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Öğe Cessation of Rectal Screening for Vancomycin-Resistant Enterococci: Experience from a Tertiary Care Hospital from Turkiye(Mdpi, 2023) Dizman, Guelcin Telli; Metan, Goekhan; Zarakolu, Pinar; Tanriverdi, Elif Seren; Hazirolan, Guelsen; Aytac Ak, Hanife; Kilincarslan, DilekObjective:Here, we compared the impact of different polices on the epidemiology of Vancomycin-resistant Enterococcus faecium bloodstream infections (VRE-BSIs) in a tertiary care hospital including two hospital buildings (oncology and adult hospitals) in the same campus. Material and Methods:All patients who were hospitalized in high-risk units were screened weekly for VRE colonization via rectal swab between January 2006 and January 2013. After January 2013, VRE screening was only performed in cases of suspicion of VRE outbreak and during point prevalence studies to evaluate the epidemiology of VRE colonization. Contact precautions were in place for all VRE-positive patients. The incidence density rates of hospital-acquired (HA)-VRE-BSIs were compared between two periods. Results:While the rate of VRE colonization was higher in the second period (5% vs. 9.5% (p < 0.01) for the adult hospital, and 6.4% vs. 12% (p = 0.02 for the oncology hospital), there was no increase in the incidence rate HA-VRE BSIs after the cessation of routine rectal screening in either of the hospitals. Conclusion:Screening policies should be dynamic and individualized according to the epidemiology of VRE as well as the workforce and cost. Periodical rectal screening of VRE can be discontinued if suspicion of an outbreak can be carefully monitored.Öğe Determination of Gene Mutations Associated with Macrolide and Fluoroquinolone Resistance in Patients Infected with Mycoplasma genitalium(Ankara Microbiology Soc, 2024) Caliskan, Zeynep Cansu; Tanriverdi, Elif Seren; Uzun, Mertcan; Otlu, Baris; Zarakolu, PinarA sexually transmitted bacterium, Mycoplasma genitalium has varying rates of reported resistance to macrolide and some fluoroquinolone group antimicrobials recommended for the treatment of its infections. It is currently recommended that the treatment of these must be planned according to macrolide resistance status. The aim of this study was to determine the presence of macrolide resistance associated mutations (MRM) and fluoroquinolone resistance associated mutations (QRM) in patients infected with M.genitalium. Sixty-one patients who were >= 18 years old, presented to our outpatient clinic between March 2017-March 2022, had symptoms of urethritis/cervicitis according to the Centers for Disease Control and Prevention definition were included in the study. By nucleic acid amplification test (NAAT), the presence of M.genitalium (Mycoplasma-Ureaplasma-OSR for BD MAX, BioGX, the Netherlands) as well as Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis (BD- MAX system, BD Diagnostics, USA) in the first stream urine samples was determined. Patients' age, gender, sexual orientation if indicated, diagnostic test results for human immunodeficiency virus (HIV) and syphilis, history of antibiotic use in the last three months, presence of concomitant microorganisms detected by NAAT and urine culture results of the symptomatic period were also recorded. Urine samples in which M.genitalium was detected were stored at-80 degrees C until the study day. On the study day, they were thawed and a modified real-time polymerase chain reaction (Rt-PCR) test was performed targeting the V region (147 bp) of the 23S rRNA gene for MRM and gyrA (nucleotides 172-402), gyrB (nucleotides 1256-1480), parC (nucleotides 164-483) and parE (nucleotides 1210-1489) gene regions for QRM. IBM SPSS 25 (IBM Inc., Armonk, NY, USA) software was used for descriptive statistical analysis of the patient data. Of the patients; 49 were male, 12 were female. The age range was 20-57 years. Sexual orientation of 15 (30.6%) male patients was men who have sex with men (MSM). Sixteen (26.2%) were individuals living with HIV and 14 (87.5%) were MSM. Four patients had previous syphilis infection. By NAAT, a second microorganism was present in 30 patients with M.genitalium; Ureaplasma urealyticum in 27 (90%), C.trachomatis in two (6.7%) and N.gonorrhoeae in one (3.3%) patient. Urine cultures performed in 42 (68.8%) of 61 patients during the symptomatic period yielded Lactobacillus delbrueckii in one patient. Eighteen (29.5%) patients had a history of antimicrobial use in the last three months. Macrolide resistance associated mutations was detected in 45 (73.8%) and QRM in 20 (32.8%) of M.genitalium infected individuals. Of those with MRM, 17 (37.8%) had concurrent QRM. Macrolide resistance associated mutations were detected at positions A2071G (75.6%) and A2072G (24.4%) in the 23S rRNA gene. The presence of QRM was detected in parC (85%) and gyrA regions (15%). C234T