Gürkan Atay

Ümraniye Eğitim ve Araştırma Hastanesi

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Seher Erdoğan

Ümraniye Eğitim ve Araştırma Hastanesi

Ayper Somer

Istanbul University

Selda Hançerlı Törün

Istanbul University

Murat Sütçü

Istinye University

Manolya Kara

Yeditepe University

Hazal Ceren Tuğrul

Sağlık Bilimleri Üniversitesi

Kemal Nişli

Istanbul University

EÇ

Emine Çalışkan

Sağlık Bilimleri Üniversitesi

Betül Sözeri

Ümraniye Eğitim ve Araştırma Hastanesi

AÇ

Agop Çıtak

Acıbadem University Atakent Hospital

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Sağlık Bilimleri Üniversitesi

124

Istanbul University

University of Health Science

Ümraniye Eğitim ve Araştırma Hastanesi

University of Health Sciences

Pediatrics and Genetics

Ministry of Health

Ankara University

Marmara University

Hacettepe University

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Bir Üniversite Hastanesi Çocuk Yoğun Bakım Ünitesinde Dirençli Gram-negatif Enfeksiyonların Değerlendirilmesi

Türk Pediatri Arşivi (2019)

Gürkan Atay Manolya Kara Murat Sütçü Yesfa Şebnem Aydın Selda Hançerlı Törün

Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital.In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively.One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1-205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance.Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.Sağlık bakımı ilişkili enfeksiyonlar yoğun bakım birimlerinde yüksek hastalık ve ölüme neden olmaktadır. Bu çalışmada, üniversite hastanemiz çocuk yoğun bakım birimindeki dirençli gram negatif enfeksiyonların özellikleri değerlendirilirken; çok ilaca dirençli ve genişletilmiş ilaç direnci olan enfeksiyonların karşılaştırılması amaçlanmıştır.Bu çalışmada Ocak 2011–Aralık 2015 yılları arasında, fakültemiz çocuk yoğun bakım biriminde yatışı sırasında gram negatif enfeksiyon saptanan çocuk hastalar geriye dönük olarak değerlendirildi.Çalışma döneminde birimimize 1 030 hasta yatırıldı; sağlık bakımı ilişkili enfeksiyon sıklığı %17,2, sıklık yoğunluğu 1 000 hasta günü başına 32,7 idi. 1 000 cihaz günü başına sağlık bakımı ilişkili enfeksiyon sıklığı ve cihaz kullanım oranı sırasıyla 66,9 ve 0,59 olarak hesaplandı. Yaş ortancası 22 (1–205) ay olan 79 hastada, 130 gram negatif enfeksiyon atağı saptandı. En sık saptanan enfeksiyonlar, ventilatör ilişkili pnömoni (n=78, %60) ve kan akım enfeksiyonu (n=38, %29,2) idi. En sık etkenler Pseudomonas aeruginosa (n=50, %38,5), Kleibsiella pneumonia (n=32, %24,6) ve Acinetobacter baumannii (n=28, %21,5) idi. A. baumannii izolatları arasında piperasilin-tazobaktam ve meropenem direnci sırası ile %96,4 ve %89,3 saptandı. Ampirik karbapenem, aminoglikozid ve florokinolon kullanımı, total parenteral nütrisyon varlığı, yoğun bakım öncesi geçirilmiş gram negatif enfeksiyon öyküsü anlamlı olarak daha yüksekti. Geç dönem ölüm hızı genişletilmiş ilaç direnci varlığında daha yüksek saptandı. Geçirilmiş gram negatif enfeksiyon öyküsü, genişletilmiş ilaç direnci açısından bağımsız risk etmeni olarak bulundu.Sağlık bakımı ilişkili enfeksiyonlar önemli bir sağlık sorunudur ve önlemede mümkünse her hastanenin kendi enfeksiyon kontrol kurulunun hastane kolonizasyonuna göre stratejiler belirleyip uygulaması önemlidir.

