Person: DURMUŞOĞLU, LÜTFİYE
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DURMUŞOĞLU
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LÜTFİYE
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Publication Open Access Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey(ELSEVIER SCI LTD, 2015-07) ERTÜRK ŞENGEL, BUKET; Saltoglu, N.; Yemisen, M.; Ergonul, O.; Kadanali, A.; Karagoz, G.; Batirel, A.; Ak, O.; Eraksoy, H.; Cagatay, A.; Vatan, A.; Sengoz, G.; Pehlivanoglu, F.; Aslan, T.; Akkoyunlu, Y.; Engin, D.; Ceran, N.; Erturk, B.; Mulazimoglu, L.; Oncul, O.; Ay, H.; Sargin, F.; Ozgunes, N.; Simsek, F.; Yildirmak, T.; Tuna, N.; Karabay, O.; Yasar, K.; Uzun, N.; Kucukardali, Y.; Sonmezoglu, M.; Yilmaz, F.; Tozalgan, U.; Ozer, S.; Ozyazar, M.We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121(27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum beta-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% Cl 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% Cl 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% Cl 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% Cl 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% Cl 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% Cl 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% Cl 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Publication Metadata only Bioadhesive tablets containing cyclodextrin complex of itraconazole for the treatment of vaginal candidiasis(ELSEVIER, 2014) DURMUŞOĞLU, LÜTFİYE; Cevher, Erdal; Acma, Ayse; Sinani, Genada; Aksu, Buket; Zloh, Mire; Mulazimoglu, LutfiyeItraconazole (ITR) is commonly used in the treatment of Candida infections. It has a nephrotoxic effect and low bioavailability in patients who suffer from renal insufficiency, and its poor solubility in water makes ITR largely unavailable. Cyclodextrins (CyDs) are used to form inclusion complexes with drugs to improve their aqueous solubility and to reduce their side effects. In this study, ITR was complexed with gamma-cyclodextrin (gamma-CyD), hydroxypropyl-beta-cyclodextrin (HP-beta-CyD), methyl-beta-cyclodextrin (Met-beta-CyD) and sulphobutyl ether-beta-cyclodextrin (SBE7-beta-CyD) to increase its water solubility and to reduce the side effects of the drug without decreasing antifungal activity. Complex formation between ITR and CyDs was evaluated using SEM,H-1 NMR and XRD studies. The antifungal activity of the complexes was analyzed on Candida albicans strains, and the susceptibility of the strains was found to be higher for the ITR-SBE7-beta-CyD complex than for the complexes that were prepared with other CyDs. Vaginal bioadhesive sustained release tablet formulations were developed using the ITR-SBE7-beta-CyD inclusion complex to increase the residence time of ITR in the vagina, thereby boosting the efficacy of the treatment. The swelling, matrix erosion and bioadhesion properties of formulations and the drug release rate of these tablets were analyzed, and the most therapeutically effective vaginal formulation was determined. (C) 2014 Elsevier B.V. All rights reserved.Publication Metadata only Can Legionnaires disease be diagnosed by clinical criteria? A critical review(ELSEVIER, 2001) DURMUŞOĞLU, LÜTFİYE; Mulazimoglu, L; Yu, VLPublication Open Access Community-acquired Klebsiella pneumoniae bacteremia: Global differences in clinical patterns(CENTER DISEASE CONTROL, 2002-02) DURMUŞOĞLU, LÜTFİYE; Ko, WC; Paterson, DL; Sagnimeni, AJ; Hansen, DS; Von Gottberg, A; Mohapatra, S; Casellas, JM; Goossens, H; Mulazimoglu, L; Trenholme, G; Klugman, KP; McCormack, JG; Yu, VLWe initiated a worldwide collaborative study, including 455 episodes of bacteremia, to elucidate the clinical patterns of Klebsiella pneumoniae. Historically, community-acquired pneumonia has been consistently associated with K. pneumoniae. Only four cases of community-acquired bacteremic K. pneumoniae pneumonia were seen in the 2-year study period in the United States, Argentina, Europe, or Australia; none were in alcoholics. In contrast, 53 cases of bacteremic K. pneumoniae pneumonia were observed in South Africa and Taiwan, where an association with alcoholism persisted (p=0.007). Twenty-five cases of a distinctive syndrome