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    ANTIBACTERIAL RESISTANCE PATTERNS AND INCIDENCE OF NOSOCOMIAL PSEUDOMONAS AERUGINOSA BACTEREMIA IN A TERTIARY-CARE EDUCATIONAL HOSPITAL IN TURKEY: A PERSPECTIVE BETWEEN 2001 AND 2019
    (Carbone Editore, 2022) Akyol, Deniz; Karatas, Mustafa; Aydemir, Sohret; Uysal, Serhat; Pullukcu, Husnu; Tasbakan, Meltem; Tunger, Alper
    Background: Pseudomonas aeruginosa (PSA) is one of the most important pathogens causing nosocomial bacteremia in most parts of the world. Objectives: In this study it was aimed to evaluate the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related PSA strains between 2001-2019. Methods: Any patient in whom PSA was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72h after hospital admission) was considered to have microbiologically confirmed NB. Blood cultures were performed on Back/Alert (bioMerieux, Durham, NC). Bacterial identifications were performed by automated API (bioMerieux, Durham, NC). Antibacterial susceptibility tests were evaluated according to Clinical Laboratory Standards Institute (CLSI) criteria until 2014 and EUCAST between 2015 and 2019. Incidence density of PSA MCNB was calculated by using hospital electronic database. Results: A total of 1705 strains of P.aeruginosa fulfilling study inclusion criteria, were isolated during the 19-year study period in the hospital from intensive care units and clinics and included in the study. When the 2001-2002 and 2018-2019 periods were compared, there was a decrease in resistance to meropenem and amikacin (31.1%-20.4% p: 0.025 and 34.3%-22.8% p:0.029). However, the analysis of the resistance patterns of carbapenem-resistant P. aeruginosa strains as a subgroup (2001-2002) vs (2018 vs 2019), ciprofloxacin and cefepime resistance rates increased significantly (58%-79% p:0.0096 and 46%-72% p: 0.026). P. aeruginosa bacteremia rates incidence density rates ranged between 0.11 and 0.30 episodes per thousand hospital day during the study period. Conclusion: During the 19 years there was a significant decrease in amikacin and meropenem resistance while there was a significant increase in the subgroup of carbapenem-resistant strains. More infection control and antimicrobial stewardship efforts are needed to decrease the antibacterial resistance rates and incidence.
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    Secondary bacterial infections and antimicrobial resistance in COVID-19: comparative evaluation of pre-pandemic and pandemic-era, a retrospective single center study
    (Bmc, 2021) Karatas, Mustafa; Yasar-Duman, Melike; Tunger, Alper; Cilli, Feriha; Aydemir, Sohret; Ozenci, Volkan
    Purpose In this study, we aimed to evaluate the epidemiology and antimicrobial resistance (AMR) patterns of bacterial pathogens in COVID-19 patients and to compare the results with control groups from the pre-pandemic and pandemic era. Methods Microbiological database records of all the COVID-19 diagnosed patients in the Ege University Hospital between March 15, 2020, and June 15, 2020, evaluated retrospectively. Patients who acquired secondary bacterial infections (SBIs) and bacterial co-infections were analyzed. Etiology and AMR data of the bacterial infections were collected. Results were also compared to control groups from pre-pandemic and pandemic era data. Results In total, 4859 positive culture results from 3532 patients were analyzed. Fifty-two (3.59%) patients had 78 SBIs and 38 (2.62%) patients had 45 bacterial co-infections among 1447 COVID-19 patients. 22/85 (25.88%) patients died who had bacterial infections. The respiratory culture-positive sample rate was 39.02% among all culture-positive samples in the COVID-19 group. There was a significant decrease in extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (8.94%) compared to samples from the pre-pandemic (20.76%) and pandemic era (20.74%) (p = 0.001 for both comparisons). Interestingly, Acinetobacter baumannii was the main pathogen in the respiratory infections of COVID-19 patients (9.76%) and the rate was significantly higher than pre-pandemic (3.49%, p < 0.002) and pandemic era control groups (3.11%, p < 0.001). Conclusion Due to the low frequency of SBIs reported during the ongoing pandemic, a more careful and targeted antimicrobial prescription should be taken. While patients with COVID-19 had lower levels of ESBL-producing Enterobacterales, the frequency of multidrug-resistant (MDR) A. baumannii is higher.