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Objective: The aim of this study was to evaluate the antibiotic resistance of microorganisms isolated in cases of culture-positive nosocomial late-onset neonatal sepsis in the neonatal intensive care unit. Materials and Methods: Infants admitted to our neonatal intensive care unit between October 2015 and June 2022 were retrospectively screened. A total of 458 different cultures from 386 sepsis incidents in 250 infants were analyzed. Results: Over an 8-year period, 407 cases of culture-positive nosocomial late-onset neonatal sepsis were reviewed in a total of 4244 infants. Twenty-one cases were excluded due to insufficient data. The incidence of culture-positive nosocomial sepsis was 6.3%. Coagulase-negative Staphylococcus and Staphylococcus aureus were the most common gram-positive bacteria found in cultures. Resistance to ampicillin and cephalosporin treatments was high, while resistance to vancomycin, teicoplanin, and linezolid was low. Klebsiella spp. were the most frequent gram-negative bacteria isolated in cultures and showed high resistance to non-carbapenembased regimens. The only fungal microorganisms isolated in cultures were Candida spp., which had a high mortality rate despite their low resistance profile. The mortality rate due to nosocomial sepsis was 19.6%. Conclusion: Our study demonstrated that microorganisms and their antibiotic resistance profiles changed over time in the newborn intensive care unit. Gram-negative pathogens exhibited high antibiotic resistance, while fungi had high mortality rates. It is essential to adjust empirical antibiotic regimens for nosocomial sepsis based on thorough surveillance. [ABSTRACT FROM AUTHOR]

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]

Increasing resistance due to extended-spectrum ß-lactamases (ESBLs) and multiple resistance mechanisms in gram-negative hospital isolates restrict the role of ß-lactam antibiotics in empirical treatment of serious infections. As the prevalence of ESBL producing strains and resistance rates to antimicrobial agents can vary in each center, local surveillanc e studies are required to guide therapy. In this study, the prevalence of ESBL-K hospitalized population and the change of prevalence through years from 2000 to 2021. Klebsiella strains isolated between 2000 and 2021 years, were included. 2000 data was col lected from two hospitals; one state and private group hospitals. The other whole data were collected only form private group hospitals. ESBL tests were performed according to CLSI and EUCAST guidelines. ESBL positive Klebsiella strains were mostly commonly isolated from intensive care units and from sputum + tracheal aspirate (%41). Total prevalence of ESBL positive Klebsiella strains were 51.29%. The prevalence of 2000 years was high probably due to the different hospital /patient profile. By excluding the 2000 data, the prevalence were increasing by years; 15.38% at 2001 to 61.50% at 2021. High prevalence of ESBL in Turkey was increasing by years. Our private hospitals data was lower than the other state hospitals in the Turkey. Different hospital /patient profile could be the reason of low prevalence through precarity level, unnecessarily broad-spectrum antibiotic treatment, environmental contamination, kitchen hygiene and European health tourism. More research must be done to clarify the reason of this differences. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to determine the contamination incidence rate of bone fragments that have been dropped on the floor of the operating theatre, as well as how effective antimicrobial solutions are at decontaminating them. Methods: Bone fragments obtained after 30 total knee arthroplasties were used in the study. Inert pieces of bone emerging after the bone cuts during total knee arthroplasty were divided into 1 × 1 cm fragments. The bone fragments were first left in free fall on the floor of the operating theatre and then were kept in a number of antimicrobial solutions for 15 s. Subsequently, they were microbiologically and histopathologically examined. A swab culture was also taken from the floor of the operating theatre. Results: It was determined that 63.3% of osteochondral fragments in the non-intervened group were contaminated. Growth was likewise detected in all swab cultures. Microorganisms growing in the swab culture and the non-intervened group were similar and mostly Staphylococcus epidermidis and Klebsiella pneumoniae. When the growth rates of the 10% povidone-iodine and 4% chlorhexidine gluconate groups were compared with the growth rate of the non-intervened group, a statistical difference was found. No difference was determined between the growth rates of the sodium hypochlorite and the non-intervened groups. The histopathological analysis revealed no statistical difference between the groups in terms of bone marrow, vascular structure, fat tissue, and osteoblastic activity results in the osteochondral fragments Conclusion: Bone tissues dropped from a sterile area on the floor of the operating theatre are highly contaminated. An effective decontamination without bone cell toxicity was achieved using povidone-iodine. Although chlorhexidine gluconate solution had an effective decontamination effect compared to the non-intervened group, it was not 100% effective. Sodium hypochlorite solution was not effective in the decontamination of grafts under our working conditions. [ABSTRACT FROM AUTHOR]

