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    Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis
    (Mosby-Elsevier, 2009) Cetin, Emel Sesli; Durmaz, Riza; Tetik, Tulay; Otlu, Baris; Kaya, Selcuk; Caliskan, Ahmet
    Background: Although members of the Acinetobacter genus are not commonly part of the human flora, their relatively high prevalence in hospital environment frequently results in colonization of the skin and respiratory tract. Objectives: The present investigation was carried out to elucidate epidemiologic characteristics of nosocomial Acinetobacter baumannii infections in a teaching hospital. Methods: Epidemiologic, clinical, and demographic features of the 66 patients with A baumannii infection during a 14-month period were recorded. Antibiotic susceptibilities of the isolates were determined by the standardized disk-diffusion method, and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis (PFGE). Results: The incidence of A baumannii infection was especially high in January, April, May and June 2006. The isolates were most frequently obtained from blood and tracheal aspirates sent from the intensive care unit and neurosurgery ward. Although the most frequently identified predisposing factors were cerebrovascular disease and surgical operation, the main risk factors identified in these patients were catheterization and mechanical ventilation. Genotype analysis of the 66 A baumannii strains by PFGE revealed the circulation of 36 different PFGE types. of which type A (12) and K (17) accounted for 44% of the isolates. We found high clonal relationship (80.3%) among the typed strains. Thirteen antibiotypes were observed. Most of the isolates were multidrug resistant. Resistance to imipenem, meropenem, gentamicin, amikacin, tobramycin, netilmicin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, cefoperazone-sulbactam, ciprofloxacin, and levofloxacin were found in 44%, 47%, 47%, 84.8%, 21.2%, 3%, 62.1%, 57.6%, 94%, 62.1%, 95.5%, and 95.5% of the isolates, respectively. Conclusion: The epidemiologic data obtained suggested that the increase in the number of A baumannii infections in our hospital was caused by the interhospital spread of especially 2 epidemic clones. We determined that clonally related strains can survive for a long time in our hospital and cause nosocomial infections in the predisposed patients. (Am J Infect Control 2009;37:56-64.)
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    Treatment of Pneumocystis jirovecii Pneumonia with Caspofungin and Clindamycin: An HIV Patient and Literature Review
    (Bilimsel Tip Yayinevi, 2023) Yilmaz, Gul Ruhsar; Kaya, Onur; Inkaya, Ahmet Cagkan; Unal, Onur; Temel, Esra Nurlu; Akcam, Fusun Zeynep; Cetin, Emel Sesli
    The first-line treatment for Pneumocystis jirovecii pneumonia (PCP) is trimethoprim-sulfamethoxazole (TMP-SMZ). However, some cases require alternative agents due to the side effects of TMP-SMZ. Treatment with TMP-SMZ was initiated in an HIV-positive patient with microbiologically confirmed PCP, who presented with acute renal failure on admission. On the third day of treatment, TMP-SMZ was discontinued due to worsening renal function. Subsequently, clindamycin was initiated in combination with caspofungin. Although caspofungin-based therapies were shown to be effective against Pneumocystis in animal models, clinical experience in humans is limited. The patient was treated successfully with clindamycin combined with caspofungin.