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Introduction: Urinary tract infection (UTI) is among the common bacterial infections in pediatric patients. These infections are more common in girls over one year old. This study aimed to investigate the bacterial distribution and drug resistance status in urine cultures of pediatric patients in our center. Materials and Methods: Urine culture results of patients who were presented to the outpatient clinics or were admitted to the Sivas Cumhuriyet University hospital between January 2017 and December 2022 were included in the study. The hospital automation system, patient files, and laboratory information management system were examined retrospectively. Statistical analysis was performed using the SPSS 22.0 software. A P-value of <0.05 was deemed significant. Results: Significant growth was observed in the urine cultures of a total of 1287 pediatric patients, 889 (69.1%) girls and 398 boys (30.9%). The patients included in the study were between the ages of 0-17, and children aged 1-6 (37.6%) were diagnosed with UTI more frequently than other ages. The most common UTI agent in the pediatric age group was Escherichia coli (56.6%). The first agent isolated in girls and boys is E.coli. Additionally, the prevalence of K. pneumoniae, P. mirabilis and K. oxytoca bacteria was higher in boys (p < 0.05). E. coli isolates showed minimal resistance to such as amikacin (0.6%), fosfomycin (1.0%), nitrofurantoin (1.4%), ertapenem (2.4%), imipenem (0.7%) and meropenem (0.9%). Conclusion: In this study, low resistance levels were detected for amikacin, fosfomycin, nitrofurantoin and carbapenem group antibiotics, which are important alternatives in the empirical treatment of UTI. On the other hand, due to the high resistance levels detected, it is thought that more caution should be exercised in the empirical use of amoxicillin-clavulanate, trimethoprimsulfamethoxazole and cefixime. If these antibiotics are to be preferred, waiting for the antibiogram results is an appropriate approach. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify subspecies of Mycobacterium abscessus complex (MABC) isolates from clinical samples by a molecular technique and to determine mutations responsible for macrolide and aminoglycoside resistance. We also aimed to investigate the correlation of phenotypic and molecular test results by examining the resistance to antimicrobial agents according to CLSI standard using the liquid microdilution test. Methods: 27 MABC isolates from clinical samples were examined. Molecular subspecies identification and mutations responsible for aminoglycoside (rrs mutation) and macrolide resistance (rrl mutation) were determined using the GenoType NTM-DR test. The resistance phenotypes of the strains to various antimicrobial agents were investigated by the Sensititre™ RAPMYCOI AST microdilution test. Results: Of the 27 isolates tested, 21 were M. abscessus subsp. abscessus, three were M. abscessus subsp. bolletii, and three were M. abscessus subsp. massiliense; rrs and rrl mutations were not observed in any strains. Except for one isolate, all M. abscessus subsp. abscessus strains showed the erm(41) T28 genotype, which indicates inducible macrolide resistance. The correlation between the GenoType NTM-DR and phenotypic susceptibility test results was 81% (k=0.5, p=0.02) for inducible macrolide resistance and 89% for acquired macrolide resistance. The most effective antimicrobial agents were amikacin, cefoxitin, imipenem, linezolid, and tigecycline. Conclusion: Although the GenoType NTM-DR test is reliable in identifying and detecting molecular macrolide and aminoglycoside resistance, there were discrepancies in the results. We recommend confirming the results with the phenotypic susceptibility method after growth on culture. Although the M. abscessus complex is resistant to many antimicrobial agents, it has shown high sensitivity to amikacin, cefoxitin, imipenem, linezolid, and tigecycline. High levels of inducible macrolide resistance in isolates indicate the importance of subtyping and sensitivity testing of isolates in patients where culture conversion has not been achieved. [ABSTRACT FROM AUTHOR]

