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Öğe Antibacterial resistance patterns and incidence of hospital-acquired Staphylococcus aureus bacteremia in a tertiary care educational hospital in Turkey: a perspective from 2001 to 2013(Tubitak Scientific & Technical Research Council Turkey, 2017) Sipahi, Oguz Resat; Uysal, Serhat; Aydemir, Sabire Sohret; Pullukcu, Husnu; Tasbakan, Meltem; Tunger, Alper; Cilli, Fatma Feriha; Yamazhan, Tansu; Arda, Bilgin; Sipahi, Hilal; Ulusoy, SercanBackground/aim: Staphylococcus aureus is an important nosocomial pathogen and a successful antimicrobial-resistance developer. In this study we retrospectively evaluated the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related S. aureus strains between 2001 and 2013. Materials and methods: Any patient in whom S. aureus was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72 h after hospital admission) was considered to have MCNB. Results: The methicillin-resistant S. aureus (MRSA) rate in 2001 was 73.8% whereas it was 36.2% in 2013. When the 2001-2003 and 2011-2013 periods were compared, resistance to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin decreased significantly (P < 0.05). When we evaluated the total S. aureus, MRSA, and methicillin-sensitive S. aureus (MSSA) bacteremia rates per 1000 days and 1000 patients, there was an increase in the 2004-2005 period, which was followed by a slight decrease until 2013 (P < 0.05). There was a plateau in MCNB-related S. aureus rates between 2008 and 2011. Conclusion: There was a decrease in overall S. aureus and MRSA bacteremia incidence as well as MRSA rates except for a plateau between 2008 and 2011. This steady decrease in the resistance rates is most probably due to the 2003 budget application and application of antimicrobial stewardship.Öğe 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, AlperBackground: 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.Öğe A CASE OF CEREBRAL ABSCESS DUE TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS WHICH IS TREATED WITH LINEZOLID plus RIFAMPIN COMBINATION(Ankara Microbiology Soc, 2010) Sipahi, Oguz Resat; Cagiran, Inanc; Yurtseven, Taskin; Tasbakan, Meltem Isikgoz; Arda, Bilgin; Tunger, Alper; Ulusoy, SercanMethicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of cerebral abscesses, however it is a relatively more common etiologic agent in post-neurosurgical abscesses and the main antibacterial therapy option is vancomycin. In this report, a case of brain abscess due to MRSA which did not respond neither to moxifloxacin + vancomycin nor vancomycin + rifampin combination therapies, and merely treated by linezolid + rifampin combination, has been presented. Fifty-one years old female patient who was operated 40 days ago for subarachnoid bleeding and aneurysm in middle cerebral artery bifurcation, was hospitalized due to purulent leakage from the operation area. She did not have fever and her physical examination, including the neurologic system, was normal. Computerized tomography revealed an approximately 1 cm lesion compatible with subdural empyema and cerebral abscess in the right frontoparietal area in supratentorial sections. The patient was operated for wound revision and moxifloxacin was initiated. Since the operation materials revealed MRSA growth, vancomycin (4 x 500 mg, IV) was added to the treatment. The isolate was identified by conventional methods, and antibiotic susceptibility test performed by disk diffusion method showed that it was susceptible to levofloxacin, linezolid, rifampin, vancomycin and teicoplanin. Since no clinical response was obtained in two weeks, moxifloxacin was switched to rifampin (300 mg 1 x 2). On the 10(th) day of vancomycin + rifampin therapy, radiological findings showed development of cerebritis and therefore vancomycin was changed with linezolid (2 x 600 mg, IV). The control CT of the patient revealed regression of the brain lesion and linezolid + rifampin treatment continued for six weeks. The patient did not develop any hematological, liver or renal toxicity during the therapy and the radiological findings regressed. No relapse were detected in the one year follow-up period. This case suggested that linezolid might be a treatment alternative in the therapy of vancomycin-refractory MRSA brain abscess.