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Özden A, Dalgıç B, Demir M, Hazırolan G, Uzun Ö, Metan G. Impact of a hospital sepsis management protocol on the selection of empirical antibiotics in infectious disease consultations. J Chemother 2024; 36:190-197. [PMID: 38131316 DOI: 10.1080/1120009x.2023.2296146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
It is well-established that Infectious Diseases consultation (IDC) enhances the prognosis of bloodstream infections. However, it is unclear if adoption of an institutional sepsis protocol would lead to any further improvement in a setting where IDC and infectious diseases approval (IDA) - available throughout 7 days/24 hours -are mandatory for administering broad spectrum antibiotics. We aimed to evaluate the influence of the institutional sepsis protocol developed by Department of Infectious Diseases and Clinical Microbiology on the selection of appropriate empirical antibiotics by IDC through focusing on patients who had bloodstream infections caused by Extended-spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae, which poses a therapeutic challenge. One hundred and fifty-three adult patients (58 patients in the pre-protocol period and 95 patients in the post-protocol period), who received empirical antibiotic treatment for ESBL-producing E. coli and K. pneumoniae, in whom at least one systemic antibiotic was started either on the day blood cultures were drawn or not later than 24 hours were included in the study, retrospectively. The primary outcome was whether the empirical treatment regimen included a carbapenem that was accepted as the appropriate treatment based on the results of the MERINO trial. Secondary outcomes included empirical treatment based on pre-defined risk factors suggesting multidrug resistance (MDR), 30-day inpatient mortality, and appropriate antibacterial treatment according to antimicrobial susceptibility test (AST) results. The median age (Interquartile range) was 61 (48-70.5) years and 76 (49.7%) out of 153 patients were male. The patients in the post-protocol period were older compared to the pre-protocol period (54 years vs 64 years, p = 0.045). The Charlson Comorbidity Index was higher during the post-protocol period compared to the pre-protocol period (4 vs 5, p=0.038). At least one risk factor for MDR bacteria infection was present in 147 (96.1%) of the 153 patients. While the rate of risk factors for MDR bacteria infections did not differ significantly between the pre-protocol and post-protocol periods, the post-protocol period showed a significantly higher level of appropriate antibiotic treatment according to the presence of MDR risk factors compared to the pre-protocol period (44.8% vs 64.2%, p=0.019). There was a significant increase in the use of carbapenems in the post-protocol period compared to the pre-protocol period (34.5% vs. 56.8%, p=0.007). When the subgroup of patients who were likely to have infection caused by ESBL-producing bacteria is taken into consideration, the carbapenem use was more frequent in the post-protocol period (37.8% vs 68.9%, p=0.002). The rate of appropriate empirical treatment according to AST was not statistically different between pre-protocol and post-protocol period. The 30-day mortality rates were similar in both periods (24.1% vs 31.5, p=0.33). However, the rate of susceptibility to piperacillin-tazobactam was statistically higher in the pre-protocol period (82.6% vs 46.2%, p=0.016) when 39.7% of the patients received piperacillin-tazobactam as the empirical treatment. This study highlights the significance of using a structured protocol to attain appropriate empirical treatment for patients suspected of sepsis, even in a setting where IDC is readily available.
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Affiliation(s)
- Aslı Özden
- Faculty of Medicine, Hacettepe University, Ankara, Turkiye
| | - Büşra Dalgıç
- Faculty of Medicine, Hacettepe University, Ankara, Turkiye
| | - Mervenur Demir
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
- Infection Control Committee Hacettepe University Hospitals, Ankara, Turkiye
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Telli Dizman G, Metan G, Karahan G, Tanrıverdi ES, Hazırolan G, Otlu B, Sönmezer MÇ, Gül ND, Çınar B, Ünal S. Does marking as sterile mean really sterile? Stenotrophomonas maltophilia outbreak caused by a blood-gas injector containing liquid heparin. Infect Control Hosp Epidemiol 2023; 44:1683-1685. [PMID: 36775899 DOI: 10.1017/ice.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
An outbreak investigation was initiated after detecting an increase in the number of patients with Stenotrophomonas maltophilia bloodstream infections (SM-BSIs) througout the hospital. S. maltophilia was isolated from the cultures of blood-gas ınjectors containing liquid heparin. The incidence density of SM-BSIs decreased significantly after prohibiting the use of those injectors.
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Affiliation(s)
- Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gizem Karahan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elif Seren Tanrıverdi
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Barış Otlu
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Meliha Çağla Sönmezer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nur Dilek Gül
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Çınar
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Telli Dizman G, Metan G, Zarakolu P, Tanrıverdi ES, Hazırolan G, Aytaç Ak H, Kılınçarslan D, Uzun M, Çelik Kavaklılar B, Arık Z, Otlu B, Ünal S. Cessation of Rectal Screening for Vancomycin-Resistant Enterococci: Experience from a Tertiary Care Hospital from Türkiye. Healthcare (Basel) 2023; 11:2641. [PMID: 37830678 PMCID: PMC10572918 DOI: 10.3390/healthcare11192641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Here, we compared the impact of different polices on the epidemiology of Vancomycin-resistant Enterococcus faecium bloodstream infections (VRE-BSIs) in a tertiary care hospital including two hospital buildings (oncology and adult hospitals) in the same campus. MATERIAL AND METHODS All patients who were hospitalized in high-risk units were screened weekly for VRE colonization via rectal swab between January 2006 and January 2013. After January 2013, VRE screening was only performed in cases of suspicion of VRE outbreak and during point prevalence studies to evaluate the epidemiology of VRE colonization. Contact precautions were in place for all VRE-positive patients. The incidence density rates of hospital-acquired (HA)-VRE-BSIs were compared between two periods. RESULTS While the rate of VRE colonization was higher in the second period (5% vs. 9.5% (p < 0.01) for the adult hospital, and 6.4% vs. 12% (p = 0.02 for the oncology hospital), there was no increase in the incidence rate HA-VRE BSIs after the cessation of routine rectal screening in either of the hospitals. CONCLUSION Screening policies should be dynamic and individualized according to the epidemiology of VRE as well as the workforce and cost. Periodical rectal screening of VRE can be discontinued if suspicion of an outbreak can be carefully monitored.