mutation in parC was detected in nine patients (45%), C184T in four, A248T in three and A248A in one, whileA288G mutation in gyrA was detected in two patients and G285T mutation in one. Chi-square test showed no significant correlation between the presence of mutations associated with resistance and MSM, HIV/syphilis infection status and antimicrobial use in the last three months (p> 0.05). To the best of our knowledge, our study is the first study on antimicrobial resistance of M.genitalium in T & uuml;rkiye and emphasizes the importance of macrolide resistance in symptomatic patients infected with M. genitalium. Further studies are needed for the clinical significance of mutations associated with fluoroquinolone resistance. Determination of antimicrobial resistance in M.genitalium diagnostic tests will be useful in terms of guiding treatment and preventing inappropriate treatment approaches in the early period.Öğe Emergence of colistin and carbapenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (CCR-Acb) complex in a neurological intensive care unit followed by successful control of the outbreak(Elsevier Science London, 2020) Metan, Gokhan; Zarakolu, Pinar; Otlu, Baris; Tekin, Ilknur; Aytac, Hanife; Bolek, Ertugrul C.; Metin, Baki C.Background: Colistin and carbapenem-resistantAcinetobacter calcoaceticus-Acinetobacter baumannii complex (CCR-Acb complex) was isolated from two consecutive patients in the neurological intensive care unit (NICU). An urgent reaction to this desperate situation was required. Patients and methods: Screening cultures were taken from the other patients sharing the NICU with index patients and repeated periodically. NICU was closed for new admissions. Infection control precautions (ICP) such as hand hygiene, cohorting patients colonized with CCR-Acb complex, cohorting the staff caring for these patients, daily bathing with chlorhexidine gluconate impregnated clothes, using gowns when contacting with patients and patient care area, and sodium hypochlorite tablets for environmental cleaning were enforced. Results: Screening cultures revealed carbapenem-resistant Acb complex in 12 out of 32 patients and 8 of them were colonized with CCR-Acb complex. NICU was opened for new admissions one month later. No further new cases with CCR-Acb complex were detected by screening cultures after 6 weeks with enforcement of ICP. Moreover, the rate of nosocomial infections caused by other multi-drug resistant Gram-negative bacilli (MDR-GNB) decreased significantly when rates before and after closing the NICU were compared. Conclusion: ICP were effective not only to limit the spread of CCR-Acb complex but also decreased the incidence of other MDR-GNB infections when applied adequately. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.Öğe In-vitro activity of fosfomycin against Escherichia coli and Klebsiella pneumoniae bloodstream isolates and frequency of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases in the carbapenem-resistant groups(Taylor & Francis Ltd, 2022) Zarakolu, Pinar; Eser, Ozgen Koseoglu; Otlu, Baris; Gurpinar, Oznur; Ozakin, Cuneyt; Akalin, Halis; Koksal, IftiharThe aim of this study was to determine the in-vitro activity of fosfomycin against Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates and the frequency of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases in the carbapenem-resistant (CR) groups. A total of 346 isolates (126 E. coli and 220 K. pneumoniae) from nosocomial bloodstream infections were included. Carbapenem and fosfomycin susceptibility were tested by Etest (bioMerieux, France) and agar dilution methods, respectively and evaluated in accordance with EUCAST criteria. The presence of OXA-48, NDM, KPC, VIM, IMP types of carbapenemases were conducted by using PCR method. Of the total 346 isolates, 185 (41 E. coli, 144 K. pneumoniae) were CR. Fosfomycin susceptibility of E. coli was higher than 95% and was not statistically significant between the CR and carbapenem-susceptible (CS) groups. Fosfomycin susceptibility of CS and CR K. pneumoniae was 90.7% and 69.4%, respectively, and statistically significantly lower in CR group. Of the total 185 CR isolates, 163 (32 E. coli, 131 K. pneumoniae) were producing carbapenemases. OXA-48 was the prominent carbapenemase type produced by E. coli (96.8%) and K. pneumoniae (70.9%). The frequency of NDM and KPC types produced by K. pneumoniae was 20.6% and 15.2%, respectively. Fosfomycin has substantial in-vitro activity against nosocomial CS and CR E. coli and CS K. pneumoniae bloodstream isolates. However, due to the risk of emerging resistance with fosfomycin monotherapy, combination therapy should be considered to obtain the possible additive or synergistic activity. Emerging fosfomycin resistance of CR K. pneumoniae isolates is alarming and OXA-48 is still the prominent carbapenemase type in Turkey.