Background: The combination aztreonam/avibactam is currently under Phase 3 trials for the treatment of serious infections caused by Gram-negative bacteria including those with MBLs.Objectives: To investigate the resistance mechanisms in Enterobacterales exhibiting aztreonam/avibactam MICs of ≥4 mg/L.Methods: Among 8787 Enterobacterales, 17 (0.2%) isolates exhibited an aztreonam/avibactam MIC of ≥4 mg/L. Isolates were sequenced and screened for β-lactamases. Sequences of porins, penicillin-binding protein 3 (PBP3) and expression levels of AmpC and AcrA were evaluated.Results: Eleven (11/4154 isolates; 0.26%) Escherichia coli, three (3/1981; 0.15%) Klebsiella pneumoniae and three (3/628; 0.5%) Enterobacter cloacae were identified. All E. coli showed either an 'YRIK' or 'YRIN' insertion in PBP3. In general, these isolates carried blaCMY and/or blaCTX-M variants, except for one isolate from Korea that also produced NDM-5 and one isolate from Turkey that produced OXA-48. Two DHA-1-producing K. pneumoniae overexpressed acrA and had a premature stop codon in either OmpK35 or OmpK36, whereas a third K. pneumoniae carried blaPER-2 and had a premature stop codon in OmpK35. All three E. cloacae expressed AmpC at levels ≥570-fold, but sequence analysis did not reveal known amino acid alterations associated with decreased avibactam binding or increased hydrolysis of β-lactams. Minor amino acid polymorphisms within OmpC, OmpF and PBP3 were noted among the E. cloacae.Conclusions: A small number of isolates (0.2%) met the inclusion criteria. E. coli showed altered PBP3 as the most relevant resistance mechanism, whereas K. pneumoniae had multiple resistance mechanisms. Further investigations are needed to clarify resistance in E. cloacae. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of infections caused by carbapenem-resistant Enterobacteriaceae has increased worldwide. Limitations in the development of new antimicrobial agents have led clinicians to reconsider the clinical efficiency of old antibiotics, such as intravenous formulation of fosfomycin, in the treatment of multidrug-resistant Gram-negative bacterial infections. We investigated the fosfomycin susceptibility of carbapenemase-producing Klebsiella pneumoniae strains isolated prior to the clinical use of the intravenous formulation of fosfomycin in Turkey. Materials and Methods: A total of the 155 K. pneumoniae isolates which previously characterized at the molecular level for their carbapenemase were included in this study. The minimum inhibitory concentration of fosfomycin was determined by the agar dilution method. Results: Overall, 65.1% of the isolates were susceptible to fosfomycin. The MIC50 and MIC90 values were 32 and 256 mg/L, respectively. According to our results, at least two-third of carbapenemase-positive K. pneumoniae are susceptible to fosfomycin. Conclusions: Although, the susceptibility of fosfomycin, which has just been put into the clinical use of intravenous formulation in Turkey, is not very high, it can be considered as an alternative adjunct antimicrobial for the treatment of systemic infections caused by carbapenemase-positive K. pneumoniae isolates. [ABSTRACT FROM AUTHOR]

Aim: Urinary tract infections are the most common genitourinary tract disease in children, and inappropriate antibiotic and/or dose selection increase the likelihood of resistance. The aim of this study was to determine the prevalence of urinary tract infection pathogens, patterns of resistance to antibiotics, and empirical treatment options. Material and Methods: Between January 2013 and December 2017, urine culture and antibiogram results of pediatric patients aged 0 days to 16 years were analyzed retrospectively. Antibiotic susceptibilities were determined using disc diffusion according to methods of the Clinical and Laboratory Standards Institute. Results: Of the 1326 children with culture growth, 1070 (80.6%) were female and 256 (19.3%) were male. The most common microorganism found was (1138, 85.8%) E. Coli, followed by Klebsiella spp. (71, 5.3%), Enterobacter spp. (44, 3.3%), and Proteus spp. (28, 2.1%). High frequency of resistance to ampicillin, ampicillin-sulbactam, amoxicillin-clavulanate, cefuroxime axetil, as TMP-SMX was detected in all microorganisms, whereas resistance to amikacin, meropenem, imipenem, ertapenem, fosfomycin, and nitrofurantoin was low. Conclusion: E. coli was the most common causative agent of urinary tract infections in childhood. High resistance to ampicillin, ampicillinsulbactam, amoxicillin-clavulanate, cefuroxime axetil, and TMP-SMX was detected in all agents in our center. [ABSTRACT FROM AUTHOR]