Acinetobacter baumannii

Tazobactam

Ventilator-associated Pneumonia

10.14744/turkpediatriars.2019.00086

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Citations (2)

Evaluation of Candida species and antifungal susceptibilities among children with invasive candidiasis

Türk Pediatri Arşivi (2017)

Murat Sütçü Manolya Acar Gonca Erköse Genç İlknur Kökçü Hacer Aktürk

Non-albicans Candida species and resistant microorganisms have been more commonly isolated in invasive candidiasis in recent years. The aim of this study was to evaluate the distrubution of Candida spp and antifungal resistance in our clinic.Fifty-four Candida isolates and antifungal susceptibility results obtained from patients diagnosed as having invasive candidiasis between December 2012 and June 2016 were included. Clinical and laboratory data were retrospectively analyzed. E-test method was used in order to determine antifungal susceptibilities of Candida spp for amphotericin B, fluconazole, voriconazole, ketoconazole, itraconazole, anidulafungin, caspofungin, and flucytosine.The clinical diagnoses of the patients were candidemia (n=27, 50%), catheter-related blood stream infection (n=1, 1.8%), urinary tract infection (n=13, 24%), surgical site infection (n=4, 7.4%), intraabdominal infection (n=3, 5.5%), empyema (n=2, 3.7%), and pneumonia (n=4, 7.4%). The most common isolated agent was C. albicans (n=27, 50%) and the others were C. parapsilosis (n=13, 24%), C. tropicalis (n=6, 11.1%), C. glabrata (n=3, 5.6%), C. lusitaniae (n=2, 3.7%), and unspecified Candida spp. (n=3, 5.6%). Fluconazole resistance was 7.4% among all isolates. Resistance against itraconazole, ketoconazole, anidulafungin, voriconazole and caspofungin were 33.3%, 12.5%, 11.1%, 5%, and 2.5%, respectively. Isolates presented intermediate resistance against itraconazole (41.7%), voriconazole (5.6%), and amphotericin B (3.7%) to varying extents. All of the isolates were susceptible to flucytosine.In our clinic, C. albicans and non-albicans Candida species were equally distributed and antifungal susceptibilities against major antifungal agents such as fluconazole, amphotericin B, and caspofungin were found considerably high.

Anidulafungin

Candida parapsilosis

Flucytosine

10.5152/turkpediatriars.2017.5291

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Citations (27)

A diabetic child presented with necrotizing pneumonia who was successfully treated with pneumonectomy

Istanbul Medical Journal (2019)

Gürkan Atay Manolya Kara Emine Çalışkan Feryal Gül Soysal Selda Hançerlı Törün

10.4274/imj.33716

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Pediatric acute respiratory distress syndrome

Çocuk Dergisi / Journal of Child (2017)

Gürkan Atay Kemal Nişli

Acute Respiratory Distress Syndrome (ARDS) is a worldwide and important clinical situation with increased morbidity and mortality. Since the year 1967 when ARDS, which is characterized with diffuse pulmonary parenchymal damage and hypoxemia was first defined many research and consensus reports have been written which especially focused on adult type pulmonary distress. When risk factors, etiology, pathophysiology, and relevant data were considered, it has been understood that it did not entirely included pediatric age group. Thus, different consensus reports were edited for pediatric ARDS (PARDS). In this review, diagnosis and treatment strategies about PARDS will be discussed in the light of updated information.

