Staphylococcus aureus is a major human pathogen whose virulence and antimicrobial resistance are regulated by complex genetic networks, including the accessory gene regulator (agr) system. Although the relationship between agr types, virulence factors, antimicrobial resistance, and toxin gene distribution has been widely investigated, inconsistencies among reported findings highlight the need for further studies in different geographic and epidemiological settings. This study investigated the distribution of toxin genes, agr types and evaluated their association with antimicrobial resistance profiles in clinical Staphylococcus aureus isolates. A total of 150 isolates, comprising 75 methicillin−resistant Staphylococcus aureus and 75 methicillin susceptible Staphylococcus aureus isolates, were collected from clinical specimens at Kocaeli University Hospital, Türkiye. Identification was performed using MALDI TOF-MS. Antimicrobial susceptibility testing was conducted by broth microdilution, and cefoxitin resistance was determined by disk diffusion. The agr groups (I–IV), toxin genes (sea, seb, sec, sed, see, eta, etb, tst, and pvl), mecA, and femA were detected by polymerase chain reaction. Agr group I was the most prevalent, followed by groups III and II. Isolates with higher toxin gene scores (≥ 2) were more frequently associated with agr group III, whereas lower scores (< 2) predominated in agr group I. MRSA isolates and resistance to tetracycline and erythromycin were more common in agr group III. Additionally, isolates harboring eta, tst, and pvl showed higher trimethoprim–sulfamethoxazole resistance rates. These findings demonstrate significant associations between agr types, toxin gene profiles, and antimicrobial resistance patterns, suggesting that agr typing may offer insight into the pathogenic and epidemiological characteristics of clinical Staphylococcus aureus isolates.

The rise in antibiotic-resistant microorganisms poses challenges in treating infectious diseases. It is known that Taraxacum officinale (dandelion) extracts have antimicrobial effects. This study aimed to investigate the antibacterial activities of different parts of T.officinale extracted through the Soxhlet device, against bacteria with various resistance patterns that cause hospital-acquired infections. The antibacterial effects of ethanolic and methanolic extracts were tested against Staphylococcus aureus, Enterococcus spp. (Enterococcus faecalis and Enterococcus faecium), Escherichia coli and Pseudomonas aeruginosa isolates obtained from clinical samples using disc and agar well diffusion methods. Besides, the total phenolic (TPC) and flavonoid contents (TFC) of the extracts, as well as their total antioxidant capacities (TAC), were evaluated in relation to their antibacterial activities. Mean inhibition zone diameters produced by extracts ranged between 6.0-8.0 mm in the disc diffusion method and 8.0-20.6 mm in the agar well diffusion method. Antibacterial activity was more pronounced particularly against S.aureus isolates. However, inhibition zone diameters against Enterococcus spp. isolates were found to be larger compared to those against other bacteria. Ethanolic and methanolic flower extracts had higher antibacterial activity on the isolates compared to leaf and root extracts. However, the TPC, TFC, and TAC values of ethanolic leaf extracts were higher than those of the other extracts, with values of 78.09 ± 1.13 mg GAE/g extract DW, 197.20 ± 6.22 mg QE/g extract DW, and 2.65 ± 0.03 µg AAE/mL extract, respectively.This study presents preliminary data on the antibacterial potential of herbal extracts against infections caused by resistant isolates.

BACKGROUND:The increasing prevalence of multidrug-resistant Pseudomonas aeruginosa limits treatment options and highlights the need for new antimicrobials. Although agents such as ceftazidime-avibactam (CZA), ceftolozane-tazobactam, imipenem-relebactam, and cefiderocol have expanded therapeutic choices, resistance to these antibiotics is also emerging. Combination therapies therefore remain an important strategy. This study evaluated the in vitro synergistic activity of the CZA-colistin (COL) combination in carbapenem-resistant P. aeruginosa (CRPA) isolates. METHODS:Twelve clinical CRPA isolates obtained from Kocaeli University Hospital (2021-2022) were included. Minimum inhibitory concentration values were determined by broth microdilution, and synergy was assessed using the checkerboard method. Synergy categories were defined as follows fractional inhibitory concentrations index (FICI) ≤ 0.5 synergism, 0.5 < FICI ≤ 1.0 partial synergism, 1.0 < FICI ≤ 4.0 indifference, and >4.0 antagonism. RESULTS:All isolates were susceptible to colistin, whereas four were resistant to CZA. Checkerboard analysis showed partial synergy in nine of 12 isolates (75.0%), with no antagonism detected. Partial synergy was more frequent in CZA-resistant isolates (100%) than in CZA-susceptible ones (62.5%) and was notably associated with isolates carrying blaNDM and blaOXA-48. CONCLUSIONS:CZA-COL combination may offer partial synergy, especially in CZA-resistant CRPA strains; however, broader in vivo and prospective studies are needed to support clinical use.