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: Recommended combination for the treatment of serious Stenotrophomonas maltophilia infections is ticarcillinclavulanate and co-trimoxazole (SXT). However, first agent is not available in our country, and the second component may be a matter of antimicrobial resistance or intolerance. Therefore, we aimed to evaluate antimicrobial susceptibility testing results of S. maltophilia and in vitro activity of ceftazidime and moxifloxacin as a potential therapeutic alternative. Methods: S. maltophilia strains isolated from clinical samples in Infectious Diseases and Clinical Microbiology Laboratory between 1 October 2007-23 November 2017 were included in the study. Disk diffusion antimicrobial susceptibility test results of the strains were evaluated retrospectively. The in vitro activity of combination of ceftazidime and moxifloxacin against 24 of these strains was investigated by Etest®. Results: During the study period, 649 S. maltophilia strains were isolated from 649 different patients, and 94%, 93%, 92%, 81%, 60%, 55%, 45%, 41%, 38% of the strains were susceptible to tigecycline, moxifloxacin, SXT, ciprofloxacin, cefoperazonesulbactam, ceftazidime, netilmicin, gentamicin and amikacin, respectively. For the 24 strains included in the combination study, the moxifloxacin minimal inhibitory concentration (MIC)50/MIC90 values were defined as 0.064/0.125 µg/mL (MIC range 0.023-4 µg/mL) and ceftazidime MIC50/MIC90 values were defined as 32/256 µg/mL (MIC range 1.5-256 µg/mL). According to the results of fractional inhibitor concentration (FIC) index; ceftazidime and moxifloxacin combination displayed synergism, additivity and indifference for 1 (4%), 18 (75%) and 5 (21%) strains, respectively and there was no antagonism. The FIC50/ FIC90 value is calculated as 0.75/1.01 (FIC range 0.5-1.01). Conclusions: SXT resistance in S. maltophilia strains is below 10%, but it should be closely monitored because of the limited treatment options. Tigecycline and moxifloxacin can be among the treatment alternatives because of their high sensitivity rates similar to SXT. The combination of moxifloxacin plus ceftazidime demonstrated in vitro synergism or additivity against majority of the strains. So, this combination may be used as an alternative for the treatment of patients with S. maltophilia infections if there is resistance or side effects to the antibiotics used as the first option. [ABSTRACT FROM AUTHOR]

Objective: We aimed to present clinical and laboratory findings of patients and the molecular analysis of strains isolated in a Salmonella typhimurium outbreak associated with food served at a wedding reception. Methods: A total of 108 patients admitted to the hospital after eating food served at a wedding reception were included in the study. The patients whose symptoms continued even after supportive care were hospitalized for further treatment. Two sets of blood and stool cultures were obtained from all the hospitalized patients, and samples were taken from the implicated food source as well. The VITEKR 2 Compact (bioMerieux, Marcy l'Etoile, France) automated microbiology system was used together with conventional methods to identify the isolates and determine their antibiotic susceptibility. Serotyping was performed according to the Kauffmann-White scheme using the slide agglutination method. The molecular epidemiology of the isolates was determined by pulsed-field gel electrophoresis using the XbaI enzyme. Results: All the patients presented with common complaints such as fatigue, abdominal pain, fever, diarrhea, nausea, and vomiting that had started 8 to 16 hours after the consumption of the food served. 45 patients were treated in the hospital whereas 63 patients were followed in an ambulatory setting after 4-6 hours of supportive care. Their hospitalization period varied between 1 and 5 days, and all patients were discharged with full recovery. S. typhimurium was isolated from stool cultures of 14 patients, and two of them were also blood culture-positive. All the isolates revealed a single clonal cluster in molecular analysis. All of them were susceptible to ampicillin, ceftriaxone, and ciprofloxacin, but resistant to amikacin. Conclusions: Despite the developments in the food industry in Turkey and across the world, food-borne disease outbreaks still occur. Hygiene rules should be strictly followed and appropriate inspections should be undertaken in the food sector to prevent food-borne outbreaks. [ABSTRACT FROM AUTHOR]

Chronic suppurative otitis media was diagnosed in a 30-year old female with left ear pain and ear discharge lasting since 5 years intermittently. Lactose-negative, oxidase-negative, Gram-negative small bacilli grown as flat and gray colonies with smooth margins were identified as Kerstersia gyiorum by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA analysis. Minimum inhibitory concentration values were determined by broth microdilution method (ciprofloxacin >2 µg/mL, ertapenem <0.25 µg/mL, imipenem 0.5 µg/mL, ceftazidime 2 µg/mL, amikacin ≤4 µg/mL, ceftriaxone ≤0.5 µg/mL, gentamicin 2 µg/mL and tigecycline 1 µg/mL). It was learned that her clinical findings resolved by oral amoxycillin-clavulanic acid and topical ciprofloxacin given empirically. [ABSTRACT FROM AUTHOR]

Objective: Urinary Tract Infections (UTI) are most common causes of bacterial infections in humans. Escherichia coli (E.coli) is the most frequently isolated microorganism in cases of uncomplicated UTI. In this study, we aimed to determine antimicrobial resistance patterns of E.coli strains isolated from patients with UTI. Materials and Methods: E.coli strains isolated from urine cultures of patients admitted to the Hospital of the Medical Faculty of Bezmialem Vakif University were retrospectively evaluated between the dates of January 2013 and December 2013. The bacterial identification and rates of antibiotic resistance were determined using VITEK-2 automatized system. Results: E.coli isolates were found to have low resistance rates to fosfomycin (0.6%), nitrofurantoin (5.3%) and amikacin (8%). Among the other antibiotics, the lowest susceptibility rates were detected to ampicillin (64%), trimetoprim/sulfomethoxazole (43.2%), amoxicillin/clavulonic acid (32.8%). Conclusion: Fosfomisin, nitrofurantoin and amikacin are thought to be suitable antimicrobial agens in the empiric treatment treatment of uncomplicated UTI. [ABSTRACT FROM AUTHOR]