Öğe A Case of Polymicrobial Brain Abscess Caused By a Rare Bacterium: Granulicatella elegans(Galenos Yayincilik, 2018) Akyol, Deniz; Yildirim, Cigdem; Tasbakan, Meltem Isikgoz; Yamazhan, Tansu; Tunger, Alper; Eraslan, Cenk; Sipahi, Oguz ResatÖğe Comparative Evaluation of In Vitro Activities of Carbapenemes Against Gram-Negative Pathogens: Turkish Data of COMPACT Study(Ankara Microbiology Soc, 2011) Korten, Volkan; Soyletir, Guner; Yalcin, Ata Nevzat; Ogunc, Dilara; Dokuzoguz, Basak; Esener, Harika; Ulusoy, Sercan; Tunger, Alper; Aygen, Bilgehan; Sumerkan, Bulent; Arman, Dilek; Dizbay, Murat; Akova, Murat; Hascelik, Gulsen; Eraksoy, Haluk; Basaran, Seniha; Koksal, Iftihar; Bayramoglu, Gulcin; Akalin, Halis; Sinirtas, MeldaThe aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest (R) strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC(50) of doripenem against Pseudomonas spp. was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC(90) of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gram-negative pathogens, mostly Acinetobacter spp., MIC(50) was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.Öğe EVALUATION OF CHILDHOOD URINARY TRACT INFECTION AND ANTIBIOTIC SUSCEPTIBILITY IN A TURKISH CENTER(Bmj Publishing Group, 2019) Bulut, Ipek Kaplan; Tunger, Alper; Taner, Sevgin; Boluk, Ezgi; Keskinoglu, Ahmet; Kabasakal, Caner; Aydemir, Sohret[No abstract available]Öğe Extended-spectrum beta-lactamase production and antimicrobial resistance patterns of Klebsiella pneumoniae strains isolated from nosocomial bacteremic patients: Evaluation of the results of 2001-2005 period(Ankara Microbiology Soc, 2008) Tasbakan, Meltem Isikogz; Pullukcu, Huesnue; Sipahi, Oguz Resat; Aydemir, Sohret; Yamazhan, Tansu; Tunger, Alper; Ulusoy, SerganExtended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae is a global health problem. This study was aimed to retrospectively evaluate the resistance patterns of K.pneumoniae strains, microbiologically proven as agents of nosocomial bacteremia, between 2001-2005 and also to compare the 2001-2002 and 2004-2005 data to investigate the effect of 2003 budget application on antimicrobial resistance in our country. Data of antimicrobial resistance and hospital admission dates were extracted from the hospital patient record database. 2003 data was excluded to better evaluate the probable effect of governmental antibiotic restriction policy, which was started in March 2003. Blood cultures were performed on Bact/Alert (bioMerieux, Durham, NC) automated system and bacterial identifications were done by conventional methods. Double or more isolates during each episode were counted as one episode. Antibacterial susceptibility testing was done by disc diffusion method according to the recommendations of Clinical Laboratory Standards Institute. Resistance patterns in the 2001-2002 and 2004-2005 periods were compared by chi-square test. No resistance to carbapenems were detected in the strains. The comparison of 2001-2002 and 2004-2005 periods revealed that resistance to amikacin (30% and 19%, respectively), cefuroxime (55% and 37%, respectively), arnoxycillin/clavulonate (59% and 46%, respectively), piperacillin/tazobactam (51% and 39%, respectively) and cotrimoxazole (53% and 35%, respectively) were decreased significantly (p < 0.05). The rate of ESBL K.pneumoniae strains was 49% in 2001-2002 period while it decreased to 35% in 2004-2005 period (p < 0.025). The decrease in the resistance rates after the 2003 budget application suggested that this success could be attributed to the evaluation of each patient to be given an extended spectrum antibiotic, by an infectious disease specialist and also more active use of the clinical microbiology laboratory.