Objective: Increased extended-spectrum beta lactamase (ESBL) production is associated with higher rates of community-acquired strains in urinary tract infections (UTI) leading to an increase in the resistance rates, duration of treatment and costs. We aimed to investigate the resistance rates of ESBL-positive urine culture strains in our clinic, reviewed the literature and analysed antibiotics used in UTI treatment in outpatients in Turkiye. Materials and Methods: 2913 patients who were admitted to the outpatient clinics of Maltepe University Faculty of Medicine and Başkent University Faculty of Medicine were evaluated retrospectively. Data on prescribed antibiotics in outpatients with the diagnosis of UTI from all cities of Turkiye were collected through the Turkish Ministry of Health, Turkish Medicines and Medical Devices Agency. Results: Out of 563 ESBL-positive (19.3%) urine culture isolates, 450 (79.9%) were Escherichia coli and 89 (15.8%) were Klebsiella sp. Resistance rates were as follows: 98.8% to cefuroxime, 67.6% to ciprofloxacin, 12.5% to fosfomycin, 8.7% to amikacin, 1.4% to meropenem and 15% to nitrofurantoin. The most commonly prescribed antibiotics were ciprofloxacin (22.25%), fosfomycin (21.10%) and nitrofurantoin (12.82%). Conclusion: Our study suggests that the antibiotic resistance rates of most antibiotics prescribed for UTI in Turkiye are above the suggested rate of 10-20% to be used as empirical therapy. Updating and dissemination of guidelines for UTI in the light of antibiotic prescribing and resistance surveillance studies will contribute to the rational use of antibiotics in Turkiye. [ABSTRACT FROM AUTHOR]

Introduction: Infections caused by Carbapenemase-producing Enterobacterales (CPE) are an important public health issue. Intravenous fosfomycin can be considered as an alternative for the treatment of serious infections caused by CPE. In this study, in vitro activity of fosfomycin was investigated among CPE isolates. Methodology: Overall, 158 clinically relevant isolates obtained from 18 hospitals of 13 cities in Turkey with predetermined carbapenemase types were evaluated in the study, including Escherichia coli (n = 19) and Klebsiella spp. (n = 139). In vitro activity of fosfomycin was determined with agar dilution method. Among Klebsiella spp., 104 harbored blaOXA-48, 15 isolates carried both blaOXA-48 and blaNDM; three had both blaOXA-48 and blaVIM and nine isolates had blaNDM alone. Four isolates carried only blaVIM and two isolates harbored blaIMP alone. One isolate co-harbored blaVIM and blaNDM. Among E. coli isolates, blaOXA-48 and blaNDM were carried by 18 and one isolates, respectively. Results: Resistance to fosfomycin was detected in 43.7% of the isolates. Among Klebsiella spp. and E. coli, these rates were 46.8% and 21.1%, respectively. In Klebsiella spp. resistance to fosfomycin was 49.5% in blaOXA-48 carriers; 26.7% in isolates co-harbouring blaOXA-48 and blaNDM and 66.7% in blaNDM carriers. In E. coli, fosfomycin resistance was detected among 16.7% of the blaOXA-48 carriers. Conclusions: High level of fosfomycin resistance in these isolates may be attributable to the fact that these isolates are multidrug resistant. The genetic background of resistance should also be investigated in order to understand the co-occurrence and transfer of resistance among the CPE. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to retrospectively analyse the data of patients with significant bacteriuria pre-diagnosed as urinary tract infection (UTI) and to compare the results with the current literature. Methods: A total of 2842 women, men, children, inpatients or outpatients with significant bacteriuria who were pre-diagnosed as UTI in TOBB University of Economics and Technology Faculty of Medicine Hospital between January 1, 2013 and December 31, 2017 were included in this study and the data of these patients were analysed retrospectively. Results: Of the patients with significant bacteriuria, 83.5% were female. Escherichia coli was isolated from urine cultures most frequently both in outpatient and inpatient groups regardless of gender. When bacterial growth was evaluated according to the clinics admitted, E. coli was found to be the most common with a ratio of 74.3%. In all age groups, E. coli was the first and Klebsiella spp. were the second most frequent bacteria. Conclusions: In this study, the most commonly isolated agent was found to be E. coli as indicated in the literature regardless of other parameters investigated. Besides, it was observed that ratio of patients from whom E. coli was isolated increased within the years. [ABSTRACT FROM AUTHOR]

