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    Antibiotic combinations in treatment of infections developed with difficult-to-treat bacterias and treatment response
    (Lippincott Williams & Wilkins, 2024) Ozguler, Muge; Temel, Esra Nurlu; Sahin, Ahmet; Buyutuna, Seyit Ali; Oz, Murtaza; Singil, Sarp; Senbayrak, Seniha
    Antimicrobial resistance is a growing threat for humanity worldwide. A new definition of resistance, defined as difficult-to-treat resistance (DTR), has been made for Gram-negative infectious agents. DTR indicates resistance to all first-line treatment options, including all beta-lactams (carbapenems and beta-lactamase inhibitor combinations) and fluoroquinolones. The aim of this study is to evaluate the antibiotic combinations used in clinical practice in the management of infections with difficult to treat microorganisms and the microbiological and clinical responses to this combination. In this study is a multicenter retrospective observational cohort study. Data were collected from 10 centers. The demographic factors, preferred combination and mortality status of patients that develops with a strain that the microorganism was found to be resistant in the antibiogram were determined. A total of 174 patients from seven different centers were included in the study. One hundred and forty-eight (85%) of the patients were hospitalized in the tertiary intensive care unit. The most common bacteria were Klebsiella spp. with a rate of 80 (45.9%). We observed an overall carbapenem resistance rate of 98.5% in Klebsiella spp., 100% both in Acinetobacter spp. and Pseudomonas spp. Conclusion: This study highlights the importance of combination treatments for DTR isolates.
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    Molecular epidemiological investigation of carbapenem resistant Klebsiella pneumoniae isolated from intensive care unit patients of six geographical regions of Turkey
    (J Infection Developing Countries, 2023) Kose, Sukran; Dal, Tuba; Cetinkaya, Riza Aytac; Ari, Oguz; Yenilmez, Ercan; Temel, Esra Nurlu; Cetin, Emel Sesli
    Introduction: Klebsiella pneumonia causes serious infections in hospitalized patients. In recent years, carbapenem-resistant infections increased in the world. The molecular epidemiological investigation of carbapenem-resistant K. pneumoniae isolates was aimed in this study.Methodology: Fifty carbapenem-resistant K. pneumoniae isolates from six geographical regions of Turkey between September 2019-2020 were included in the study. The disk diffusion method was used for the antibiotic susceptibility testing. The microdilution confirmed colistin susceptibility. Genetic diversity was investigated by MLST (Multi-Locus Sequence Typing).Results: The resistance rates were as follows: 49 (98%) for meropenem, 47 (94%) imipenem, 50 (100%) ertapenem, 30 (60%) colistin and amoxicillin-clavulanate, 49 (98%) ceftriaxone, 48 (96%) cefepime, 50 (100%) piperacillin-tazobactam, 47 (94%) ciprofloxacin, 40 (80%) amikacin, 37 (74%) gentamicin. An isolate resistant to colistin by disk diffusion was found as susceptible to microdilution. ST 2096 was the most common (n:16) sequence type by MLST. ST 101 (n:7), ST14 (n:6), ST 147 and ST 15 (n:4), ST391 (n:3), ST 377 and ST16 (n:2), ST22, ST 307, ST 985, ST 336, ST 345, and ST 3681 (n:1) were classified in other isolates. In Istanbul and Ankara ST2096 was common. Among Turkey isolates, the most common clonal complexes (CC) were CC14 (n:26) and CC11 (n = 7).Conclusions: In Turkey, a polyclonal population of CC14 throughout the country and inter-hospital spread were indicated. The use of molecular typing tools will highlight understanding the transmission dynamics.