Öğe In vitro Antimicrobial Susceptibility of Urinary Tract Infection Pathogens in Children(Galenos Publ House, 2023) Taner, Sevgin; Aydemir, Sabire Sohret; Ozgur, Su; Aksoy, Ezgi; Keskinoglu, Ahmet; Tunger, Alper; Kabasakal, CanerAim: Urinary tract infection (UTI) is one of the most common bacterial infections in children. Empirical treatment is commenced according to the patient's characteristics and the antimicrobial susceptibility patterns in the region. Therefore, a determination of antimicrobial resistance patterns has a great importance in effective treatment. The aim of this study was to determine the pathogens which cause UTIs in patients admitted to a university hospital in Izmir and to determine their antimicrobial susceptibility pattern. Materials and Metkods: The files of patients aged between 0-18 years, followed up with a diagnosis of UTI, vesicoureteral reflux and neurogenic bladder in Ege University Faculty of Medicine Paediatric Nephrology Unit between February, 2013 and November, 2018 were retrospectively reviewed.Results: A total of 1,126 positive urine cultures from 729 patients (65% female) were included in this study. Gram-negative pathogens constituted 88.2% of the cultures. Escherichia coli (E. coli) was the most commonly isolated bacteria with a prevalence of 59.1%, followed by Klebsiella pneumonia with 17.9%, and Enterococcus faecalis with 8.3% (n=93). Ampicillin, cefuroxime and trimethoprim-sulfamethoxazole with susceptibility rates of 18.6%, 39.6%, 49.0% respectively, constituted the highest resistant antimicrobials to Enterobacteriaceae. Enterococcus spp. showed the highest resistance to gentamycin with 50% resistance in tested cases. Pseudomonas spp. with 64.3% susceptibility showed the highest resistance to piperacillin-tazobactam.Conclusion: This study revealed that bacterial resistance to commonly used antimicrobials in UTI is an important and challenging problem which requires planning.Öğe Investigation of Bacterial and Viral Etiology in Community Acquired Central Nervous System Infections with Molecular Methods(Ankara Microbiology Soc, 2017) Kahraman, Hasip; Tunger, Alper; Senol, Sebnem; Gazi, Horu; Avci, Meltem; Ormen, Bahar; Turker, Nesrin; Atalay, Sabri; Kose, Sukran; Ulusoy, Sercan; Isikgoz Tasbakan, Meltem; Sipahi, Oguz Resat; Yamazhan, Tansu; Gulay, Zeynep; Cavus, Sema Alp; Pullukcu, HusnuIn this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 +/- 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.Öğe Investigation of Carbapenemases in Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae Strains Isolated in 2014 in Turkey(Ankara Microbiology Soc, 2016) Cakar, Asli; Akyon, Yakut; Gur, Deniz; Karatuna, Onur; Ogunc, Dilara; Baysan, Betil Ozhak; Coplu, Nilay; Cagatay, Mustafa; Kilic, Abdullah; Baysallar, Mehmet; Bakici, Zahir; Celik, Cem; Gulay, Zeynep; Aydemir, Sohret; Tunger, Alper; Kilic, Huseyin; Ercal, Baris Derya; Toraman, Zulal Asci; Zer, Yasemin; Buyuktas, Ayse; Ay, Selma; Aktas, Zerrin; Kayacan, Cigdem; Bayramoglu, Gulcin; Aydin, Faruk; Dundar, Devrim; Hasdemir, Ufuk; Ayas, Ramazan; Yanik, Keramettin; Gunaydin, Murat; Guducuoglu, Huseyin; Parlak, MehmetCarbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.Öğe Investigation of Colistin resistance and method comparison in Klebsiella pneumoniae strains(Elsevier Science Inc, 2024) Aydin Uysal, Ayca; Tunger, AlperPurpose: This study aimed to assess the prevalence of colistin resistance in the study group and compare alternative methods with the gold standard. It sought to evaluate the prevalence of plasmid-mediated colistin resistance genes. Material and methods: The colistin susceptibility of 151 K. pneumoniae strains was determined using SensititreTM, CBDE, ETEST (R), and VITEK (R) 2. Results were compared with BMD. The presence of the mcr gene was assessed using polymerase chain reaction. Results: The colistin resistance rate was 16,6 %. The categorical agreement of SensititreTM, CBDE, and ETEST (R) was 100 %. VITEK (R) 2 had a CA of 98 %, a major error of 0.79 %, and a very major error of 8 %. Essential agreement for SensititreTM, ETEST (R), and VITEK (R) 2 was 92.7 %, 52.3 %, and 78.1 %, respectively. There were no mcr genes in any strains. Conclusions: Due to the difficulty of applying BMD, colistin resistance data are insufficient globally. Continuous epidemiological studies and validation of alternative methods are needed.