Objective: Resistant Gram-negative bacteria isolated from health-related infections are a worldwide problem. Increasing frequency of infections particularly caused by Enterobacteriaceae producing expanded spectrum beta lactamase, leads to the use of more carbapenem group antibiotics which, in turn, leads to bacterial resistance. In this study, we aimed to evaluate carbapenem resistance in Klebsiella pneumoniae (K. pneumoniae) isolates, the mechanisms causing this resistance and the clonal relationship between these isolates. Methods: Ninety-one K. pneumoniae strains isolated from clinical samples obtained in our laboratory were included to the study. The identification of the bacteria was performed with Matriks assisted laser desorption ionization time of flight mass spectrometry (bioMérieux, Marcy-I’Étoile, France) and antimicrobial susceptibility with VITEK-2 (bioMérieux), and the carbapenem resistance was confirmed by ertapenem E-test (bioMérieux). Reverse transcription polymerase chain reaction method was used for the investigation of genes causing carbapenemase production (blaOXA-48, blaNDM-1, blaKPC, blaIMP, blaVIM-1). The clonal relationship between isolates was investigated by pulsed-field jel elektroforez. Results: In carbapenem resistant isolates, blaOXA-48 positivity was found to be 55%, blaNDM-1positivity 37.4%, blaKPC and blaVIM-1 positivity 1.1%. A total of 10 isolates was identified with different resistance genes. In 73 of the isolates included in the study, the clonal relationship was examined, and 16 different groups were identified. Twenty isolates were not clonally associated with any other isolates. The most common resistance mechanism causing the carbapenem resistance was blaOXA-48 gene that is known to be endemic in Turkey. Conclusion: As a result, the carbapenem resistance that we found as 3.13% in our study is similar to the rates obtained in other studies performed in our country which indicates that this resistance is not at a high level yet in our country. However, the ability of carbapenem resistance genes to spread between strains can be a major problem in the near future. Molecular methods are gold standard in carbapenemase detection, but because of having high cost they can not be used in laboratories routinely. Modified Hodge test or carbapenemase inactivation test are alternative tests with low costs that can be used in the determination of carbapenemase. [ABSTRACT FROM AUTHOR]

Aim: Bloodstream infections in hospitalized patients are one of the most important causes of morbidity and mortality despite antimicrobial therapy. Early diagnosis and treatment of these infections is crucial. The aim of this study was to evaluate the distribution and antibiotic susceptibility of bacteria isolated from blood cultures in a children's hospital in the Southeastern Anatolia during an 18-month period. Material and Methods: 7 040 blood cultures which were sent from hospitalized patients in Gaziantep Children's Hospital between 01.07.2010 and 01.01.2012 were evaluated. Results: A total of 7 040 blood cultures were evaluated in this study. Microbial growth was detected in 2075 (29.47%) blood cultures. The most frequently isolated bacteria were coagulase-negative staphylococci (%45.97) which were followed by Salmonella spp. (%7.8). 12.12% of enterococcal isolates were resistant to glycopeptide antibiotics. The most frequently isolated gram negative bacterium was S almonella spp. 15.43% of Salmonella spp. showed decreased susceptibility against quinolones. The ESBL positivity rate of E. coli and K. pneumoniae strains was found to be 35.08% and 57.14%, respectively. The imipenem resistance rate of P. aeruginosa was found to be 33.33%. The most common nonfermentative bacterium was S. maltophilia . Conclusions : The distribution of bacteria isolated from blood cultures and antibiotic resistance rates differ among different regions of Turkey. Differ - ent results obtained in our study may be related with regional tendencies to infections and patient population. Distribution of infectious agents and antibiotic resistance rates should be evaluated at regular intervals. This will lead to establishment of proper antibiotic usage policies in our country. (Turk Pediatri Ars 2015; 50: 102-7) [ABSTRACT FROM AUTHOR]