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Affiliation(s)
- Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Pınar Zarakolu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
| | - Elif Seren Tanrıverdi
- Molecular Microbiology Laboratory, Department of Medical Microbiology, Faculty of Medicine, İnönü University, Malatya 44280, Türkiye; (E.S.T.); (B.O.)
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye;
| | - Hanife Aytaç Ak
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Dilek Kılınçarslan
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Mertcan Uzun
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
| | - Başak Çelik Kavaklılar
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye;
| | - Zafer Arık
- Department of Internal Medicine, Section of Oncology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye;
| | - Barış Otlu
- Molecular Microbiology Laboratory, Department of Medical Microbiology, Faculty of Medicine, İnönü University, Malatya 44280, Türkiye; (E.S.T.); (B.O.)
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
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Isler B, Vatansever C, Özer B, Çınar G, Aslan AT, Falconer C, Bauer MJ, Forde B, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Can F, Paterson DL, Harris PNA. Higher rates of cefiderocol resistance among NDM producing Klebsiella bloodstream isolates applying EUCAST over CLSI breakpoints. Infect Dis (Lond) 2023; 55:607-613. [PMID: 37391868 DOI: 10.1080/23744235.2023.2226709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Cefiderocol is generally active against carbapenem-resistant Klebsiella spp. (CRK) with higher MICs against metallo-beta-lactamase producers. There is a variation in cefiderocol interpretive criteria determined by EUCAST and CLSI. Our objective was to test CRK isolates against cefiderocol and compare cefiderocol susceptibilities using EUCAST and CLSI interpretive criteria. METHODS A unique collection (n = 254) of mainly OXA-48-like- or NDM-producing CRK bloodstream isolates were tested against cefiderocol with disc diffusion (Mast Diagnostics, UK). Beta-lactam resistance genes and multilocus sequence types were identified using bioinformatics analyses on complete bacterial genomes. RESULTS Median cefiderocol inhibition zone diameter was 24 mm (interquartile range [IQR] 24-26 mm) for all isolates and 18 mm (IQR 15-21 mm) for NDM producers. We observed significant variability between cefiderocol susceptibilities using EUCAST and CLSI breakpoints, such that 26% and 2% of all isolates, and 81% and 12% of the NDM producers were resistant to cefiderocol using EUCAST and CLSI interpretive criteria, respectively. CONCLUSIONS Cefiderocol resistance rates among NDM producers are high using EUCAST criteria. Breakpoint variability may have significant implications on patient outcomes. Until more clinical outcome data are available, we suggest using EUCAST interpretive criteria for cefiderocol susceptibility testing.
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Affiliation(s)
- Burcu Isler
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Cansel Vatansever
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Berna Özer
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, School of Medicine, Ankara University Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Caitlin Falconer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Brian Forde
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Ankara Hospital, Başkent University, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, School of Medicine, Uludağ University, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Infectious Diseases, VKV American Hospital, Istanbul, Turkey
| | - Özlem Doğan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, School of Medicine, Ankara University Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Ankara Hospital, Başkent University, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Önder Ergönül
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Füsun Can
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - David L Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Nayir Buyuksahin H, Dogru D, Emiralioglu N, Ademhan Tural D, Özsezen B, Sunman B, Guzelkaş I, Alboğa D, Arikan-Akdagli S, Sarıbaş Z, Gulmez D, Alp A, Hazırolan G, Soyer Ö, Şekerel BE, İnam G, Irmak İ, Damadoğlu E, Kalyoncu F, Yalçın E, Ozcelik U, Kiper N. A case-control study of the effects of Aspergillus clinical phenotypes on pulmonary functions in patients with cystic fibrosis. Pediatr Pulmonol 2023; 58:1185-1193. [PMID: 36651101 DOI: 10.1002/ppul.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION There are no precise data about the effect of Aspergillus infection on lung function other than allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (pwCF). Here, we aimed to determine clinical phenotypes caused by Aspergillus spp. using laboratory and immunologic parameters and to compare Aspergillus phenotypes in terms of pulmonary function tests (PFT) prospectively. METHODS Twenty-three pwCF who had Aspergillus isolation from respiratory cultures in the last year (case group) and 20 pwCF without Aspergillus isolation in sputum (control group) were included. Aspergillus immunoglobulin (Ig)-G, Aspergillus IgE, Aspergillus polymerase chain reaction (PCR), galactomannan, total IgE from blood samples, and Aspergillus PCR and galactomannan from sputum, and skin prick test reactivity to Aspergillus antigen were used to distinguish different Aspergillus phenotypes. Pulmonary functions and frequency of pulmonary exacerbations were evaluated during a 1-year follow-up. RESULTS Of 23 pwCF, 11 (47.8%) had Aspergillus colonization, nine (39.1%) had Aspergillus bronchitis, and three (13%) had ABPA. Aspergillus infection was not associated with worse z-scores of forced expiratory volume in the first second (FEV1) (p = 0.612), forced vital capacity (p = 0.939), and the median FEV 1% decline (0.0%/year vs. -4.7%/year, p = 0.626). The frequency of pulmonary exacerbations in the Aspergillus infected and noninfected groups was similar. CONCLUSION Although Aspergillus spp. Isolation in pwCF was not associated with decreased lung function, a further decline was seen in the ABPA subgroup, and frequent pulmonary exacerbations during the 1-year follow-up.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Beste Özsezen
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Guzelkaş
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Sarıbaş
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dolunay Gulmez
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Soyer
- Department of Pediatrics, Division of Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatrics, Division of Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gözde İnam
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlim Irmak
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Damadoğlu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fuat Kalyoncu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Işık MC, Karcıoğlu O, Hazırolan G, Gülmez D, Onur MR, Kunt MM, Arikan-Akdagli S, Metan G. Necrotizing pneumonia due to Aspergillus and Salmonella after immune checkpoint inhibitor treatment: An unusual case and review of the literature. Rev Iberoam Micol 2023; 40:26-30. [PMID: 37714729 DOI: 10.1016/j.riam.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are a promising new treatment for different types of cancer. The infectious complications in patients taking ICIs are rare. CASE REPORT A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy. CONCLUSIONS Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.