Öğe Investigation of the Antimicrobial Susceptibility Profile, Virulence Genes, and Epidemiologic Relationship of Clinical Salmonella Isolates(Turkish Pharmacists Assoc, 2018) Tekintas, Yamac; Yilmaz, Fethiye Ferda; Aydemir, Sabire Sohret; Tunger, Alper; Hosgor-Limoncu, MineObjectives: The objectives of this study were to investigate the epidemiologic relationship, prevalence of the beta-lactamase and virulence genes of clinical ampicillin-resistant Salmonella enterica. Materials and Methods: In vitro ampicillin susceptibilities of 117 Salmonella enterica isolates obtained between 2011-2012 from Ege University Hospital, Bacteriology Laboratory of Medical Microbiology Department were examined using disc diffusion assays in accordance with the CLSI guidelines. The MIC levels in the ampicillin-resistant bacteria were determined using the broth microdilution method. The resistant strains were serotyped by the Public Health Institution. Epidemiologic relations of resistant strains were evaluated using ERIC-PCR. The presence of betalactamase genes and virulence factors were detected using PCR. Results: The 117 S. enterica strains had ten isolates that were resistant to ampicillin, and the MIC range of ampicillin was found as 512-128 mu g/mL. Ampicillin-resistant strains were susceptible to nalidixic acid, ciprofloxacin, cefotaxime, sulfamethoxazole/trimethoprim. Four different serotypes were identified and isolates were grouped into seven clusters. Five isolates carried bla(TEM), and two carried the bla(CTX-M) gene. However, it was determined that bla(SHV) and bla(PER) genes did not exist in these strains. Virulence genes invA, pipD, and sopB were found in all isolates. sifA, pefA, and sopE genes were found in seven, four, and three isolates, respectively. Conclusion: Our data suggest that the rate of ampicillin resistance in S. enterica isolates was 8.5% in the two year period, but this ratio was generally lower than rates abroad. bla(CTX-M) and bla(TEM) genes could be responsible for ampicillin resistance. The bla(SHV) gene, which is highly prevalent in our country, was not found in any strains. sopB and pipD genes, which might be associated with beta-lactam resistance, were found in all strains. It is also noteworthy that the three isolates containing the sopE gene, which is associated with epidemic cases, were of the same serotypes and epidemiologic clusters.Öğe Is there a rise in resistance rates to fosfomycin and other commonly used antibiotics in Escherichia coli-mediated urinary tract infections? A perspective for 2004-2011(Tubitak Scientific & Technical Research Council Turkey, 2013) Pullukcu, Husnu; Aydemir, Sohret; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Hall, Feriha Cilli, Jr.; Tunger, AlperAim: Resistance patterns of Escherichia coli to fosfomycin, ciprofloxacin, amikacin, and cotrimoxazole were evaluated in 2 different studies held in 2004 and 2005. In this study, it was aimed to compare the changes in the susceptibility patterns of uropathogenic E. coli strains to the above-mentioned antibiotics after 6 years. Materials and methods: Between February and April 2011, E. coli strains isolated from urine samples were included prospectively in the study. Results: A total of 502 E. coli strains (358 from outpatients and 144 from inpatients) were isolated from urine specimens between February and April 2011. Extended spectrum beta-lactamase (ESBL)-producer E. coli rate was 35%. Resistances to cotrimoxazole, ciprofloxacin, amikacin, and fosfomycin were 54.5%, 49.8%, 22.7%, and 1.4%, respectively. When we compared ESBL-producer E. coli strains isolated in 2005 and 2011, amikacin resistance increased (11% to 22.7%, P = 0.0001), whereas cotrimoxazole resistance decreased significantly (74% to 62.9%, P = 0.0063). When we compared resistance patterns of non-ESBL-producer E. coli in relation to 2004 and 2011, there was no significant change in the resistance to fosfomycin, cotrimoxazole, ciprofloxacin, and amikacin. Pooled analysis of fosfomycin studies from Turkey revealed 1.6% fosfomycin resistance in a total of 6439 strains. Conclusion: Our results suggest that despite common usage, there is not an increase in the resistance to fosfomycin. We conclude that fosfomycin can be used as one of the primary choices in the empirical therapy of urinary tract infections.