Etiology

Consensus conference

Diffuse alveolar damage

10.5222/j.child.2017.099

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Shear wave elastography of parotid glands in pediatric patients with HIV infection

La radiologia medica (2018)

Manolya Kara Emine Çalışkan Gürkan Atay Murat Sütçü Özge Kaba

10.1007/s11547-018-0945-9

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Citations (5)

The Clinico-radiologic Evaluation and Risk Factor of Ventilator-associated Pneumonia in a Pediatric Care Unit of a Tertiary Center

Journal of Academic Research in Medicine (2021)

Gürkan Atay Emine Çalışkan Nezahat Gürler Demet Demirkol Ayper Somer

Objective: Ventilator-associated pneumonia (VAP) is the second most common form of hospital-acquired infection.Prediction of possible etiologic agents and initiation of appropriate and narrow-spectrum antibiotherapy is crucial to reduce morbidity and mortality.Clinical and radiologic variable analyses may help clinicians to foresee the usual cause of VAP.Methods: This was a retrospective observational study evaluating the clinico-radiologic characteristics of VAP in a pediatric intensive care unit (PICU) of a tertiary referral university hospital between January 2011 and December 2016.Results: A total of 1,323 patients in the PICU were followed during the study period, wherein 78 with a median age of 10 months (1-188) were detected to have VAP.Patients were divided into two groups according to the etiologic agents as gram-positive (n=16, 20.5%) and gram-negative VAP (n=62, 79.5%).Radiologic findings included peribronchial thickening (n=32, 41.0%), diffuse interlobular septal thickening (n=38, 48.7%), patchy infiltrate (n=54, 69.2%), consolidation (n=54, 69.2%), and pleural effusion (n=21, 26.9%).The presence of consolidation and pleural effusion were significantly more common among the patients with gram-positive VAP (p-values are 0.004 and 0.02).Conclusion: Clinical and radiologic evaluation of patients may be a clue for the estimation of the microbiology of VAP, which is highly recommended before the initiation of empirical antibiotherapy.

Tertiary care

Center (category theory)

10.4274/jarem.galenos.2021.22931

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The Value of C-reactive Protein, Procalcitonin, Interleukin-6 Levels to Predict Urinary Tract Infection in Children with Fever without A Focus

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection (2014)

Medine Ayşin Taşar Hasan Demır Gürkan Atay Fatma Arıkan Yıldız Bilge Dallar

Procalcitonin

10.5152/ced.2014.1931

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Citations (3)

A Child with 3p Deletion Syndrome Who Recovered from Influenza-Related Acute Respiratory Distress Syndrome

Istanbul Medical Journal (2017)

Gürkan Atay Gülşah Kavrul Kayaalp Manolya Acar Murat Sütçü Kemal Nişli

10.5152/imj.2017.90532

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Vancomycin and Linezolid Combination for the Treatment of Resistant Gram Positive Infection: Case Report

Çocuk Dergisi / Journal of Child (2018)

Sevliya Öcal Demi̇r Gürkan Atay Özge Kangallı Boyacıoğlu Manolya Kara Özge Kaba

Linezolid and vancomycin have been used successfully in the treatment of infections caused by multidrug resistant gram-positive bacteria. Due to the similarity of the antibacterial spectrum, they are not classically used in combination. Herein we present a patient who was successfully treated for catheter-related bloodstream infection and ventilator-associated pneumonia with linezolid and vancomycin combination. Our experience was that; linezolid and vancomycin combination can be used when either patient has a resistant Gram-positive bacterial infection or has a new onset severe infection that can not be treated with bacteriostatic agents.

Linezolid

Gram

Gram-Positive Bacteria

10.5222/j.child.2018.58224

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Citations (1)

Tracheostomy in Pediatric Intensive Care: A Single Center Experience

Forbes Journal of Medicine (2021)

Gürkan Atay

Amaç: Trakeostomi, yoğun bakım ünitesindeki kritik hasta çocuklarda en sık kullanılan cerrahi müdahalelerden biridir.Pediatrik trakeostomi; küçük ve esnek trakea, sınırlı cerrahi alan ve anestezi riski nedeniyle daha zordur.Bu çalışma üçüncü basamak bir çocuk yoğun bakım ünitesinde (ÇYBÜ

Center (category theory)

10.4274/forbes.galenos.2021.29491

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