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Affiliation(s)
- Muhammed Cihan Işık
- Department of Clinical Microbiology and Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oğuz Karcıoğlu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dolunay Gülmez
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Mahir Kunt
- Department of Emergency, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Metan
- Department of Clinical Microbiology and Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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7
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Isler B, Falconer C, Vatansever C, Özer B, Çınar G, Aslan AT, Forde B, Harris P, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Can F, Paterson DL. High prevalence of ArmA-16S rRNA methyltransferase among aminoglycoside-resistant Klebsiella pneumoniae bloodstream isolates. J Med Microbiol 2022; 71. [PMID: 36748503 DOI: 10.1099/jmm.0.001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction. Aminoglycosides are used for the treatment of carbapenemase-producing Klebsiella pneumoniae (CPK) infections. 16S rRNA methyltransferases (RMTs) confer resistance to all aminoglycosides and are often cocarried with NDM.Hypothesis/Gap Statement. There is a dart of studies looking at the aminoglycoside resistance mechanisms for invasive CPK isolates, particularly in OXA-48 endemic settings.Aim. We aimed to determine the prevalence of RMTs and their association with beta lactamases and MLSTs amongst aminoglycoside-resistant CPK bloodstream isolates in an OXA-48 endemic setting.Methodology. CPK isolates (n=181), collected as part of a multicentre cohort study, were tested for amikacin, gentamicin and tobramycin susceptibility using custom-made sensititre plates (GN2XF, Thermo Fisher Scientific). All isolates were previously subjected to whole-genome sequencing. Carbapenemases, RMTs, MLSTs and plasmid incompatibility groups were detected on the assembled genomes.Results. Of the 181 isolates, 109(60 %) were resistant to all three aminoglycosides, and 96 of 109(88 %) aminoglycoside-resistant isolates carried an RMT (85 ArmA, 10 RmtC, 4 RmtF1; three isolates cocarried ArmA and RmtC). Main clonal types associated with ArmA were ST2096 (49/85, 58 %) and ST14 (24/85, 28 %), harbouring mainly OXA-232 and OXA-48 +NDM, respectively. RmtC was cocarried with NDM (5/10) on ST395, and NDM +OXA-48 or NDM +KPC (4/10) on ST14, ST15 and ST16. All RMT producers also carried CTX-M-15, and the majority cocarried SHV-106, TEM-150 and multiple other antibiotic resistance genes. The majority of the isolates harboured a combination of IncFIB, IncH and IncL/M type plasmids. Non-NDM producing isolates remained susceptible to ceftazidime-avibactam.Conclusion. Aminoglycoside resistance amongst CPK bloodstream isolates is extremely common and mainly driven by clonal spread of ArmA carried on ST2096 and ST14, associated with OXA-232 and OXA48 +NDM carriage, respectively.
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Affiliation(s)
- Burcu Isler
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Caitlin Falconer
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Cansel Vatansever
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Berna Özer
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brian Forde
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Patrick Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, School of Medicine, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases, VKV American Hospital, Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Özlem Doğan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, School of Medicine, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Önder Ergönül
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Füsun Can
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - David L Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,ADVANCE ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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8
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Isler B, Vatansever C, Özer B, Çınar G, Aslan AT, Stewart A, Simos P, Falconer C, Bauer MJ, Forde B, Harris P, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Paterson DL, Can F. Comparison of ceftazidime-avibactam susceptibility testing methods against OXA-48-like carrying Klebsiella blood stream isolates. Diagn Microbiol Infect Dis 2022; 104:115745. [DOI: 10.1016/j.diagmicrobio.2022.115745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/25/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
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9
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Er B, Er AG, Gülmez D, Şahin TK, Halaçlı B, Durhan G, Ersoy EO, Alp A, Metan G, Saribas Z, Arikan‐Akdagli S, Hazırolan G, Akıncı SB, Arıyürek M, Topeli A, Uzun Ö. A screening study for
COVID
‐19‐associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic. Mycoses 2022; 65:724-732. [PMID: 35531631 PMCID: PMC9348343 DOI: 10.1111/myc.13466] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
Abstract
Background COVID‐19‐associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves. Objectives We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic. Patients/Methods This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID‐19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS‐CoV‐2 PCR‐positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases. Results A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001). Conclusions One fifth of critically ill patients in COVID‐19 ICUs developed CAPA, and this was associated with a high mortality.
