Seniha Basaran

Comparative activity of carbapenem testing: the COMPACT study

OBJECTIVES Doripenem is a new carbapenem recently introduced into Europe. The COMParative Activity of Carbapenem Testing (COMPACT) study compared the susceptibility of common Gram-negative bacilli causing serious infections in hospitalized patients with doripenem, imipenem and meropenem. METHODS Gram-negative isolates (4498 total: 2171 Pseudomonas species; 1910 Enterobacteriaceae; and 417 other Gram-negative bacilli) were collected from 80 centres in 16 countries in Europe, the Middle East and Africa during 2008-09. The MICs of doripenem, imipenem and meropenem were determined using Etest methodology and broth microdilution. Susceptibility was interpreted according to CLSI, EUCAST and FDA breakpoints. RESULTS The MIC(90)s of doripenem, imipenem and meropenem for all isolates were 8, ≥64 and 32 mg/L, respectively. Doripenem had the lowest MIC(90) for Pseudomonas species at 16 mg/L, with imipenem and meropenem values of ≥64 mg/L. Enterobacteriaceae were highly susceptible to all three carbapenems, with MIC(90)s of doripenem, imipenem and meropenem of 0.06, 0.5 and 0.12 mg/L, respectively. Other Gram-negative isolates, predominantly Acinetobacter baumannii, were resistant to all three carbapenems (MIC(90) ≥64 mg/L). Susceptibility to doripenem was observed in 14.9% of isolates resistant to imipenem and/or meropenem. CONCLUSIONS Doripenem showed excellent activity against Gram-negative isolates; generally it was more active than imipenem and at least as good as meropenem. Against Pseudomonas species, doripenem was more active than both imipenem and meropenem, with doripenem susceptibility observed for some imipenem- and/or meropenem-resistant isolates.

Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality.

This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

Hematologic Adverse Effects of Prolonged Piperacillin-Tazobactam Use in Adults

Objective: We aimed to find the incidence and risk factors of hematologic adverse effects of piperacillin-tazobactam (TZP). Materials and Methods: Adult patients who used TZP for more than 10 days were included in the study. Results: The incidence of leukopenia, neutropenia, and eosinophilia in 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%, respectively. Lower Charlson Comorbidity Index score, lower initial leukocyte count, combination of TZP with another antibiotic, and total duration of TZP therapy were found to be independent risk factors for leukopenia, while initial higher eosinophil count (IHEC) and usage of TZP for >20 days were independent risk factors for neutropenia and IHEC and total duration of TZP therapy were independent risk factors for eosinophilia. Conclusion: Longer duration of therapy, combination with other antibiotics, younger age with fewer comorbidities, and IHEC could result in hematologic adverse effects in patients treated with TZP. Patients with IHEC may be more prone to allergic reactions, so immunological mechanisms may facilitate the development of hematological adverse effects of TZP.

Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection

Objectives We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55%) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61%. ST101 was the most common ST and accounted for 68 (59%) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72%. In ST101, 94% (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40% (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81%) and 22 (19%) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P = 0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P = 0.002) were found to be significantly associated covariates. Conclusions Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.

Serratia marcescens, Morganella morganii, Klebsiella oxytoca related peritonitis attacks in a patient on automated peritoneal dialysis: A case report

acterial peritonitis is a common complication of peritoneal ialysis.1 We report here a case presented with peritonitis ttacks caused by rarely reported unusual pathogens, probably elated with poor home environment and hygienic conditions. A 57-year-old female patient had a history of end-stage enal disease secondary to hypertensive nephrosclerosis and ndergone dialysis for 4 years. She was sharing a small house n poor hygienic conditions with eleven other family memers with low socioeconomic status. Five months after the nitiation of automated peritoneal dialysis (APD), the patient resented with abdominal pain and nausea to our PD clinic. he was febrile (38 ◦C), had involuntary abdominal guarding nd rebound tenderness on physical examination. Dialysate hite blood cell count was 1100/mm3 (79% neutrophils). mpiric antibiotherapy was initiated with intraperitoneal efazolin (1 g/day) and oral ciprofloxacin (250 mg every 12 h). A pure growth of Serratia marcescens was obtained in both ifferent culture media. The organism was resistant to cefaolin, ceftriaxone, piperacillin/tazobactam, but sensitive to efepime. Cefazolin was stopped; cefepime could not be used ue to a drug shortage; instead, intraperitoneal gentamicin 0.6 mg/kg/day). Oral ciprofloxacin was also continued based pon the susceptibility results. Following the treatment modfication, high-sensitivity CRP level decreased from 240 mg/L o 9 mg/L. Peritoneal effluent became clear and drainage fluid eukocyte count was 100/mm3 (10% neutrophils) on the third eek of admission. The patient was readmitted to the hospital with similar

Imported Malaria Caused by Plasmodium falciparum: A Global Problem

Objective: Plasmodium falciparum acquired abroad, has become the main causative malaria agent in Turkey due to the elimination of endemic P. vivax in recent years. By describing clinical, laboratory and treatment features of imported malaria cases caused by P. falciparum, we aimed to distinguish it from other infectious diseases with similar epidemiological and clinical features, such as viral haemorrhagic fevers, and therefore to ensure the recognition of this kind of deadly malaria earlier. Methods: All cases hospitalized in Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University with a diagnosis of malaria between 2000 and 2016 were included in the study. Epidemiological, clinical, laboratory features and antimalarial drugs used either for prophylaxis or treatment of the cases were retrieved from the hospital database retrospectively. Results: A total of 16 patients diagnosed as having malaria caused by P. falciparum were followed our clinic during the study period. Apart from one patient who had visited Afghanistan, all of the cases acquired the infection during an Africa visit. Except two patients who received irregular prophylaxis, none of the patients had used prophylactic drugs for prevention of malaria. All of the patients had fever and shaking chills. The most frequently encountered pathologic laboratory findings were thrombocytopenia and elevated serum LDH levels. Of the patients, 50% had severe malaria and 31% were followed in intensive care unit. Artemether-lumefantrine was the most frequent (44%) regimen for treatment. All patients were discharged with full recovery except one lost due to cerebral malaria. Conclusions: Patients who acquired malaria abroad are most likely to acquire a more severe form of the disease because of the lack of the antibodies resulting from previous exposure. To avoid this severe disease, it is important to give more attention to appropriate prophylaxis against malaria among persons who plan to visit endemic areas. Klimik Dergisi 2017; 30(3): 120-5.

A Highly Rare Cause of Lumbar Spondylodiscitis with Epidural Abscess: Actinomyces israelii.

Actinomyces species may lead to slowly progressive infection of almost any site once mucosal breakdown exists; hence, it has the name “great pretender.” Its diagnosis may be unthinkable unless proper cultures/histologies are taken. We describe a patient with lumbar spondylodiscitis and epidural abscess. This is an exceptional another disease by actinomycosis.