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    An outbreak associated with multidrug-resistant Pseudomonas aeruginosa contamination of duodenoscopes and an automated endoscope reprocessor
    (Allied Acad, 2017) Yetkin, Funda; Ersoy, Yasemin; Kuzucu, Cigdem; Otlu, Baris; Parmaksiz, Nalan; Seckin, Yuksel
    Background: Duodenoscopes are semi-critical devices used for endoscopic retrograde cholangiopancreatography (ERCP). Disinfection of these instruments is usually based on high-level disinfection procedures with a manual or automated endoscope reprocessor (AER). Duodenoscopes and AER are reported very rarely as a source of infection and outbreaks. Aim: To investigate an outbreak caused by Pseudomonas aeruginosa in a Gastroenterology Department and ERCP unit in a university hospital and its underlying risk factors. Method: Three patients in the gastroenterology unit were diagnosed as infected by multidrug-resistant P. aeruginosa and a case control study was conducted for detection of the risk factors. Our infection control team commenced active epidemiological surveillance to determine the cause of these infections. Clonal relationship of the strains was investigated by pulsed field gel electrophoresis (PFGE). Results: Eight patients were affected in the gastroenterology unit during the period November 2007-February 2008. The case-control analysis confirmed that undergoing ERCP was significantly associated with isolation of P. aeruginosa (P=0.0001) in this unit. Six patients' isolates and seven environmental isolates had an indistinguishable PFGE profile, confirming cross-transmission. The healthcare worker implemented infection control measures to resolve the outbreak and no further cases occurred. Conclusions: This outbreak resulted from failure of AER and inadequate high level disinfection procedures. AERs can cause contamination of duodenoscopes and can be related P. aeruginosa outbreaks. Reuse of ancillary materials of ERCP play a critical role in outbreak development.
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    An outbreak associated with multidrug-resistant pseudomonas aeruginosa contamination ofduodenoscopes and an automated endoscope reprocessor
    (Allıed acad, 40 bloomsbury way, lower ground flr, london, wc1a 2se, england, 2017) Yetkin, Funda; Ersoy, Yasemin; Kuzucu, Cigdem; Otlu, Baris; Parmaksiz, Nalan; Seckin, Yuksel
    Background: Duodenoscopes are semi-critical devices used for endoscopic retrograde cholangiopancreatography (ERCP). Disinfection of these instruments is usually based on high-level disinfection procedures with a manual or automated endoscope reprocessor (AER). Duodenoscopes and AER are reported very rarely as a source of infection and outbreaks. Aim: To investigate an outbreak caused by Pseudomonas aeruginosa in a Gastroenterology Department and ERCP unit in a university hospital and its underlying risk factors. Method: Three patients in the gastroenterology unit were diagnosed as infected by multidrug-resistant P. aeruginosa and a case control study was conducted for detection of the risk factors. Our infection control team commenced active epidemiological surveillance to determine the cause of these infections. Clonal relationship of the strains was investigated by pulsed field gel electrophoresis (PFGE). Results: Eight patients were affected in the gastroenterology unit during the period November 2007-February 2008. The case-control analysis confirmed that undergoing ERCP was significantly associated with isolation of P. aeruginosa (P=0.0001) in this unit. Six patients' isolates and seven environmental isolates had an indistinguishable PFGE profile, confirming cross-transmission. The healthcare worker implemented infection control measures to resolve the outbreak and no further cases occurred. Conclusions: This outbreak resulted from failure of AER and inadequate high level disinfection procedures. AERs can cause contamination of duodenoscopes and can be related P. aeruginosa outbreaks. Reuse of ancillary materials of ERCP play a critical role in outbreak development.
