.
