Susceptibility patterns and cross resistances of antibiotics against Pseudomonas aeruginosa in a teaching hospital of Turkey

BACKGROUND: Pseudomonas aeruginosa is the third most common pathogen responsible for nosocomial infections and the prevalence of multiple resistant isolates has been increasing. Ninety-nine clinical isolates were studied in order to assess the current levels of susceptibility and cross-resistances of widely used antipseudomonal antibiotics against P. aeruginosa and to determine some resistance mechanisms by phenotypic methods. METHODS: MICs of isolates for nine antipseudomonal antibiotics were determined by the E test method. RESULTS: Thirty-six percent of isolates were resistant to more than one group of antibiotics. The rates of susceptible isolates were ciprofloxacin 75%, amikacin 73%, ceftazidime 65%, meropenem 63%, imipenem 63%, piperacillin/tazobactam 60%, cefoperazone/sulbactam 59%, cefepime 54% and tobramycin 44%. The majority of carbapenem resistant isolates were susceptible to ciprofloxacin and amikacin. CONCLUSION: Ciprofloxacin seems to be the most active agent against P. aeruginosa followed by amikacin in our unit. The usefulness of combinations of these antibiotics and β-lactams should be tested in treating multi-drug resistant P. aeruginosa

Central population of Karaman access according to 1844 century

YÖK Tez No: 703069XIX. yüzyılın ilk yarısında tanzim edilen Nüfus Defterleri, Osmanlı Devleti'nin demografik, sosyal ve ekonomik tarihi hakkında önemli bilgiler barındırmaktadır. Bu çalışmanın ana kaynağını Türkiye Cumhuriyeti Cumhurbaşkanlığı Devlet Arşivleri Başkanlığı Osmanlı Arşivi'nde bulunan 1844 yılına ait Karaman (Larende) Nüfus Defterleri oluşturmaktadır. Karaman kaza merkezi esas alınarak Karaman'ın sosyal, ekonomik, demografik ve idarî yapısı değerlendirilmiştir Çalışma neticesinde, defterler aracılığıyla Karaman kazasının yerleşim yerleri tespit edilmiş, Karaman'ın sosyal, ekonomik ve demografik eğilimleri ortaya konularak bu eğilimlerin neden ve sonuçları sorgulanmıştır. Bu doğrultuda öncelikle bölgenin nüfusu, aile yapısı ve yaş gruplarının dağılımı irdelenmiştir. Bunların yanında tipoloji özellikleri, meslek grupları, şehrin sosyal yapısı ve nüfus hareketleri ortaya konularak, bu veriler ışığında genel bir değerlendirme yapılmıştır.XIX. The Population Registers, prepared in the first half of the century, contain important information about the demographic, social and economic history of the Ottoman Empire. The main source of this study is the Karaman (Larende) Population Registers of 1844, which are in the Ottoman Archives of the Presidency of the Presidency of the State Archives of the Republic of Turkey. Social and economic, demographic and administrative structure has been evaluated on the basis of Karaman district centre. Our work; In the light of the of the notehooks, the Settlements of Karaman district were determined, the social-economic and demographictrends were revealed and the causes andconsequences of these trends were questioned. In this direction, first of all, the population of the region, the family structure and the distribution of age groups were examined. In addition to these, typological features, occupational groups, social structure of the city and populationmovements were revealed and a general evaluation was made in the light of these data

Distribution of Bacteria Isolated from Febrile Neutropenic Cases and Their Antibiotic Susceptibilities

Gram-positive bacteria have recently been increasing in frequency as infectious agents of febrile neutropenic patients in our country as in the world. Bacteria isolated from febrile neutropenic patients who were followed between May 1997 and December 2002 and their antibiotic susceptibilities were investigated in order to find out our data. Of 111 isolates, 61 were from blood, 35 from urine, 17 from wound and others from various materials. Gram-negative organisms were responsible for 70 (63%) isolates and the remaining 41 (37%) were gram-positive organisms. The most common isolate was Escherichia coli (n= 37) followed by Staphylococcus aureus (n= 26) and Pseudomonas aeruginosa (n= 12). Antibiotic susceptibilities were investigated by Bauer-Kirby disk diffusion method according to the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. Of the gram-negative isolates, 100% were susceptible to imipenem and meropenem, 90% to amikacin, 89% to cefepime, 84% to piperacillin-tazobactam, 84% to ciprofloxacin, 80% to ceftazidime, 80% to cefoperazone-sulbactam, 80% to gentamicin and 73% to ceftriaxone. Twelve of 26 S. aureus isolates were methicillin-resistant. None of 10 S. pneumoniae isolates were penicillin-resistant. None of the gram-positive isolates were resistant to glycopeptides. Although the frequency of gram-positive isolates has increased over the years (from 20% to 39%), gram-negative organisms are still the most common isolates. However, the frequency of gram-positive bacteremic isolates has also increased (from 41% to 50%) and became the most common bacteremic isolates. As a result; gram-negative organisms, especially E. coli, are still predominant pathogen in our center, but gram-positive isolates, especially S. aureus, became the most common bacteremic pathogen. These new data will be leading us in decision of proper empirical antibiotic policy and the outcome will be success in treatment

