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    Community Acquired Lower Urinary Tract Infections in Primary Care: Causative Agents and Antimicrobial Susceptibility
    (Galenos Yayincilik, 2012) Arman, Dilek; Agalar, Canan; Dizbay, Murat; Tunccan, Ozlem Guzel; Keten, Derya Tozlu; Aygun, Gokhan; Tunger, Ozlem
    Introduction: The aim of this study was to determine the causative agents of community-acquired lower urinary tract infections (CALUTIs) in primary care. We also aimed to evaluate the antimicrobial susceptibility rates of urinary Escherichia coli isolates to various oral antibiotics and to assist primary care physicians with antibiotic selection. Materials and Methods: The study was performed in 55 primary care centers in 13 cities between May and July 2009. Adult patients with at least two of dysuria, pollakiuria, nocturia, suprapubic tenderness, or blurred urine symptoms, but not fever, were included in the study. Urinary samples were obtained and patient data were recorded at the primary care centers. Results: Totally, 400 patients were enrolled. In 175 (43.8%) patients, urine cultures yielded a urinary pathogen. The most frequently encountered pathogen was E. coli (62.8%). Among E. coli isolates, the lowest resistance rates were detected for nitrofurantoin (0.9%) and fosfomycin (3.6%) and the highest for trimethoprim/sulfamethoxazole (43.6%) and amoxicillin/clavulanate (41%). Resistance rates to quinolones were 23.6% for ciprofloxacin and 21% for levofloxacin. Minimum inhibitory concentration (MIC)(50) and MIC90 values for ciprofloxacin and levofloxacin were 0.015 and 32 mu g/mL and 0.06 and 16 mu g/mL, respectively. Quinolone resistance was significantly higher in patients who received an antimicrobial treatment within the last three months (p< 0.001). Extended spectrum beta-lactamase (ESBL) positivity was detected in 15 of 110 (13.6%) E. coli isolates. Quinolone resistance was significantly higher among ESBL positive than ESBL negative strains (53.3% vs. 15.8%, p= 0.002). Conclusion: In conclusion, the most frequent causative agent in CALUTIs was E. coli. The lowest resistance rates among E. coli isolates were detected for nitrofurantoin and fosfomycin. Resistance rates to quinolones were over 20% in our study. Our study provides important data about the causative agents and their antibiotic susceptibilities and also contains valuable data for rational antibiotic usage in the treatment of CALUTI in Turkey.
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    Investigation of carbapenem resistance and the first identification of Klebsiella pneumoniae carbapenemase (KPC) enzyme among Escherichia coli isolates in Turkey: A prospective study
    (Elsevier Sci Ltd, 2016) Kuskucu, Mert Ahmet; Karakullukcu, Asiye; Ailiken, Mailihaba; Otlu, Bans; Mete, Bilgul; Aygun, Gokhan
    Background: The aim of this study was to determine the presence of carbapenem resistance and carbapenemase production in Escherichia coil isolates from clinical samples in Turkey. Methods: The prospective study included a total of 4.052 Escherichia coli isolates collected from patients admitted to a hospital from March 2011 to May 2012. We used ertapenem disc for screening carbapenemase production, and the confirmation was performed by using Etest. The resistance mechanisms and genetic relatedness of the carbapenem resistant strains were investigated by using PCR (polymerase chain reaction) and pulsed -field gel electrophoresis (PFGE), respectively. Results: Among the 4.052 E coli isolates, 24 (0.59%) were found to be carbapenem resistant. Of these, only 5 isolates were positive for OXA-48 and 2 isolates were positive for ICIebsiella pneumoniae carbapenemase (KPC)-2. The KPC-2 producing E. coil strains (n = 2) were both isolated from the same patient. The bla(KPC) genes were confirmed using DNA sequence analysis. The genetic relationship between the 24 E. coil strains studied by PFGE revealed that the strains were genetically unrelated. Conclusions: This article confirms, to our knowledge for the first time, the detection of KPC-2-producing E. coil in Turkey, with OXA-48 being the most frequent carbapenemase in the study. (C) 2016 Elsevier Ltd. All rights reserved.