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Affiliation(s)
- Berrin Er
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
- Ankara City Hospital, Intensive Care Unit Ankara
| | - Ahmet Görkem Er
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Dolunay Gülmez
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Taha Koray Şahin
- Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Burçin Halaçlı
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gamze Durhan
- Department of Radiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Zeynep Saribas
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Sevtap Arikan‐Akdagli
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Seda Banu Akıncı
- Division of Intensive Care, Department of Anaestesiology and Reanimation Hacettepe University Faculty of Medicine Ankara Turkey
| | - Macit Arıyürek
- Department of Radiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
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10
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Isler B, Özer B, Çınar G, Aslan AT, Vatansever C, Falconer C, Dolapçı İ, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Chatfield MD, Forde B, Saltoğlu N, Azap A, Azap Ö, Akova M, Paterson DL, Can F, Ergönül Ö. Characteristics and outcomes of carbapenemase harbouring carbapenem-resistant Klebsiella spp. bloodstream infections: a multicentre prospective cohort study in an OXA-48 endemic setting. Eur J Clin Microbiol Infect Dis 2022; 41:841-847. [PMID: 35301623 DOI: 10.1007/s10096-022-04425-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam.
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Affiliation(s)
- Burcu Isler
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Berna Özer
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cansel Vatansever
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Caitlin Falconer
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - İştar Dolapçı
- Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases, School of Medicine, Koç University, Rumelifeneri, 34450, Sarıyer, Istanbul, Turkey.,Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Özlem Doğan
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey.,Infectious Diseases, School of Medicine, Koç University, Rumelifeneri, 34450, Sarıyer, Istanbul, Turkey
| | - Mark D Chatfield
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Brian Forde
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - David L Paterson
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Füsun Can
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey.,Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Önder Ergönül
- Infectious Diseases, School of Medicine, Koç University, Rumelifeneri, 34450, Sarıyer, Istanbul, Turkey. .,Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.
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11
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Inal N, Hazırolan G. Misidentification of Brucella melitensis as Octrobactrum deajoenense with MALDI-TOF MS: A report of three cases. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:210-212. [PMID: 35473994 DOI: 10.1016/j.eimce.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Neşe Inal
- Faculty of Medicine, Department of Medical Microbiology, Hacettepe University, Ankara, Turkey.
| | - Gülşen Hazırolan
- Faculty of Medicine, Department of Medical Microbiology, Hacettepe University, Ankara, Turkey
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12
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Aslan AT, Kırbaş E, Sancak B, Tanrıverdi ES, Otlu B, Gürsoy NC, Yılmaz YA, Tozluyurt A, Liste Ü, Bıçakcıgil A, Hazırolan G, Dağ O, Güven GS. A retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic setting. Int J Antimicrob Agents 2022; 59:106554. [PMID: 35176476 DOI: 10.1016/j.ijantimicag.2022.106554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
We aimed to characterize the epidemiology and clinical outcomes of patients with bloodstream infections (BSIs) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in an OXA-48 predominant environment. This was a retrospective single-center cohort study including all consecutive patients with CRKP BSIs treated between 01.01.2014 and 31.12.2018. Multivariate analysis, subgroup analysis and propensity score-matched analysis were employed to analyze 30-day mortality as the primary outcome. Clinical cure at day 14 was also analyzed in the whole cohort. 124 patients with unique isolates met all the inclusion criteria. OXA-48 was the most common type of carbapenemase (85.5%). Inappropriate therapy was significantly associated with 30-day mortality (70.6% vs. 39.7%; adjusted odds ratio [aOR], 4.65; 95% Confidence Interval [CI], 1.50-14.40; p = 0.008) and 14-day clinical failure (78.5% vs. 56.2%; aOR, 3.14; 95% CI, 1.09-9.02; p = 0.033) in multivariate analyses. Among those treated appropriately, the 30-day mortality rates were similar in monotherapy and combination therapy arms (OR, 2.85; 95% CI, 0.68-11.95; p = 0.15). INCREMENT CPE mortality score (aOR, 1.16; 95% CI, 1.01-1.33; p = 0.029), sepsis at the onset of BSI (aOR, 2.90; 95% CI, 1.02-8.27; p = 0.046), and inappropriate therapy (aOR, 4.65; 95% CI, 1.50-14.40; p = 0.008) were identified as independent risk factors for 30-day mortality. Colistin resistance in CRKP had no significant impact on 30-day mortality. These results were also confirmed in all propensity score-matched analyses and sensitivity analyses. Appropriate regimens were associated with better clinical outcomes than were inappropriate therapies in BSIs with CRKP possessing OXA-48, dominantly.
