Search

Sonuç: Amerikan Enfeksiyon Hastalıkları Derneği [Infectious Diseases Society of America (IDSA)] rehberinde ÜSE tedavisinde ilk seçenek olarak trimetoprim/sulfametoksazol, alternatif olarak da kinolonlar tavsiye edilmektedir. Ayrıca uluslararası tedavi rehberleri, komplikasyonsuz alt ÜSE'lerin ampirik tedavisinde direnç oranları %20'den yüksek antimikrobiyallerin kullanımını önermemektedir. Çalışmamızda; levofloksasin, siprofloksasin ve norfloksasin direnç oranları birbirine yakın olup ampirik tedavi için uygun görünmektedir, ancak trimetoprim/sulfametoksazol direnç oranı yüksek göörülmüştür (%36,3). Toplum kökenli hasta idrar örneklerinden beş yıllık sürede izole edilen E. coli izolatlarında saptadığımız %26,1'lik GSBL (genişlemiş spektrumlu ß-laktamaz) oranıyla birlikte, direnç oranları yüksek ampisilin, amoksisilin, amoksisilin/klavulanat, trimetoprim/sulfametoksazol ve sefalosporinlerin ampirik tedavi için uygun olmadığını düşünmekteyiz. Çalışmamızdaki sonuçlara dayanarak fosfomisinin tek doz oral kullanım avantajı, yüksek hasta uyumu ve düşük yan etki profili ile ayaktan hastalarda ampirik tedavi için ilk seçilecek ilaç olduğunu ve özellikle nonkomplike ÜSE'lerin ampirik tedavisinde nitrofurantoinin alternatif olduğunu düşünmekteyiz. Objective: Escherichia coli (E. coli) is the most common pathogen of bacterial infections worldwide and is responsible for 80% of urinary tract infections (UTIs). In recent years, resistance to antimicrobials used in the treatment of infections caused by E. coli has been increasing all over the world, and it is necessary to constantly monitor resistance rates and update empirical treatment recommendations in order to prevent treatment failure and increase in treatment costs. Methods: In this study, antimicrobial resistance rates of E. coli strains grown in urine culture samples sent from all polyclinics to Malatya Training and Research Hospital Microbiology laboratory between 2015-2019 were retrospectively investigated. Conventional methods and Vitek 2 Compact automated system (BioMérieux, France) were used for the identification of bacteria in plaques with significant growth and for antimicrobial susceptibility testing (AST). AST results were determined as sensitive and resistant according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Results: It was detected significant growth in 14.8% (22636/153006) of urine cultures of outpatients over a five-year period, and identification and ASTs were studied. E. coli constituted 68.3% (15475/22636) of the identified factors. The antimicrobial drugs with the highest resistance rates were ampicillin (65.2%), amoxicillin/clavulanate (38.5%), trimethoprim/sulfamethoxazole (36.3%), cephalexin (35%) and cefuroxime (31.3%) respectively. The least resistance rates were found against carbapenems (0.6-2.1%), fosfomycin (3.6%), nitrofurantoin (5.8%) and amikacin (7.5%), respectively. Quinolone resistance rates were found to be 16.7% for levofloxacin, 19.1% for ciprofloxacin and 21.9% for norfloxacin. Conclusion: In the guideline of the Infectious Diseases Society of America (IDSA), trimethoprim/sulfamethoxazole is recommended as the first choice in the treatment of UTI, and quinolones are recommended as an alternative. In addition, international treatment guidelines do not recommend the use of antimicrobials with resistance rates higher than 20% in the empirical treatment of uncomplicated lower UTIs. In our study, the resistance rates of levofloxacin, ciprofloxacin and norfloxacin were close to each other and seemed appropriate for empirical treatment, but the rate of trimethoprim/sulfamethoxazole resistance was high (36.3%). It is thought think that ampicillin, amoxicillin, amoxicillin/clavulanate, trimethoprim/sulfamethoxazole and cephalosporins with high resistance rates are not suitable for empirical treatment, with an ESBL (extended spectrum ß-lactamase) rate of 26.1% in E. coli isolates isolated from community-acquired patient urine samples over a five-year period. Based on the results of our study, it is thought that fosfomycin is the first drug of choice for empirical treatment in outpatients with its advantage of single-dose oral use, high patient compliance and low side-effect profile, and nitrofurantoin is an alternative especially in the empirical treatment of non-complicated UTIs. [ABSTRACT FROM AUTHOR]

