Ziya Cibali Acikgoz

Colistin alone or combined with sulbactam or carbapenem against A. baumannii in ventilator-associated pneumonia

INTRODUCTION Colistin use has increased over the last ten years because of multidrug-resistant microorganisms. The aim of this study was to compare the clinical and microbiological efficacy of colistin alone or in combination with sulbactam or carbapenem in the treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) and extremely drug-resistant (XDR) A. baumannii. METHODOLOGY Cases treated for VAP because of MDR and XDR A. baumannii between January 2011 and January 2013 were included in the study. The primary and secondary outcome for colistin alone, colistin with sulbactam, and colistin with carbapenems were evaluated. The primary outcomes were clinical efficacy and microbiological efficacy; the secondary outcomes were nephrotoxicity, length of hospitalization, and mortality. RESULTS A total of 70 VAP patients were evaluated. A total of 17 patients (24.3%) were administered colistin alone, 20 patients (28.6%) were administered colistin and sulbactam, and 33 patients (47.1%) were administered colistin and carbapenem. Clinical and microbiological response rates were higher in the carbapenem combination group (63.6% and 63.6% in both) than in the sulbactam combination group, which registered 55.0% and 60.0%, respectively. However, this did not represent a significant difference statistically (p > 0.05). There was also no significant difference between colistin alone and the combination groups regarding clinical and microbiological efficacy and mortality. CONCLUSIONS Neither the administration of colistin alone nor colistin combined with either sulbactam or carbapenem had any noticeable advantage in the treatment of VAP in terms of clinical response, microbiological response, nephrotoxicity, length of hospitalization, and mortality.

Brucellosis as an aetiology of septic arthritis

Brucellosis is a zoonotic disease caused by a Gram-negative coccobacillus from the Brucella genus. The disease has a broad spectrum of clinical manifestations. The musculoskeletal system involvement is frequent and, rarely, arthritis can be the only clinical feature of the disease. We report a case of monoarthritis caused by Brucella melitensis.

Risk factors for infection with colistin-resistant gram-negative microorganisms: a multicenter study.

BACKGROUND Knowing risk factors for colistin resistance is important since colistin is the only remaining choice for the treatment of infections caused by multi-drug resistant microorganisms. OBJECTIVE Evaluate risk factors associated with infection by colistin-resistant microorganisms. DESIGN Retrospective study. SETTINGS Tertiary healthcare centers. PATIENTS AND METHODS An e-mail including the title and purpose of the study was sent to 1500 infectious disease specialists via a scientific and social web portal named “Infeksiyon Dunyasi (Infection World)”. Demographic and clinical data was requested from respondents. MAIN OUTCOME MEASURE(S) Colistin-resistance. RESULTS Eighteen infectious disease specialists from twelve tertiary care centers responded to the invitation. Data was collected on 165 patients, 56 cases (39.9%) and 109 (66.0%) age- and sex-matched controls. The colistin-resistant microorganisms isolated from cases were 29 Acinetobacter baumannii (51.8%), 18 Pseudomonas aeruginosa (32.1%) and 9 Klebsiella spp. Colistin, carbapenem, and quinolone use in the last three months were risk factors for colistin resistance in the univariate analysis. Previous quinolone use in the last three months (P=.003; RR:3.2; 95% CI:1.5–6,7) and previous colistin use in the last three months (P=.001; RR: 3.6; 95% CI: 1.63–7.99) were significant risk factors in the multivariate analysis. CONCLUSION Clinicians should limit the use of quinolones and remain aware of the possibility of resistance developing during colistin use. LIMITATIONS The lack of a heteroresistance analysis on the isolates. No data on use of a loading dose or the use of colistin in combination.

Molecular characterization of vancomycin-resistant Enterococcus faecium strains isolated from carriage and clinical samples in a tertiary hospital, Turkey.

This study aimed to determine the presence of vancomycin resistance (vanA and vanB) and virulence genes (esp, asa1, gelE, ace, hyl, cylA, cpd and ebpA) in vancomycin-resistant Enterococcus faecium (VREfm) strains and to analyse the clonal relationships among the strains. E. faecium strains were identified from rectal and clinical specimens by biochemical tests and the API-20 Strep kit. Susceptibility testing was performed using disc-diffusion and broth-dilution methods. PFGE was used for molecular typing of the VREfm strains. The vancomycin resistance and virulence genes were amplified by two-step multiplex PCR. All 55 VREfm isolates were resistant to penicillin G, ampicillin and high-level gentamicin but were susceptible to quinupristin/dalfopristin and linezolid. Multiplex PCR analysis indicated that all isolates harboured vanA and that 41 (75 %) were positive for virulence genes. The esp gene was the most common virulence factor and was detected in nine (41 %) invasive and 32 (96.7 %) non-invasive isolates. Multiple virulence genes were observed only in two non-invasive isolates; one harboured esp and ebpA and the other harboured esp, ebpA, asa1, gelE and cpd. PFGE typing yielded 16 different types, seven of which were clusters with two to 14 strains each. The clustering rates of the rectal swab, blood and urine isolates were 72.7 %, 61.5 % and 87.5 %, respectively. The genetic similarity observed among the VREfm isolates indicated cross-transmission in the hospital. Further studies on the virulence factors present in the strains might provide insight into the acquisition of these traits and their contribution to increased prevalence of VREfm.

Evaluation Of Clonal Relationship Between Acinetobacter baumannii Isolates and Determination Of Resistance To Antibiotics Which Were Obtained from Different Hospitals In Ankara

199 1Rize Halk Sağlığı Laboratuvarı Tıbbi Mikrobiyoloji, Rize 2Ankara Eğitim ve Araştırma Hastanesi Tıbbi Mikrobiyoloji, Ankara 3Ankara Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji, Ankara 4Ankara Atatürk Eğitim ve Araştırma Hastanesi Tıbbi Mikrobiyoloji, Ankara 5Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Tıbbi Mikrobiyoloji, Ankara 6Hacettepe Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Mikrobiyoloji, Ankara 7Bartın Halk Sağlığı Laboratuvarı Tıbbi Mikrobiyoloji, Bartın