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Affiliation(s)
- Abdullah Tarık Aslan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, 06100 Sihhiye, Ankara, Turkey
| | - Ekin Kırbaş
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Banu Sancak
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Elif Seren Tanrıverdi
- Inonu University Faculty of Medicine, Inonu University Turgut Ozal Medical Center, Department of Medical Microbiology, Molecular Microbiology Laboratory, 44000 Malatya, Turkey
| | - Barış Otlu
- Inonu University Faculty of Medicine, Inonu University Turgut Ozal Medical Center, Department of Medical Microbiology, Molecular Microbiology Laboratory, 44000 Malatya, Turkey
| | - Nafia Canan Gürsoy
- Inonu University Faculty of Medicine, Inonu University Turgut Ozal Medical Center, Department of Medical Microbiology, Molecular Microbiology Laboratory, 44000 Malatya, Turkey
| | - Yakut Akyön Yılmaz
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Abdullah Tozluyurt
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Ümran Liste
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Asiye Bıçakcıgil
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Gülşen Hazırolan
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Osman Dağ
- Hacettepe University Faculty of Medicine, Department of Biostatistics, 06100 Sihhiye, Ankara, Turkey
| | - Gülay Sain Güven
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, 06100 Sihhiye, Ankara, Turkey
| | -
- Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, 06100 Sihhiye, Ankara, Turkey
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13
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Özsezen B, Doğru D, Emiralioğlu N, Tural DA, Sunman B, Büyükşahin HN, Güzelkaş İ, Hazırolan G, Yalçın E, Özçelik U, Kiper N. Clinical findings of methicillin-resistant Staphylococcus aureus in cystic fibrosis. Turk J Pediatr 2022; 64:848-858. [PMID: 36305434 DOI: 10.24953/turkjped.2021.5050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) rates have increased in cystic fibrosis (CF) patients.This study aimed to determine the rate of MRSA, define risk factors, and clarify the effect of MRSA on pulmonary functions, annual pulmonary exacerbation (aPEx) in children with MRSA positive CF. METHODS This was a retrospective case control study. CF patients who had ≥1 MRSA (+) respiratory culture between September 2016-2019 were included. MRSA growth rate, colonization status, clinical characteristics, hospitalization rates, FEV1 %predicted, and z-score one year prior to the MRSA isolation, at MRSA growth and one year after MRSA growth were recorded. The aPEx rate changes before-after MRSA growth were evaluated. RESULTS Sixty-one subjects who had ≥1MRSA growth and 66 controls were enrolled. There was no statistically significant difference between the spirometry indices at first, and 12th month after MRSA acquisition. The mean aPEx was 0.6 one year prior to MRSA acquisition and this rate significantly increased to 1.2 one year after MRSA growth(p < 0.05). The mean hospitalization rate before and after one year of MRSA acquisition significantly increased from 0.17(±0.12) to 0.48 (±0.3)(p:0.008) admissions per year. CONCLUSIONS MRSA growth was related to increased aPEx. Increased aPEx and hospitalization rates after MRSA acquisition suggest MRSA should be eradicated when detected.
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Affiliation(s)
- Beste Özsezen
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Deniz Doğru
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Nagehan Emiralioğlu
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Dilber Ademhan Tural
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Birce Sunman
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Halime Nayır Büyükşahin
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - İsmail Güzelkaş
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Gülşen Hazırolan
- Departments of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ebru Yalçın
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Uğur Özçelik
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Nural Kiper
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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14
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Nigiz Ş, Hazırolan G, Köseoglu Eser Ö, Gür D. First Detection of Klebsiella pneumoniae Isolate Co-Harboring Fosfomycin Resistance Gene fosA3 and blactx-m Among Gram Negative Urine Isolates in a Turkish Hospital. Microb Drug Resist 2021; 28:317-321. [PMID: 34851744 DOI: 10.1089/mdr.2021.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The most common gram-negative pathogens in urinary tract infections are Escherichia coli and Klebsiella pneumoniae. Therapy that is often empirical relies on local antibiotic resistance data, hence monitorization of antimicrobial resistance periodically in each hospital is a requirement. In this study, antibiotic susceptibility profiles of consecutive urinary isolates (E. coli [n = 235] and K. pneumoniae [n = 56]) of adult patients collected between February 2018 and February 2019 from inpatients in Hacettepe University Hospital were assessed. Isolates resistant to fosfomycin (minimum inhibitory concentration >32 mg/L) were further investigated for the presence of fosA, fosA3, and fosC2. Fosfomycin susceptibility was determined by agar dilution method. Broth microdilution method was performed for amikacin, gentamicin, ceftazidime, ceftriaxone, meropenem, ciprofloxacin, tigecycline, trimethoprim/sulfamethoxazole (TMP/SMX), colistin, and piperacillin/tazobactam (PIP/TAZ). PCR method was employed to investigate fosA, fosA3, fosC2, and blaCTX-M. Existence of fosA3 gene was confirmed by sequencing. Resistance rates to amikacin, gentamicin, ceftazidime, ceftriaxone, meropenem, ciprofloxacin, tigecycline, TMP/SMX, colistin, and PIP/TAZ were 2.7%, 18.5%, 25.4%, 33.0%, 3.4%, 45.4%, 2.4%, 43.6%, 6.2%, and 23.7%, respectively. Sixteen isolates (5.5%) were resistant to fosfomycin. Resistance was most frequently observed in K. pneumoniae (n = 9). fosA3 gene was detected in one fosfomycin-resistant K. pneumoniae isolate. This isolate also carried blaCTX-M. fosC2 and fosA genes could not be detected in any of the isolates. In this study, we report for the first time the existence of fosA3 in Turkey and its association with the blaCTX-M gene. As a result of increasing blaCTX-M producing Enterobacterales isolates globally, increase in fosfomycin resistance may be expected in near future.
