The Turkish Clinical Microbiology and Infectious Diseases Society (KLİMİK) Evidence-Based Guideline for the Diagnosis and Treatment of Brucellosis, 2023

Bruselloz, dünyada ve ülkemizde çok yaygın olarak görülmesine rağmen hastalığın tanı ve tedavisini yönlendirmede kullanılabilecek kanıta dayalı bir rehber bulunmamaktadır. Bu rehber, brusellozun tanı ve tedavisi ile ilgilenen farklı uzmanlık alanlarından hekimlere kanıta dayalı öneriler sunmak üzere Türk Klinik Mikrobiyoloji ve İnfeksiyon Has- talıkları Derneği tarafından hazırlanmıştır. Rehberin hazırlanmasında, ABD İnfeksiyon Hastalıkları Derneği (IDSA)’nin Klinik Uygulama Rehberi Geliştirme Kı- lavuzu önerileri esas alınmıştır. Rehberi hazırlayan grup üyeleri tarafından, bruselloz tanı ve tedavisinde önemli olduğu düşünülen 20 soru belirlenmiş ve PICO [hasta/popülasyon (P), müdahale/indikator (I), karşılaştırma/kontrol (C), sonuç (O)] formatında oluşturulan bu sorulara yanıt verebilecek yayınlar, ULAKBİM TR Dizin, PubMed ve Cochrane veritabanlarından, tarih kısıtlaması olmadan taranmıştır. Her bir PICO sorusu ve her bir ayrı sonlanım için kanıtların derecelendirilmesinde ve önerilerin gücünün belirlenmesinde “Grading of Recommendations, Assessment, Develop- ment and Evaluation (GRADE) Working Group” yöntemi kullanılmıştır. PICO sorularına yanıt oluşturabilecek şekilde karşılaştırmalı klinik araştırmaların olması halinde bunların meta-analizleri, olmaması halindeyse olgu sunumları ve olgu serilerinden elde edilen verilerle “individual participant data” (IPD) meta-analizleri yapılmıştır. Önerilerin yeni çalışmaların sonuçları doğrultusunda belli aralıklarla güncellenmesi planlanmaktadır.Although brucellosis is very common in the world and Türkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of Amer- ica (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommen- dations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Me- ta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies

Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022

Publisher Copyright: © 2024 The Author(s)Introduction: The ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs. Methods: We conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020–2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated. Results: Our study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%). Conclusions: This study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics.publishersversionpublishe

Ventricular Assist Device-Related Infections

Ventricular assist devices are important treatment modalities for end-stage heart failure patients because the demand for donor hearts far exceeds the supply. The incidence of ventricular assist device-related infections is 13-80%. Ventricular assist device-related infections cause significant morbidity and mortality. There are not yet clear recommendations about the definitions, diagnostic algorithms, treatment, and prophylaxis. Here, the diagnosis, clinical manifestations and therapeutic, and prophylactic approaches for ventricular assist device-related infections are discussed in light of the current literature

In Vitro Susceptibility of Tigecycline and Colistin Against Stenotrophomonas maltophilia

Introduction: Gram-negative bacillus Stenotrophomonas maltophilia is resistant to drugs (multi-drug resistance-MDR) and it can be isolated from nature. Treatment of the infections resulting from S. maltophilia could be problematic due to multi-resistance. Materials and Methods: 72 S. maltophilia strains isolated from clinical samples were included into the study. Sensitivity was determined using Tigecycline and Colistin E-test MIC method performed in the Clinical Microbiology laboratory of Baskent University, Medical Faculty between 2010 and 2014. Results: In our study, colistin MIC range was found as 0.016-8 mg/L. MIC50 and MIC90 values were determined respectively as 1.5 mg/L and 12 mg/L. Tigecycline MIC range was 0-96 mg/L, and MIC50 was 0.19 mg/L and MIC90 was 1.5 mg/L. Furthermore, one tigecycline resistant strain was detected. Conclusion: We believe that the determination of novel treatments and protocols and their standardization using multidisciplinary approaches can facilitate to cope with problematic and resistant nosocomial infections developed by S. maltophilia

Ventilator Associated Pneumonia in Baskent University Hospital: Incidence, Risk Factors, Causative Agents and Antibiotic Resistance Patterns

Ventilator associated pneumonia (VAP) is the most common infection in intensive care units (ICUs). The aim of this study is to determine the VAP incidence, risk factors, causative agents and the susceptibility patterns. Intubated patients in the four ICUs in our hospital were evaluated prospectively for one year, according to the CDC criteria. Demographic data and risk factors of all the patients in ICUs were collected by filling up a form. Chi-square and Mann-Whitney/U tests were used for statistical analysis. A hundred and fortyseven patients were included in the study. Seventy-three (49.6%) of the patients were diagnosed as VAP. Fifty-nine percent of these patients were male. VAP ratio was calculated to be 16.1/1000 ventilator days. Sixty-five (44.1%) of the patients had concomittant infections. Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, bacteremia, surgical wound infections, antibiotic usage, duration of intubation were determined as independent risk factors by logistic regression analysis. The most common causative agents were Klebsiella oxytoca, Pseudomonas aeruginosa, Acinetobacter spp. and methicillin resistant Staphylococcus aureus. Carbapenem and quinolone resistance were common among P. aeruginosa and Acinetobacter spp

Antibiotic overconsumption and resistance in Turkey

WOS: 000468097700002PubMed ID: 30844434The latest report of the OECD Health Policy Studies stated that in2015 the highest rates of antimicrobial resistance (around 35% inTurkey, Korea and Greece) were seven times higher than the lowestrates among its member countries. As the OECD country with thehighest rate of resistance (38.8%), despite a 15-year hospital anti-biotic restriction programme, Turkey is in urgent need of revisingits policies and drawing an effective action plan to reverse thecurrent trend. In this commentary we review previous measurestaken to tackle antimicrobial overuse and resistance in Turkey and discuss their effectiveness

A Rare Cause of Endocarditis: Streptococcus pyogenes

Although group A β-hemolytic streptococcus is an uncommon cause of infective endocarditis, an increase in the incidence of invasive group A streptococcus infections including bacteremia has been reported in the last two decades. Herein we report Streptococcus pyogenes endocarditis in a previously healthy adult patient who was hospitalized to investigate the etiology of fever. Because of a suspicion of a new vegetation appeared in the second (aortic) valve in the 14th day of high dose penicillin G treatment, the mitral and aortic valves were replaced by mechanical prosthesis on the 22nd day of treatment. He was discharged from hospital after the 6 week course of antibiotic treatment