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    Pathogens of Intensive Care Unit-Acquired Infections and Their Antimicrobial Resistance: A 9-Year Analysis of Data from a University Hospital
    (Kowsar Publ, 2018) Yetkin, Funda; Yakupogullari, Yusuf; Kuzucu, Cigdem; Ersoy, Yasemin; Otlu, Baris; Colak, Cemil; Parmaksiz, Nalan
    Background: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive actions in healthcare settings. Objectives: We investigated the causative agents of intensive care unit (ICU)-acquired infections and their antimicrobial resistance in a university hospital over a nine-year period. Methods: An active, prospective surveillance was conducted in the ICUs of a tertiary care hospital between 2007 and 2015. The changing patterns in the frequency of pathogens and their antimicrobial resistance by the time were statistically evaluated with Mann-Whitney U test. Results: A total of 3044 pathogens were isolated from 4272 healthcare-associated infections attacks in 3437 patients. The most frequently detected organisms were Acinetobacter spp. (n = 1060, 34.8%), Pseudomonas aeruginosa (n = 622, 20.4%), Escherichia coli (n = 340, 11.1%), Klebsiella pneumoniae (n = 331, 10.8%), and Candida spp. (n = 285, 9.3%). Carbapenem resistance among Acinetobacter spp., P. aeruginosa, E. coli, and K. pneumoniae was found as 82%, 30.7%, 2%, and 9.3%, respectively. The prevalence of extended-spectrum betalactamase (ESBL) among E. coli and K. pneumoniae was 49.7% and 41.3%, orderly, and methicillin resistance in Staphylococcus aureus was 81.8%. Substantial reductions occurred in the rates of E. coli (16.8% to 8.9%), S. aureus (11% to 3.2%), coagulase-negative staphylococci (7.9% to 0), and Stenotrophomonas maltophilia (4.2% to 0.3%) during the study period by the applied infection control measures while the rate of Acinetobacter spp. (9.7% to 51%) significantly increased. Furthermore, the increases in the carbapenem resistance among Acinetobacter spp. (52.5% to 91.4%), Pseudomonas spp. (25.7% to 51.6%), E. coli (0 to 12.7%), and K. pneumoniae (2.6% to 9%) and the decrease in the prevalence of ESBL-producing E. coli (57% to 27.2%) were statistically significant. Conclusions: Despite the decreases in the frequencies of staphylococci and some Gram-negative bacteria, the current infection control measures have been unable to limit the spread of carbapenem-resistant Gram-negative bacteria in our facility. Additional precautions are required to control such pathogens in the intensive care units.
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    Pathogens of ıntensive care unit-acquired ınfections and their antimicrobial resistance: a 9-yearanalysis of data from a university hospital
    (Ahvaz jundıshapur unıv med scı, po box 6357-33118, ahvaz, 00000, ıran, 2018) Yetkin, Funda; Yakupogullari, Yusuf; Kuzucu, Cigdem; Ersoy, Yasemin; Otlu, Baris; Colak, Cemil; Parmaksiz, Nalan
    Background: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive actions in healthcare settings. Objectives: We investigated the causative agents of intensive care unit (ICU)-acquired infections and their antimicrobial resistance in a university hospital over a nine-year period. Methods: An active, prospective surveillance was conducted in the ICUs of a tertiary care hospital between 2007 and 2015. The changing patterns in the frequency of pathogens and their antimicrobial resistance by the time were statistically evaluated with Mann-Whitney U test. Results: A total of 3044 pathogens were isolated from 4272 healthcare-associated infections attacks in 3437 patients. The most frequently detected organisms were Acinetobacter spp. (n = 1060, 34.8%), Pseudomonas aeruginosa (n = 622, 20.4%), Escherichia coli (n = 340, 11.1%), Klebsiella pneumoniae (n = 331, 10.8%), and Candida spp. (n = 285, 9.3%). Carbapenem resistance among Acinetobacter spp., P. aeruginosa, E. coli, and K. pneumoniae was found as 82%, 30.7%, 2%, and 9.3%, respectively. The prevalence of extended-spectrum betalactamase (ESBL) among E. coli and K. pneumoniae was 49.7% and 41.3%, orderly, and methicillin resistance in Staphylococcus aureus was 81.8%. Substantial reductions occurred in the rates of E. coli (16.8% to 8.9%), S. aureus (11% to 3.2%), coagulase-negative staphylococci (7.9% to 0), and Stenotrophomonas maltophilia (4.2% to 0.3%) during the study period by the applied infection control measures while the rate of Acinetobacter spp. (9.7% to 51%) significantly increased. Furthermore, the increases in the carbapenem resistance among Acinetobacter spp. (52.5% to 91.4%), Pseudomonas spp. (25.7% to 51.6%), E. coli (0 to 12.7%), and K. pneumoniae (2.6% to 9%) and the decrease in the prevalence of ESBL-producing E. coli (57% to 27.2%) were statistically significant. Conclusions: Despite the decreases in the frequencies of staphylococci and some Gram-negative bacteria, the current infection control measures have been unable to limit the spread of carbapenem-resistant Gram-negative bacteria in our facility. Additional precautions are required to control such pathogens in the intensive care units.