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    Comparison of Various Methods for Identification of Anaerobic Bacteria and Investigation of Sensitivity to Antibiotics
    (Bilimsel Tip Yayinevi, 2022) Ugrakli, Selin; Dogan, Metin
    Introduction: In this study, it was aimed to identify anaerobic bacteria isolated from clinical specimens admitted to Necmettin Erbakan University Meram Faculty of Medicine Hospital, Microbiology Laboratory with suspicion of anaerobic infection via different methods and to determine the antibiotic susceptibility against several antibiotics.Materials and Methods: The study included 197 clinical specimens sent for anaerobic culture between August 2019 and March 2020. The samples were incubated using anaerobic culture techniques and the isolates obtained were identified by conventional methods, an-ident discs, API 20 a panel and Vitek 2 semi-automatic system compatible ANC cards. Penicillin G, cefoxitin, clindamycin, metro-nidazole, imipenem, piperacillin/tazobactam, ceftolozane /tazobactam susceptibilities of isolates were determined by concentration gradient method.Results: A total of 46 anaerobic bacteria were isolated from 37 (18.8%) samples; 69.6% of these isolates were gram-positive anaerobic bacteria and 30.4% were gram-negative anaerobes. The most frequently isolated anaerobic bacteria were Clostridium spp. (n= 9) and Peptostreptococcus spp. (n= 8) in gram-positives; Prevotella spp. (n= 7) and Bacteroides fragilis group (n= 5) in gram-negatives. The compatibility between API20A panels and ANC cards was determined 79.5% (35/44), 43.2% (19/44) of test strains at the genus and species levels respectively. The highest rate of resistance was detected against penicillin G (38.6%). Cefoxitin, clindamycin, metronidazole, piperacillin/tazobactam and imipenem sensitivity rates were 93.2%, 65.9%, 84.1%, 93.2% and 100% respectively. The MIC value of ceftolozane-tazobactam, one of the new antimicrobials, varied in a wide range (0.032-12mg/L) according to the bacterial species. While the highest MIC values were found in B. fragilis group strains, the lowest levels were detected in Veillonella spp. (MIC= 0.25) and Fusobacterium spp. (MIC= 0.5 mg/L) isolates.Conclusion: As a result, the data of this study, which is one of the limited number of studies evaluating the performance among anaerobic diagnostic tests frequently used in routine; suggested that the diagnosis should be supported by a different diagnostic test in case of inconsistency between the identification result and clinical or antibiotic susceptibility profiles. One of our isolates was the first strain of metronidazole resistant B. fragilis isolated in our laboratory in which requires monitoring of susceptibility profiles. To our knowledge, this is the first study to evaluate the efficacy of ceftolozane/tazobactam on anaerobic clinical isolates from our country. Ceftolozane/tazobactam activity was detected in great variability between bacterial species in accordance with the literature data. So, it is need optimized studies including more bacterial species and numbers.
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    Comperative Evaluation of Vitek 2 and Etest Methods with the Referance Broth Microdilution for Antimicrobial Susceptibility Testing of Colistin Among Multi-Drug Resistant Gram-Negative Bacteria
    (Bilimsel Tip Yayinevi, 2021) Ugrakli, Selin; Dogan, Metin
    Introduction: Despite the increased need for colistin, especially in serious infections caused by carbapenem resistant gram-negative bacteria, problems and challenges regarding colistin susceptibility testing remain. The aim of this study was to evaluate the performance of Vitek 2, one of the commonly used automated systems, and Etest for colistin susceptibility testing compared with reference broth microdilution method (BMD). Materials and Methods: This study included 657 multi-drug resistance (MDR) Gram negative bacteria obtained from clinical samples; Negative control, Escherichia coli ATCC 25922 and Positive control, Escherichia coli NCTC 13846. The collected MDR isolates were performed colistin BMD according to ISO standard 20776-1, prospectively. Categorical agreement (CA), Very Major Error (VME), and Major Error (ME) rate were calculated. Acceptable performance was evaluated as; CA >= 90%; VME <1.5% and ME <3%. Results: Colistin resistance rates were detected by Vitek 2, Etest and BMD; 40.3%, 48.7%, 53.9%, respectively. CA rates were as fol- lows: Vitek 2 92.4% and Etest 71.9%. While the compatibility of Vitek 2 and BMD was observed (kappa value= 0.85) to be 'excellent agreement'; the agreement of Etest and BMD was found to be 'moderate' (kappa value= 0.45). Although CA varied from 85.7% to 100% for Vitek 2, it ranged 63.6% to 80% for Etest depending on bacterial species. Alarming high rates of VME were determined for Vitek 2 (14.5%) and Etest (36.5%). While MEs were 1.7% by Vitek 2; there was no false resistant isolate with Etest. Conclusion: It may be recommended for laboratories not to rely on Vitek 2 and Etest colistin susceptibility results. Additionally, colistin resistant isolates will be underestimated by reducing colistin susceptibility studies to a specific minimum inhibitory concentration (MIC). In this regard, our suggestion is that laboratories would improve their infrastructure and staff skills to apply BMD routinely.
