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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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    Daptomycin vs. glycopeptides in the treatment of febrile neutropenia: results of the Izmir matched cohort study
    (Springer Heidelberg, 2019) Sipahi, Oguz Resat; Kahraman, Hasip; Erdem, Huseyin Aytac; Yetkin, Funda; Kaya, Selcuk; Demirdal, Tuna; Tunccan, Ozlem Guzel
    PurposeIn this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin).MethodsData and outcomes of adult (aged>18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status.ResultsOverall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72h antibiotic treatment (p=0.25). There was no significant difference in cured, improved and (cured+improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p>0.05). There was also no significant difference (p>0.05), in terms of persistent response in the (D) versus (G) cohorts,ConclusionsThese findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question.