Objective: In this study, it was aimed to investigate the change of antibiotic susceptibility of Acinetobacter baumannii strains over the years and to help develop antibiotic use policy by determining the multiple antibiotic resistance rate. Methods: Acinetobacter species isolated from various clinical samples sent to Necip FazılCity Hospital Microbiology Laboratory between January 2013 and December 2018 were included. Vitek 2 Compact (bioMérieux-SE, France) automated systems were used for the identification and antibiotic susceptibility of the isolates. Results: Acinetobacter isolates were isolated at the most from tracheal aspirate samples (n=73; 35%) and samples sent from Anesthesia and Reanimation intensive care unit(n=160; 68%). The distribution of antibiotic sensitivity percentages (%) was given as yearly, three-year averages for 2013-2015, 2016-2018, and the total average for 2013-2018. In the study period, the highest sensitivity was determined to colistin at 97% and the lowest to ceftriaxone at 5%. When the antibiotic sensitivity rates of A. baumannii are evaluated roughly; In the period of 2016-2018, compared to 2013-2015, there was a decrease in sensitivity to amikacin, ampicillin-sulbactam, cefepime, ceftriaxone, colistin and tigecycline, while sensitivity to other antibiotics was observed. Multiple antibiotic resistance was examined in a total of 237 A. baumannii isolated. Multidrug resistant (MDR) resistance was 92%, Extensively Drug Resistant (XDR) resistance was 84% and Pan Drug Resistant(PDR) resistance was 3%. Conclusion: It is observed that resistance against some antibiotics has increased in A. baumannii over the years, and resistance to some antibiotics has decreased. It seems that our XDR resistance rate is very high. Our PDR resistance rate is higher than that of America, but lower than many European countries. In the other hand our result is lower than the average of Turkey. [ABSTRACT FROM AUTHOR]

Objective: Pseudomonas aeruginosa is an opportunistic pathogen that can cause serious infections, especially in health care settings where host defense is impaired. In addition to resistance problem, the different virulence characteristics of these bacteria can change the course of infection and cure. In this study, it was aimed to determine antibiotic susceptibilities, epidemiological relations and virulence factors of clinical P. aeruginosa isolates. Methods: This study was performed, a total of 83 P. aeruginosa isolated from different clinical samples of Ege University Faculty of Medicine Hospital. Antibiotic susceptibilities of isolates were investigated by the VITEK 2 Compact® automated system and epidemiological relations of isolates determined via "Enterobacterial Repetitive Intergenic Consensus- Polymerase Chain Reaction (ERIC-PCR)". Phenotypic tests were performed to determine the virulence factors of the selected representatives from each clone. While the "Elastin Congo Red" method was used for the investigation of elastase activity, appropriate methods applied for Protease, DNase, Lipase, Siderophore and Twitching activities to the detect virulence properties phenotypically. The biofilm production of isolates was investigated by crystal violet method, and the quorum sensing (QS) genes thought to be related to biofilm were determined by PCR method. Results: According to results of antibiotic susceptibility test, the highest resistance was observed against imipenem (43,4%) and the lowest resistance was observed against amikacin (14,5%). Isolates were found in 19 unrelated clones according to ERIC-PZR results. Siderophore and elastase production were observed in all of the representative isolates. Protease, lipase and twitching motility were determined at 5, 14 and 15 isolates respectively, no DNAse production was detected. Nine of the 19 representative isolates produced strong biofilms, and the lasI, lasR, rhlR genes were identified in 17, 18, 13 isolates respectively and the rhlI gene was found in all strains. Conclusion: When the data were evaluated, different antibiotic resistant P. aeruginosa isolates which have different resistance profiles were detected at Ege University Faculty of Medicine Hospital. The inclusion of these resistant isolates in epidemiologically unrelated clones suggests that isolates with genotypically different properties are circulating in the clinics. Despite the many virulence factors that can contribute to pathogenesis, it is noteworthy that biofilm production is particularly prevalent in these isolates. This situation has meant that treatment becomes more difficult, as well as being able to colonize on many different surfaces in health care facilities. More extensive studies in both our country and our region could show the resistance profile of P. aeruginosa bacteria and the effects of virulence factors on the severity of infection. [ABSTRACT FROM AUTHOR]