Clinical efficacy and safety of prolonged versus intermittent administration of antipseudomonal beta-lactam antibiotics in adults with severe acute infections: A meta-analysis of randomized controlled trials

Introduction: In order to compare the clinical efficacy and safety of prolonged versus intermittent antipseudomonal beta-lactam antibiotic infusion for the treatment of severe acute infections in adult patients, a meta-analysis of randomized controlled trials (RCTs) was performed. Methods: We systematically searched MEDLINE and Cochrane Library databases until December 2022. The outcomes were all-cause mortality, clinical success, microbiological eradication and adverse events. The pooled risk ratios (RR) were estimated by the fixed or random effect methods according to heterogeneity statistics. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the certainty of evidence for each outcome. Results: Twenty eligible RCTs with 2081 participants were included in the meta-analysis. The risk of all-cause mortality was significantly lower in the prolonged infusion group than in the intermittent infusion group (RR 0.77, 95% confidence interval [CI] 0.63–0.95, p = 0.01, I2 = 0%; moderate certainty). Treatment with prolonged infusion showed significant benefit in clinical success (RR 1.09, 95% CI 1.02–1.17, p = 0.008, I2 = 19%; moderate certainty). There were no significant differences in microbiological eradication (RR 1.12, 95% CI 0.99–1.28, p = 0.07, I2 = 49%; low certainty), any adverse events (RR 0.96, 95% CI 0.86–1.08, p = 0.50, I2 = 27%; moderate certainty) and serious adverse events (RR 0.99, 95%CI 0.70–1.39 p = 0.95, I2 = 0%; low certainty). Conclusions: Prolonged antipseudomonal beta-lactam infusion probably decreases all-cause mortality. Additionally, it probably increases clinical success in adults with severe acute infections. This infusion strategy may result in little to no difference in microbiological eradication and is probably not associated with a rise in any adverse events.The evidence suggests that prolonged infusion may not increase serious adverse events

Prediction of Mortality in Patients with Sepsis Due to Gram-negative Bacteremia: Pitt Bacteremia Score, qSOFA, SIRS

Introduction: Sepsis is a syndrome of physiologic, biochemical and pathologic abnormalities induced by infection and has been associated with high mortality and morbidity. This study aimed to compare Systemic Inflammatory Response Syndrome (SIRS) criteria, Pitt bacteremia score and quick Sequential Organ Failure Assessment (qSOFA) for the prediction of mortality in patients with sepsis due to Gram-negative bacteremia

The Importance of Microbiological Diagnosis of Gas Gangrene

The direct Gram staining examinations of materials in gas gangrene quickly provide valuable information for the clinician in establishing the diagnosis when a rapid decision about therapy is necessary to be made. Here the importance of laboratory diagnosis of gas gangrene has been desired to be emphasized on the occasion of two materials examined in our laboratory at different times. Both materials were obtained in the operating room before surgery. Gram-stained smears were quickly examined and the operating room was informed at once that the microscopic apperances were well-proposed to Clostridium and supported the diagnosis of gas gangrene. Anaerobic jar was used for the anaerobic cultures. C. septicum and C. perfringens were biochemically identified in anaerobic culture of the first material. But mixed colonies were produced in the anaerobic culture of the second material and further identification of the second one could not be done because of inability to keep them alive. Consequently it has been emphasized that in a severe infection such as gas gangrene a simple gram staining provides a useful information for the physician to choose a treatment and the most common isolates can be identified by some simple tests which are able to be done in all laboratory conditions