consisting of K. pneumoniae bacteremia in conjunction with community-acquired liver abscess, meningitis, or endophthalmitis were observed. A distinctive form of K. pneumoniae infection, often causing liver abscess, was identified, almost exclusively in Taiwan.Publication Open Access Antibiotics are not needed during tube thoracostomy for spontaneous pneumothorax: an observational case study(BIOMED CENTRAL LTD) DURMUŞOĞLU, LÜTFİYE; Olgac, Guven; Aydogmus, Umit; Mulazimoglu, Lutfiye; Kutlu, Cemal AsimBackground: Usefulness of prophylactic antibiotics following tube thoracostomy remains controversial in the literature. In this study, we aimed to investigate the consequences of closed tube thoracostomy for primary spontaneous pneumothorax without the use of antibiotics. Methods: One-hundred and nineteen patients underwent tube thoracostomy for primary spontaneous pneumothorax. None of them received prophylactic antibiotic treatment. Eight patients with prolonged air leak undergoing either video assisted thoracoscopic surgery or thoracotomy were excluded. Results: Of the remaining 111 ( 104 male and 7 female), 28 (25%) patients developed some induration around the entry site of chest tube that settled without further treatment. White blood cell count was high without any other evidence of infection in 12 (11%) patients and returned to its normal levels before discharge home in all. There was also some degree of fever not lasting for more than 48 hours in 8 (7%) patients. Bacterial cultures from suspected sites did not reveal any significant growth in these patients. Conclusion: Prophylactic antibiotic treatment seems avoidable during closed tube thoracostomy for primary spontaneous pneumothorax. This policy was not only cost-effective but also prevented our patients from detrimental properties of unnecessary antibiotic use, such as development of drug resistance and undesirable side effects.Publication Open Access Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study(HINDAWI LTD, 2018) BİLGİLİ, BELİZ; Bilgin, Huseyin; Haliloglu, Murat; Yaman, Ali; Ay, Pinar; Bilgili, Beliz; Arslantas, Mustafa Kemal; Ozdemir, Filiz Ture; Haklar, Goncagul; Cinel, Ismail; Mulazimoglu, LutfiyePurpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p < 0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.Publication Metadata only Severe respiratory failure secondary to Varicella zoster pneumonia(2010-01-01) KARAKURT, SAİT; DURMUŞOĞLU, LÜTFİYE; ÇELİKEL, TURGAY HÜSEYİN; ERYÜKSEL E., ABUL Y., KARAKURT S., AKBAŞ T., DURMUŞOĞLU L., ÇELİKEL T. H.Varicella is one of the most contagious diseases of childhood. Whenever varicella is seen in adults, it can cause serious complications. Pneumonia is one of the most serious complications of varicella during adulthood and it has a high mortality rate. Cases of varicella pneumonia which need mechanical ventilation in intensive care unit, have %50 of mortality rate. This report presents a patient who was diagnosed as varicella pneumonia in our intensive care unit. Our treatment and diagnostic approach is presented together with actual literature. J Clin Exp Invest 2010; 1(2): 113-116Publication Metadata only Oral tablet formulations containing cyclodextrin complexes of poorly water soluble cefdinir to enhance its bioavailability(ELSEVIER, 2020) DURMUŞOĞLU, LÜTFİYE; Morina, Deniz; Sessevmez, Melike; Sinani, Genada; Mulazimoglu, Lutfiye; Cevher, ErdalCefdinir (CFD) is an oral cephalosporin antibiotic commonly used in the treatment of community-acquired infections. The oral bioavailability of CFD is limited due to its poor aqueous solubility. Cyclodextrins (CyDs) and their chemically modified derivatives are used in the pharmaceutical field to form inclusion complexes with drug molecules to improve their aqueous solubility as well as stability and to prevent side effects. In this study, CFD was complexed with CyDs such as beta-cyclodextrin (beta-CyD), gamma-cyclodextrin (gamma-CyD), hydroxypropyl-beta-cyclodextrin (HP-beta-CyD), and sulphobutyl ether 7-beta-cyclodextrin (SBE7-beta-CyD) to increase its aqueous solubility and to reduce its side effects without decreasing the antimicrobial activity. Phase solubility studies were performed and the stability