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Affiliation(s)
- Şeyma Nigiz
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özgen Köseoglu Eser
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Gür
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Oral H, Sönmezer MÇ, Yıldız AE, Hazırolan G, Metan G, İnkaya AÇ. Disseminated Brucella melitensis infection following canakinumab treatment. Travel Med Infect Dis 2021; 45:102227. [PMID: 34856407 DOI: 10.1016/j.tmaid.2021.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Hakan Oral
- Hacettepe University, Department of Internal Medicine, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | | | - Gülşen Hazırolan
- Hacettepe University, Department of Microbiology, Ankara, Turkey
| | - Gökhan Metan
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
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16
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Ismayilov R, Koray N, İnal N, Telli Dizman G, Hazırolan G, Tanrıöver MD, Akova M. Pulmonary nocardiosis caused by Nocardia abscessus mimicking pulmonary thromboembolism in a patient with atypical anti-glomerular basement membrane glomerulonephritis. Tuberk Toraks 2021; 69:237-241. [PMID: 34256514 DOI: 10.5578/tt.20219813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nocardia species are opportunistic bacteria that are frequently contagious by inhalation. Recently, Nocardia abscessus has been described as a different species. We report a 54-year-old male who presented with acute pleuritic chest pain, mimicking pulmonary thromboembolism on the 5th day of discharge from the hospital. The patient was receiving immunosuppressive therapy for newly diagnosed atypical anti-glomerular basement membrane disease. Thorax computed tomography revealed a 17x19 mm soft tissue lesion in the lateral segment of the middle lobe of the right lung. After further examinations, a biopsy decision was made and Nocardia abscessus was isolated in the aerobic culture of the aspiration material.
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Affiliation(s)
- Rashad Ismayilov
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Neslihan Koray
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Neşe İnal
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mine Durusu Tanrıöver
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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17
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Demir Çuha M, Er AG, Durukan BM, Karagöz A, Hazırolan G, Ünal S. A rare case of necrotizing fasciitis of the abdominal wall due to Hungatella effluvii and Streptococcus constellatus. Anaerobe 2021; 70:102409. [PMID: 34171472 DOI: 10.1016/j.anaerobe.2021.102409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
We report a rare case of necrotizing fasciitis of the abdominal wall caused by Hungatella effluvii and Streptococcus constellatus. Necrotizing fasciitis has high mortality, so early diagnosis and aggressive treatment are essential for good clinical outcome. Identification of the microbial contribution to these infections is crucial for targeted antibiotic treatment.
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Affiliation(s)
- Mervenur Demir Çuha
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ahmet Görkem Er
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bekir Mert Durukan
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alper Karagöz
- Department of Microbiology, Faculty of Molecular Biology and Genetics, Usak University, Usak, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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18
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İnal N, Hazırolan G. A case of bacteremia caused by Leptotrichia trevisanii in pediatric patient with febrile neutropenia and review of literature. Acta Microbiol Immunol Hung 2021. [PMID: 34051072 DOI: 10.1556/030.2021.01358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
Leptotrichia species are fastidious anaerobic, fusiform, pencil-shaped Gram-negative bacilli that reside in microbiota of humans. Leptotrichia species have increasingly been recognized as an opportunistic pathogen in humans, mainly in the immunocompromised patient. Anaerobic organisms have rarely been isolated from blood cultures of pediatric patients. In our study, we isolated Leptotrichia trevisanii from central venous catheter culture of a five-year-old male patient. It was identified with both matrix-assisted laser desorption ionization time-of-flight mass spectrometry and confirmed via 16S rRNA gene sequencing. The early recognition of anaerobic bacteremia and administration of appropriate antimicrobial and play an important role preventing mortality and morbidity in children. In our study we report a rarely diagnosed case of L. trevisanii bacteremia in a pediatric patient.
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Affiliation(s)
- Neşe İnal
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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19
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Er B, Er AG, Metan G, Halaçlı B, Ortaç Ersoy E, Hazırolan G, Alp A, Sarıbaş Z, Arıkan Akdağlı S, Topeli A, Uzun Ö. Is COVID-19 a risk factor for invasive pulmonary aspergillosis in critically ill patients? Tuberk Toraks 2021; 69:118-120. [PMID: 33853317 DOI: 10.5578/tt.20219918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Berrin Er
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Görkem Er
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burçin Halaçlı
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Sarıbaş
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arıkan Akdağlı
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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20
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Inal N, Hazırolan G. Misidentification of Brucella melitensis as Octrobactrum deajoenense with MALDI-TOF MS: A report of three cases. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00069-0. [PMID: 33836909 DOI: 10.1016/j.eimc.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Neşe Inal
- Faculty of Medicine, Department of Medical Microbiology, Hacettepe University, Ankara, Turkey.
| | - Gülşen Hazırolan
- Faculty of Medicine, Department of Medical Microbiology, Hacettepe University, Ankara, Turkey
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21
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Sunman B, Emiralioĝlu N, Hazırolan G, Tural D, Özsezen B, Nayir Büyükşahin H, Güzelkaş İ, Yalçın E, Doĝru D, Özçelik U, Kiper N. P125 Impact of infection with Achromobacter spp. on clinical outcome in paediatric patients with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Hazırolan G. Capnocytophaga sputigena: A rarely encountered gram-negative bacterium in microbiology laboratories. J Infect Public Health 2020; 14:683-684. [PMID: 33250368 DOI: 10.1016/j.jiph.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gülşen Hazırolan
- Faculty of Medicine, Department of Medical Microbiology, Hacettepe University, Ankara, Turkey.