Öğe Is there a rise in resistance rates to fosfomycin and other commonly used antibiotics in Escherichia coli-mediated urinary tract infections? A perspective for 2004-2011(Tubitak Scientific & Technical Research Council Turkey, 2013) Pullukcu, Husnu; Aydemir, Sohret; Tasbakan, Meltem Isikgoz; Sipahi, Oguz Resat; Hall, Feriha Cilli, Jr.; Tunger, AlperAim: Resistance patterns of Escherichia coli to fosfomycin, ciprofloxacin, amikacin, and cotrimoxazole were evaluated in 2 different studies held in 2004 and 2005. In this study, it was aimed to compare the changes in the susceptibility patterns of uropathogenic E. coli strains to the above-mentioned antibiotics after 6 years. Materials and methods: Between February and April 2011, E. coli strains isolated from urine samples were included prospectively in the study. Results: A total of 502 E. coli strains (358 from outpatients and 144 from inpatients) were isolated from urine specimens between February and April 2011. Extended spectrum beta-lactamase (ESBL)-producer E. coli rate was 35%. Resistances to cotrimoxazole, ciprofloxacin, amikacin, and fosfomycin were 54.5%, 49.8%, 22.7%, and 1.4%, respectively. When we compared ESBL-producer E. coli strains isolated in 2005 and 2011, amikacin resistance increased (11% to 22.7%, P = 0.0001), whereas cotrimoxazole resistance decreased significantly (74% to 62.9%, P = 0.0063). When we compared resistance patterns of non-ESBL-producer E. coli in relation to 2004 and 2011, there was no significant change in the resistance to fosfomycin, cotrimoxazole, ciprofloxacin, and amikacin. Pooled analysis of fosfomycin studies from Turkey revealed 1.6% fosfomycin resistance in a total of 6439 strains. Conclusion: Our results suggest that despite common usage, there is not an increase in the resistance to fosfomycin. We conclude that fosfomycin can be used as one of the primary choices in the empirical therapy of urinary tract infections.Öğe Kaposi Sarkomlu Bir Hastadaki Çoklu İlaç Direncine Sahip Pseudomonas aeruginosa Bakteriyel Keratitinde Kolistin Etkisi(2019) Selver, Özlem Barut; Eğrilmez, Sait; Hasanov, Samir; Yılmaz, Medine Dağ; Tunger, AlperYetmiş bir yaşındaki erkek hasta, sağ gözünde 5 gündür devam eden görme azlığı, kızarıklık ve çapaklanma şikayeti ile başvurdu. Sol göz yıllar öncesinde evisserasyon cerrahisi geçirmişti. Hastanın mevcut durumu öncesinde skalp Kapasi sarkomu için kemoterapi kullanım hikayesi bulunmaktaydı. Biyomikroskobik muayenede, etrafında stromaya uzanan infiltrasyon bulunan, hipopyonla birliktelik gösteren geniş korneal ülser mevcuttu. Mikrobiyolojik inceleme sonucu etken çoklu ilaç direncine sahip Pseudomonas aeruginosa olarak tanımlandı. Kültür antibiyogram sonucuna göre hastaya %0,19 konsantrasyonunda topikal kolistin, saat başı damla olarak başlandı. Keratitin, rezidü korneal skar bırakarak tamamen düzeldiği izlendi. Son yıllarda, P. aeruginosa keratitinde giderek artan bir ilaç direnci ortaya çıkmaktadır. Dirençli ajanlara karşı yeni geliştirilen antimikrobiyellerin bulunmaması, klinisyenleri eski bir ilaç olan kolistini tedavide yeniden kullanmaya yöneltmiştir. Bu olgu sunumu ile Kaposi sarkomlu bir hastada gelişen bakteriyel keratitin tedavisinde kolistinin yerini vurgulamayı istedik.