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    The effect of concomitant proton pump inhibitor use on survival outcomes of Nivolumab-treated renal cell carcinoma patients: a multicenter study
    (Springer, 2023) Ugrakli, Muzaffer; Kocak, Mehmet Zahid; Dinc, Gulhan; Genc, Tugrul Burak; Caglayan, Melek; Ugrakli, Selin; Hendem, Engin
    AimWe aimed to evaluate the effect of concomitant proton pump inhibitors (PPI) use with nivolumab on survival outcomes in metastatic renal cell carcinoma (mRCC) in second-line setting.MethodsThe study was designed as a multicenter and retrospective involving patients with metastatic renal cell carcinoma receiving second-line nivolumab therapy. One hundred and nine patients with mRCC were divided into two groups based on whether they use PPI concomitantly with nivolumab: concomitant PPI users and non-users. Overall survival (OS) and progression-free survival (PFS) were compared between the groups with and without concurrent PPIs.ResultsOf 109 patients in our study, 59 were not using PPI concomitantly with nivolumab and 50 were using PPI concomitantly. The median PFS was 6.37 (5.2-7.5) months in the concomitant PPI group and 9.7 (4.5-15) months in the non-users (p = 0.03). The median OS was 14.6 (7.1-22.1) months in patients on PPI concurrently with nivolumab and 29.9 (17.1-42.7) months in the non-users (p = 0.01). Accordingly, PPI use for PFS (Non-use vs. Use = HR: 0.44, 95%Cl 0.28-0.96, p = 0.014) and PPI use for OS (Non-use vs. Use = HR: 0.68, 95%Cl 0.22-0.88, p = 0.01) were found to be as independent risk factors.ConclusionsConcomitant use of PPIs is associated with worse survival outcomes in patients with mRCC treated with nivolumab. Clinicians should carefully consider the concomitant use of PPIs in such patients.
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    Infection Diseases Following Natural Disaster in Children: Health Prevention and Assessment
    (Georg Thieme Verlag Kg, 2023) Ugrakli, Selin; Ozdemir, Mehmet; Gray, James W.
    [Abstract Not Availabe]
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    Prevalence and Genotype Distribution of High-risk Human Papilloma Virus Types Compared with Cervical Cytology
    (Galenos Yayincilik, 2021) Ugrakli, Selin; Ozdemir, Mehmet; Gulseren, Yasemin Derya; Findik, Siddika
    Introduction: Human papilloma virus (HPV) is a well-known causative pathogen of cervical cancer. The distribution of HPV prevalence and genotypes differ between regions. This study aimed to detect the prevalence of high-risk HPV (hrHPV) and genotype distribution among patients with cervical cytology. Materials and Methods: A total of 1,571 women aged 17-91 years who presented to the department of Gynecology and Obstetrics Outpatient Clinic of our hospital, between January 1, 2017, and July 30, 2019, were included. Samples were collected for cytology and transported to the Medical Microbiology Laboratory for HPV deoxyribonucleic acid (DNA) test. Cervical specimens were investigated for the presence of hrHPV and genotyping of HPV using a commercial kit (Nuclear Laser Medicine S.r.l., Milano, Italy) by real-time polymerase chain reaction. Simultaneously, cytological examination was performed using conventional (Papanicolaou) method and interpreted according to the Bethesda system. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22.0 (SPSS Inc., Chicago, IL, USA). Results: Of the 1,571 women with a mean age of 39.98 (+/- 10.17) years, HPV DNA was negative in 972 (61.9%) patients, while 599 (38.1%) patients were positive for hrHPV. No significant difference was found between age groups in terms of HPV positivity (p=0.18). The most common hrHPV types detected were HPV16 (28.5%), HPV68 (18.7%), HPV51 (15.5%), HPV39 (15.4%), and HPV31 (13.4%), in descending order. Single HPV infections were found in 61.4% (368/599), while infections with multiple HPV genotypes were detected in 38.6% (231/599) of all cases. Conclusion: This study indicated that HPV infection is more prevalent than expected among women living in the central part of Turkey. Additionally, the high prevalence of non-vaccinable genotypes should be considered a regional difference, and the use of this knowledge for guidance in the selection and development prophylactic vaccines may lead to successful broader prevention.