constant of the CFD:CyD inclusion complexes was determined. The solubility of CFD was increased after complexation with CyDs as indicated by phase solubility studies, in the order beta-CD < HP-beta-CyD < gamma-CyD < SBE7-beta-CyD, a result that depends on the conditions of complexation formation. Complex formation between CFD and CyDs was evaluated using scanning electron microscopy (SEM), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and powder x-ray diffractometry (PXRD) studies. The antimicrobial activity of the complexes against Staphylococcus aureus and Escherichia coli strains were evaluated and the strains showed higher susceptibility to CFD:HP-beta-CyD complex. Oral tablet formulations were fabricated using Avicel (R) PH 102 or Ludipress (R) as direct compression agent and magnesium stearate as lubricant. Using CFD:HP-beta-CyD complex in tablets significantly improved the dissolution rate of the drug when compared with that of formulation containing CFD alone.Publication Metadata only Treatment of community-acquired pneumonia in hospitalised patients(Elsevier, 2001) DURMUŞOĞLU, LÜTFİYE; Mulazimoglu L.Community-acquired pneumonia (CAP) can be life-threatening. The prognosis is generally poorest in elderly patients and/or those with underlying chronic conditions, but fatalities can occur in all age groups. Current challenges in the clinical management of CAP are discussed, and the criteria for identifying those patients who should be treated in hospital with initial intravenous therapy are considered. Rapid initiation of therapy is important, using an agent that provides coverage against the most likely pathogens - Streptococcus pneumoniae and the atypical organisms. There is an increasing tendency to minimise the duration of intravenous therapy, with an early transition to oral therapy and the rapid return of the patient to the community. The efficacy of oral macrolides in the treatment of CAP is well established. Evidence for the use of intravenous azithromycin to provide effective and well-tolerated, first-line intervention in the hospitalized CAP patient is summarised. © 2001 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.Publication Metadata only Outcomes of Fecal Carriage of Extended-spectrum beta-Lactamase After Transrectal Ultrasound-guided Biopsy of the Prostate(ELSEVIER SCIENCE INC, 2014) ERTÜRK ŞENGEL, BUKET; Tigen, Elif Tukenmez; Tandogdu, Zafer; Ergonul, Onder; Altinkanat, Gulsen; Gunaydin, Bilal; Ozgen, Mahir; Sariguzel, Nevin; Sengel, Buket Erturk; Odabasi, Zekaver; Cek, Mete; Tokuc, Resit; Turkeri, Levent; Mulazimoglu, Lutfiye; Korten, VolkanOBJECTIVE To determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (PE) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy (TRUSbx) and its relationship with post-biopsy infections. METHODS A prospective clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted. Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy. Rectal swab culture specimens were acquired immediately before the procedure. Demographic data, prophylaxis choice, quinolone or any other antibiotic consumption within the past 2 months, history of prostatitis, repeat biopsy, intensive care unit admission, hospitalization, urethral catheterization, diabetes mellitus (DM), and steroid usage were recorded. RESULTS ESBL carriage was detected in 19% of patients and quinolone use within the last 2 months; other antibiotic use within the last 2 months and DM were found to be significantly associated (P < .05). Symptomatic urinary tract infection (UTI) on the third day after biopsy was seen in 9% of patients and was associated with fluoroquinolone (FQ) consumption before biopsy. Although ESBL-PE carriage was associated with post-biopsy UTI symptoms, it was not found to be associated with post-biopsy symptomatic UTI. Urosepsis was seen in 2 patients (0.5%) after biopsy, and both the patients were ESBL-PE carriers. CONCLUSION The presence of ESBL-PE was associated with DM and FQ consumption before biopsy. ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation; however, it was not associated with microbiologically proven infections. FQ consumption before TRUSbx was also associated with post-biopsy infections. (C) 2014 Elsevier Inc.