Öğe Nosocomial Infections in a Neurological Intensive Care Unit(Journal Neurological Sciences, 2009) Buke, Cagri; Biyikli, Bilge; Tuncel, Murside; Aydemir, Sohret; Tunger, Alper; Sirin, Hadiye; Kocaman, Ayse SagduyuBackground: Nosocomial infections in intensive care units are common and associated with high morbidity, mortality. This study was planned to evaluate the occurance and causes of site specific nosocomial infections in a neurological intensive care unit (NICU) and their relevance to underlying diseases. Methods: Patients treated for more than 24 hours in Ege University Medical School Hospital NICU were evaluated by prospective daily surveillance for overall and site specific infections during the 12 months of the year 2005. Nosocomial infections incidence and their relation with underlying disease were investigated. Results: Three hundred and fifty six patients were included. A hundred and ten nosocomial infections were seen. The rate of infection per 100 patients was 30.8. Site-specific infections were; urinary tract infection (49.1%), pneumonia (30.9%), catheter related blood stream infections (18.1%) and primary bacteremia (1.8%). In univariate analysis, no differences were found between the patients with stroke and other NICU disorders in terms of risk factors for NICU-AI such as; age, gender, type of nosocomial infections, length of stay, and mortality. But the length of stay was significantly prolonged and mortality was significantly higher in patients with NICU-AI when compared with patients without NICU-AIs. Conclusion: The incidence of nosocomial infections in our NICU was found to be as high as in other critical care units and causes higher mortality. This was supposed to be associated with prolonged hospital stay and insufficient compliance to infection control measures instead of the underlying disease of the patients.Öğe Risk Factors for Gastrointestinal Colonization by ESBL-Producing Klebsiella pneumoniae and Escherichia coli in Anaesthesiology and Reanimation Intensive Care Unit(Ankara Microbiology Soc, 2013) Mizrakci, Serpil Oguz; Arda, Bilgin; Erdem, Huseyin Aytac; Uyar, Mehmet; Tunger, Alper; Sipahi, Oguz Resat; Ulusoy, SercanIn this study it was aimed to investigate the risk factors for gastrointestinal colonization by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli in intensive care unit (ICU) of anaesthesiology and reanimation, Ege University Faculty of Medicine, Izmir, Turkey. This study was performed prospectively on adult patients hospitalized in ICU of anaesthesiology and reanimation and rectal swab cultures were performed in all patients in the first 48 hours of hospitalization and every one week until discharge or death. Samples were transported to the laboratory in Stuart transport medium and were cultured on two EMB agar plates (one including 4 mg/L ceftazidime) and incubated for 48 hours. E.coli and K.pneumoniae isolates were identified by conventional methods. Antibiotic susceptibility tests were performed by disc diffusion method on Mueller Hinton agar and interpreted according to CLSI guidelines. ESBL was confirmed by double disc synergy test. A total of 140 patients (49 female 91 male; age range: 18-83 years, mean age: 56.3 years) were evaluated, and 41(29.3%) of the patients were found to be colonized with ESBL positive E.coli (n=39) or K.pneumoniae (n=2). The mean time for colonization was 11.15 +/- 10.91 (range between 2-39) days. Age and gender of the patients and antibiotic consumption before or during the stay in ICU of anaesthesiology and reanimation were not found to be associated with colonization (p>0.05). However length of ICU of anaesthesiology and reanimation stay in colonized patients was longer than non-colonized patients (27.59 +/- 22.52 vs. 17.78 +/- 11.74 days; p<0.05). Infectious episodes developed in 22% (9/41) of the colonized cases and three of the nine strains were isolated from the blood cultures, five from the urine cultures and one from both blood and bronchoalveolar lavage cultures. ESBL-positive E.coli or K.pneumoniae colonization was found as an independent risk factor for the development of infection (9/41 vs. 4/99 cases; p=0.002). Forward logistic regression analysis revealed that diabetes mellitus, immunosuppresive drug use and length of intubation were associated with ESBL-positive E.coli or K.pneumoniae colonization (p<0.05). The results of this study indicated that the risk of development of infection was significantly high in intensive care patients colonized by ESBL positive E.coli and K.pneumoniae and the identification of the related risk factors was critically important for the establishment of effective control measures.