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23
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Hazırolan G, Karagöz A. Emergence of carbapenemase-producing and colistin resistant Klebsiella pneumoniae ST101 high-risk clone in Turkey. Acta Microbiol Immunol Hung 2020; 67:216-221. [PMID: 33174866 DOI: 10.1556/030.2020.01275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
Carbapenemase-producing and colistin resistant Klebsiella pneumoniae has become a worldwide healthcare problem. This study describes molecular characterization of carbapenemase-producing and colistin resistant clinical K. pneumoniae isolates.A total of 93 non-replicate carbapenem and colistin resistant K. pneumoniae were recovered from clinical specimens in a university hospital during 2017-2019. Detection of blaOXA-48, blaKPC, blaNDM-1, blaIMP, blaVIM-1 and mcr-1, -2, -3, -4, -5, -6, -7, and -8 genes was performed by PCR. The bacterial isolates were assigned to clonal lineages by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).All isolates harbored blaOXA-48 and only two isolates harbored blaOXA-48, and blaNDM-1 genes together. In colistin resistant K. pneumoniae, mcr-1 was detected in two (2.1%) isolates. Ninety three isolates of K. pneumoniae were categorized into three clusters and five pulsotypes. MLST revealed two different sequence types, ST101 (89/93) and ST147 (4/93).In our study ST101 was found to be a significantly dominant clone carrying blaOXA-48 and among our strains a low frequency of mcr-1 gene was determined. The emergence of colistin resistance was observed in K. pneumoniae ST101 isolates. ST101 may become a global threat in the dissemination of carbapenem and colistin resistance.
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Affiliation(s)
- Gülşen Hazırolan
- 1Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Alper Karagöz
- 2Department of Microbiology, Faculty of Molecular Biology and Genetics, Usak University, 64200, Usak, Turkey
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24
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Özkul C, Hazırolan G. Oxacillinase Gene Distribution, Antibiotic Resistance, and Their Correlation with Biofilm Formation in Acinetobacter baumannii Bloodstream Isolates. Microb Drug Resist 2020; 27:637-646. [PMID: 32991256 DOI: 10.1089/mdr.2020.0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: The limitations of treatment options in bloodstream infections caused by multidrug-resistant Acinetobacter baumannii (MDRAB) have been related to high morbidity and mortality. The aim of our present study was to determine antimicrobial susceptibility profiles, molecular resistance patterns, and biofilm properties of A. baumannii isolated from bloodstream infections. Materials and Methods: In the present study, a total of 44 A. baumannii bloodstream isolates were included. Antimicrobial susceptibility profiles and biofilm formation ability were assessed. The distribution of class D carbapenemases, ISAba1, ISAba1/blaOXA-23, blaNDM-1, mcr-1, and ompA was investigated by polymerase chain reaction (PCR). Arbitrarily primed-PCR (AP-PCR) was performed to evaluate clonal relationships. Results: A total of 32 isolates were MDRAB, whereas 6 isolates were also resistant to colistin without mcr-1 positivity. All isolates were harboring blaOXA-51 gene, whereas blaOXA-23 positivity was 63.6%. Fifty percent of the isolates had ISAba1. ISAba1 upstream of blaOXA-23 was determined in 18 isolates. None of the isolates were positive for blaNDM-1 gene. Majority of the strains were strong biofilm producers (86.8%). A total of 56.8% of the isolates were positive for ompA gene with no direct association with strong biofilm formation. However, blaOXA-51 + 23 genotype and trimethoprim-sulfamethoxazole resistance showed a significant relationship with biofilm formation. AP-PCR analysis revealed six distinct clusters of A. baumannii. Conclusions: Herein, majority of the A. baumannii blood isolates were characterized as blaOXA-51+OXA-23 carbapenemase genotype and were strong biofilm formers. None of the isolates were positive for blaNDM-1, which was promising. Resistant isolates were tended to form strong biofilms. Our results highlight the emergence of oxacillinase-producing MDRAB isolated from bloodstream with high biofilm formation ability.
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Affiliation(s)
- Ceren Özkul
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy and Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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25
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Abstract
Lactobacilli are part of the microbiota and are also used as probiotics. However, in recent years they have been associated with invasive infections, especially bacteremia. Lactobacillus spp. are usually susceptible to penicillins, macrolides, and carbapenems, but Lactobacillus rhamnosus is intrinsically resistant to glycopeptides. The aim of this study was to determine the antimicrobial susceptibility profile and resistance mechanism of a clinical isolate of L. rhamnosus isolated from 10 sets of blood cultures of the same patient. The isolate was identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (Bruker Daltonics; BD, Bremen, Germany) and 16S rRNA gene sequencing. In vitro susceptibilities to penicillin, ampicillin, imipenem, vancomycin, erythromycin, clindamycin, and linezolid were determined with gradient test strips (bioMérieux, France) on Mueller-Hinton agar plates supplemented with 5% defibrinated horse blood and 20 mg/L β-NAD. The isolate was resistant to vancomycin and imipenem. Polymerase chain reaction test was positive for blaOXA-48 and the presence of this carbapenemase was confirmed by gene sequencing. Although plasmid analysis suggested that the blaOXA-48 is chromosomal in this isolate, it is still an alarming finding for potential transmission of antibiotic resistance genes to other bacteria in the gut. To our knowledge, this is the first report of the presence of blaOXA-48 in a Lactobacillus spp. and has utmost importance as these bacteria are used as probiotics. The isolation of these bacteria from sterile body sites should not go unnoticed.