The present study was carried out to identify virulence properties (siderophores, serum resistance, and hemolysin) and antibiotic resistance in extended spectrum β-lactamase (ESBL)--producing Klebsiella isolates from 60 calf and chicken meat samples purchased from various supermarkets in Ankara, Turkey. Of the 45 Klebsiella isolates, 24 (53%) were identified as K. oxytoca and 21 (47%) were identified as K. pneumoniae. A high proportion of Klebsiella isolates had virulence factors such as hemolytic activity (67%), siderophore production (44%), and serum resistance (38%). The double-disk synergy test was used to determine ESBL production. ESBL production was detected in 13 (29%) of the 45 Klebsiella isolates. Resistance to 14 antimicrobials was tested in all Klebsiella isolates by the disk diffusion method. All isolates were resistant to two or more antimicrobial agents. All ESBL-producing Klebsiella isolates were highly resistant to cephalosporins and monobactams. Our findings indicate that meat and its products represent potential hazardous sources of multidrug-resistant and virulent Klebsiella species. [ABSTRACT FROM AUTHOR]

Background Gram-negative-resistant bacterial infections are increasing due to widespread use of antibiotics. Infections caused by Klebsiella spp. are an important part of healthcare-associated infections and cause morbidity and mortality. The aim of this study was to determine the epidemiological, clinical features, carbapenem resistance rates and risk factors of bloodstream infections of children with Klebsiella spp. Methods In this retropective study, medical records of 85 episodes of 75 patients caused by with Klebsiella spp. bacteriaemia who admitted to Ege University Faculty of Medicine, Pediatric Hospital in Turkey between 2014 and 2017 were evaluated. Conventional biochemical methods were performed using the automated systems of MALDİ-TOFF MS / VITEK 2 (Biomerieux, France). According to EUCAST recommendations, VITEK 2 (Biomerieux, France) automated microdilution method was used in sensitivity tests. Results The mean age of 85 episodes included in the study was 3.49 (±5.4) years. 58% of the patients were male and 42% were female. 18.8% of the patients were premature. The most common service was newborn service (30.6%). Neutropenia was 26% and thrombocytopenia was 55% at the time of diagnosis. Klebsiella pneumonia was 93% and Klebsiella oxytoca was 7%. Carbapenem resistance rate was found to be 30.6% in Klebsiella spp. Carbapenem resistance was found 18% in 2014, 38% in 2015, 42% in 2016 and 25% in 2017. In patients who developed carbapenem-resistant Klebsiella infection, the duration of pre-hospitalization ≥14 days (P = 0.034), the absolute neutrophil count < 100 (P = 0.048) and steroid use (P = 0.025) were statistically significant risk factors. The mean length of hospital stay was 107 (±103) days. Klebsiella spp. attributable mortality due to infection was 14% and crude mortality was 15%. No statistically significant difference was found in patients who developed resistant and susceptible infections. Conclusion Carbapenem resistance in Klebsiella infections was increased. Prolonged hospital stay, neutropenia and steroid use in the last 3 months were identified as significant risk factors for carbapenem-resistant Klebsiella infections. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Comparative in vitro activity of plazomicin and 4 older aminoglycosides was evaluated with broth microdilution in 714 blood isolates from 14 hospitals in Turkey. Isolates included Escherichia coli (n=320), Klebsiella spp. (n =294), Enterobacter spp. (n =69), Serratia marcescens (n =20), and Citrobacter spp. (n =11). Isolates resistant to older aminoglycosides (n =240) were screened for aminoglycoside modifying enzyme genes: aac(6′)-Ib, aac(3)-Ia, aac(3)-IIa, ant(2″)-Ia. Isolates with high MICs for plazomicin (n =41) were screened for 16S rRNA methyltransferase genes (armA, rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH, npmA) and 2 carbapenemase genes (blaOXA-48, blaNDM-1). Overall, resistance to plazomicin, amikacin, netilmicin, gentamicin, and tobramycin was 7.7%, 7.4%, 31.5%, 32.9%, and 34.7%, respectively. aac(6')-Ib and aac(3)-IIa were the most common AME genes. Co-occurrence of blaNDM-1 with armA and rmtC and blaOXA-48 with armA was striking. Enterobacter cloacae carrying rmtC+blaNDM-1, S. marcescens with armA+blaOXA-48, and rmtF+ blaOXA-48 in K. pneumoniae were reported for the first time. [ABSTRACT FROM AUTHOR]

The article discusses the detection of OXA-48-like carbapenemase-producing Klebsiella pneumoniae in a tertiary care center in Turkey. Five of the 16 strains were isolated from solid organ transplant recipients hospitalised at Baskent University Hospital between the years 2007 and 2011. Based on in vitro susceptibility test, all Klebsiella pneumonia isolates were susceptible to amikacin and colistin.