Öğe 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, VolkanPurpose 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.Öğe Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance(W B Saunders Co Ltd, 2007) Arda, Bilgin; Sipahi, Oguz Resat; Yamazhan, Tansu; Tasbakan, Meltem; Pullukcu, Husnu; Tunger, Alper; Buke, Cagri; Ulusoy, SercanObjectives: In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial. resistance patterns and nosocomiat infection rates in intensive care units (ICUs) of our setting for March-October 2002 and March-October 2003 periods. Methods and results: Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303 USD (-19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (p < 0.05). When all. microbiologically confirmed nosocomial bacteremia cases during the study period were analysed, amoxycittine/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (p < 0.05). Amikacin resistance in Escherichia coli and Acinetobacter baumannii increased significantly (p < 0.05). Conclusion: Antibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance. (c) 2007 The British Infection Society. Published by Elsevier Ltd. All rights reserved.Öğe Susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli urine isolates to fosfomycin, ciprofloxacin, amikacin and trimethoprim-sulfamethoxazole(Tubitak Scientific & Technical Research Council Turkey, 2008) Pullukcu, Husnu; Aydemir, Sohret; Tasbakan, Meltem Isikgoz; cilli, Feriha; Tunger, Alper; Ulusoy, SercanAim: Urinary tract infections (UTIs) caused in particular by extended-spectrum beta-lactamase (ESBL)producing Escherichia coli strains are related with high morbidity and mortality, and treatment is quite difficult. These infections generally are treated by carbapenems, and their costs are high. We aimed in this study to investigate the susceptibilities of ESBL-producing E. coli strains isolated from urine cultures to fosfomycin, ciprofloxacin, amikacin and trimethoprim-sulfamethoxazole and to determine the general resistance profile in our region of these strains isolated from UTIs. Materials and Methods: Between January 2005-December 2005, ESBL-producing E coli strains isolated from urine samples sent from various outpatient and inpatient clinics to the Bacteriology Laboratory of the Department of Microbiology and Clinical Microbiology were included prospectively in the study. ESBL production was detected using the double disk synergy test. Antibiotic susceptibility testing was performed for ESBL-producing isolates by disk diffusion test according to Clinical and Laboratory Standards Institute (CLSI) criteria. Escherichia coli ATCC 35218 and ATCC 25922 were used as control strains. The diagnosis of nosocomial UTIs was established according to the Centers for Disease Control and Prevention criteria. The data were assessed using the SPSS 11.0 packet program. Results: A total of 344 ESBL-producing E. coli isolates (241 nosocomial isolates; 103 outpatient isolates) were included in the study. The rates of resistance were 3.5% for fosfomycin, 76.5% for ciprofloxacin, 11% for amikacin, and 74.4% for trimethoprim-sulfamethoxazole. While resistance rates of nosocomial strains were 4.1%, 81.3%, 11.2%, and 71%, respectively, resistance rates of the strains isolated from outpatients were 1.9%, 65%, 10.7%, and 82.5%, respectively. There were statistically significant differences between the two groups for ciprofloxacin and trimethoprim-sulfamethoxazole. Conclusions: Because of the high antibiotic resistance rates in our country, we think that fosfomycin and amikacin may have priority in the treatment of non-complicated UTIs caused by ESBL-producing E. coli strains due to ease of use and high concentration in the urine.