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Affiliation(s)
- Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aycan Gündoğdu
- Department of Medical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Seyma Nigiz
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Belgin Altun
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Gür
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Hazırolan G, Sarıbaş Z, Arıkan Akdağlı S. [Comparison of microdilution and disk diffusion methods for the detection of fluconazole and voriconazole susceptibility against clinical Candida glabrata isolates and determination of changing susceptibility with new CLSI breakpoints]. MIKROBIYOL BUL 2016; 50:428-37. [PMID: 27525398 DOI: 10.5578/mb.26544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Candida albicans is the most frequently isolated species as the causative agent of Candida infections. However, in recent years, the isolation rate of non-albicans Candida species have increased. In many centers, Candida glabrata is one of the commonly isolated non-albicans species of C.glabrata infections which are difficult-to-treat due to decreased susceptibility to fluconazole and cross-resistance to other azoles. The aims of this study were to determine the in vitro susceptibility profiles of clinical C.glabrata isolates against fluconazole and voriconazole by microdilution and disk diffusion methods and to evaluate the results with both the previous (CLSI) and current species-specific CLSI (Clinical and Laboratory Standards Institute) clinical breakpoints. A total of 70 C.glabrata strains isolated from clinical samples were included in the study. The identification of the isolates was performed by morphologic examination on cornmeal Tween 80 agar and assimilation profiles obtained by using ID32C (BioMérieux, France). Broth microdilution and disk diffusion methods were performed according to CLSI M27-A3 and CLSI M44-A2 documents, respectively. The results were evaluated according to CLSI M27-A3 and M44-A2 documents and new vs. species-specific CLSI breakpoints. By using both previous and new CLSI breakpoints, broth microdilution test results showed that voriconazole has greater in vitro activity than fluconazole against C.glabrata isolates. For the two drugs tested, very major error was not observed with disk diffusion method when microdilution method was considered as the reference method. Since "susceptible" category no more exists for fluconazole vs. C.glabrata, the isolates that were interpreted as susceptible by previous breakpoints were evaluated as susceptible-dose dependent by current CLSI breakpoints. Since species-specific breakpoints remain yet undetermined for voriconazole, comparative analysis was not possible for this agent. The results obtained at 24 hours by disk diffusion method were evaluated by using both previous and current CLSI breakpoints and the agreement rates for fluconazole and voriconazole were 80% and 92.8% with previous CLSI breakpoint, 87.1% and 94.2% with new breakpoints, respectively. The high agreement rates between the two methods obtained by the new breakpoints in particular suggest that disk diffusion appears as a reliable alternative method in general for in vitro susceptibility testing of fluconazole and voriconazole against C.glabrata isolates.
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Affiliation(s)
- Gülşen Hazırolan
- Ankara Numune Training and Research Hospital, Medical Microbiology Laboratory, Ankara, Turkey.
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27
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Karabıçak N, Uludağ Altun H, Karatuna O, Hazırolan G, Aksu N, Adiloğlu A, Akyar I. [Evaluation of common commercial systems for the identification of yeast isolates in microbiology laboratories: a multicenter study]. MIKROBIYOL BUL 2015; 49:210-20. [PMID: 26167821 DOI: 10.5578/mb.9370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Accurate and rapid identification of yeast isolates have become important in recent years for not only antifungal susceptibility testing due to the species-specific clinical resistance breakpoints but also early initiation of appropriate antifungal therapy. In clinical microbiology laboratories species identification of yeasts is often performed with several commercial systems based on biochemical properties and rarely according to the physiological and morphological characteristics. The aim of this study was to compare the two common commercial systems, VITEK 2 YST ID Card (Vitek; bioMérieux, France) and API 20C AUX (API; bioMérieux, France) with conventional mycological methods. A total of 473 clinical yeast strains isolated from clinical specimens in different university and training/research hospitals and identified by Vitek system were included in the study. The isolates were re-identified with API and conventional methods including morphological identification in the Mycology Reference Laboratory of the Public Health Institute of Turkey. Candida dubliniensis MYA 583, Candida krusei ATCC 6258, Candida parapsilosis ATCC 22019, Candida albicans ATCC 10231 and Cryptococcus neoformans ATCC 32268 were used as quality control strains and those standard strains were studied consecutively 10 days with both of the methods. The results of identification by Vitek and API were compared with the results of conventional methods for those 473 yeast isolates [6 genus (Candida, Cryptococcus, Blastoshizomyces, Rhodotorula, Saccharomyces, Trichosporon), 17 species (5 common and 12 rarely isolated)]. The performances of the systems were better (Vitek: 95%; API: 96%) for the commonly detected species (C.albicans, C.parapsilosis, C.glabrata, C.tropicalis and C.krusei) than those for rarely detected species (Vitek: 78.4%; API: 71.6%) (p= 0.155). Misidentification or unidentification were mostly detected for C.parapsilosis (Vitek: 6/87; API: 7/87) and C.glabrata (Vitek: 9/104; API: 3/104) by both of the systems. For rarely detected yeast isolates, misidentification or unidentification were most frequently observed in species of C.pelliculosa (Vitek: 3/11; API: 6/11) and C.dubliniensis (API and Vitek: 2/5) isolates. Candida guilliermondii (API: 2/5) isolates had lower rate of identification with API compared to other species. Blastoschizomyces capitatus and Saccharomyces cerevisiae isolates could not be identified by both of the systems. As a result, the accurate diagnosis of Vitek and API systems were similar in terms of consistency (86.3%). Two systems performed well in correct identification of common clinical yeast species (at least 95%), while the identification of rare species was more challenging indicating that they require further morphological and physiological testing. The addition of morphological identification to commercial systems will be useful for accurate diagnosis and treatment of mixed infections.
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Affiliation(s)
- Nilgün Karabıçak
- Public Health Institution of Turkey, Mycology Reference Laboratory, Ankara, Turkey.
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28
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Hazırolan G, Yıldıran D, Baran I, Mumcuoğlu İ, Aksu N. Evaluation of species distribution and anti fungal susceptibility profiles of Candida isolates from hospitalized patients. ACTA ACUST UNITED AC 2015. [DOI: 10.5505/turkhijyen.2015.75010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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