Shiga toxin-producing Escherichia coli (STEC) is a major foodborne pathogen with significant public health risks. This study comprehensively investigated the prevalence and distribution of seven clinically important STEC serotypes and the O104 serotype, which was assessed in food samples for the first time in T & uuml;rkiye. A total of 220 raw food samples beef (n = 49), chicken (n = 40), fish (n = 42), leafy greens (n = 44), and raw milk (n = 45) were collected from four regions in Kocaeli, T & uuml;rkiye, between May and October 2024. Samples were analyzed for stx, eae, and serotype genes using Real-Time PCR (qPCR). Serotyping was performed with multiplex qPCR for O26, O45, O103, O111, O121, O145, and monoplex qPCR for O104 and O157. STEC was detected in 27 samples (12.27 %). Among the 46 isolates, O103 (32.60 %) was the most prevalent, followed by O157 (19.56 %), O45 (17.39 %), O121 (8.69 %), O104 (6.52 %), and others (15.21 %). This study represents the first report of STEC O104 in food samples in T & uuml;rkiye, emphasizing its public health significance and the necessity for enhanced food safety surveillance. STEC prevalence was highest in beef (32.65 %), followed by raw milk (13.33 %), chicken (7.50 %), fish (2.38 %), and leafy greens (2.27 %). The most frequently detected serotypes in beef were O103 and O157, while O45 was dominant in chicken. O157 was the only serotype found in fish, whereas O103 was identified in leafy greens. Multiple serotypes, including O103, O111, and O157, were detected in raw milk. These findings underscore the need for sustained monitoring and control strategies to mitigate STEC-related risks.

Carbapenem-resistant Enterobacterales (CRE) have become a major public health problem worldwide. The aim of this study was to investigate efficacy of ceftazidime/avibactam and plazomicin on carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates. Susceptibility of imipenem, meropenem, ertapenem, ceftazidime/avibactam and plazomicin was investigated by broth-microdilution method. Major carbapenemases NDM, VIM, IMP, KPC, OXA-48 as well as other β-lactamases namely, TEM, SHV, OXA-1-like, CTX-M, ACC, FOX, MOX, DHA, CIT, EBC, VEB, GES, PER were investigated by PCR. A total of 120 carbapenem-resistant isolates (60 E. coli and 60 K. pneumoniae) were included in this study and blaOXA-48-like was found in 78.33%, blaNDM in 26.66%, blaKPC in 7.5%, blaIMP in 5.83%, and blaVIM in 5%. Among 94 isolates with the blaOXA-48-like gene, 22.3% were resistant to ceftazidime/avibactam and 51.1% were resistant to plazomicin. Of 32 isolates with blaNDM, 31 (96.9%) were resistant to ceftazidime/avibactam and 30 (93.75%) were resistant to plazomicin, and both antibiotics had limited effects against blaNDM carriers (P < 0.001). Of the 12 isolates with blaNDM+OXA-48 combination, 11 (91.7%) were resistant to ceftazidime/avibactam and plazomicin. The effect of both antibiotics was significantly lower in strains with blaNDM+OXA-48 combination (P < 0.005).The most common carbapenemase genes in this study were blaOXA-48-like and blaNDM. Ceftazidime/avibactam demonstrated a good efficacy among OXA-48 producing K. pneumoniae and E. coli, however, plazomicin had a significantly lower antibacterial effect in our study. Both antimicrobial agents should be considered as an option by evaluating combined susceptibility results and gene patterns obtained by regional and global molecular data in the treatment of CRE infections.

New and effective antibiotics are needed in the treatment of carbapenem-resistant Enterobacterales. T & uuml;rkiye is one of the high-risk countries in terms of carbapenem-resistance. Cefiderocol, which has been used in different countries recently, is promising in the treatment of carbapenem-resistant isolates. Since cefiderocol is newly approved, there is a lack of data about its resistance mechanisms. The aim of this study is to investigate the in-vitro activity of cefiderocol, which is not yet in use in T & uuml;rkiye, in the light of carbapenemase and (3- lactamase resistance genes. A total of 121 (50 Escherichia coli and 71 Klebsiella pneumoniae) clinical isolates which were determined resistant to at least one of the carbapenems and whose (3- lactamase and carbapenemase-resistance genes were investigated, were included. For the investigation of major (3- lactamase classes in 50 E. coli and 50 K. pneumoniae strains, four multiplex PCRs (blaTEM/ bla SHV / bla OXA-1-like ; bla CTX-M including phylogeneticgroups 1, 2, and 9; plasmid-derived ampC including six phylogeneticgroups; and blaVEB/blaGES/blaPER) and one simplex PCR (bla CTX-M-8/-25 ) were used. For the investigation of carbapenemase genes, one multiplex PCR (blaKPC, bla NDM , bla OXA-48-like , blaVIM, and blaIMP) was employed. For 21 K. pneumoniae strains, only carbapenem-resistance genes (VIM/NDM/OXA-48/KPC/IMP) (Gene-Xpert) were analyzed. Cefiderocol susceptibility testing was performed according to The European Committee on Antimicrobial Susceptibility Testing recommendations, and the antimicrobial susceptibility test was repeated three times. Carbapenemase genes were present in all isolates. Of the 121 isolates included in the study, 51 (42%) were resistant to cefiderocol. Twenty five (50%) of carbapenem-resistant E. coli and 26 (36.61%) of carbapenem-resistant K. pneumoniae isolates were resistant to cefiderocol. Cefiderocol resistance was higher in E. coli than K. pneumoniae isolates. Cefiderocol was found to be 57% (70/121) effective against all the strains. However, this rate increases to 74% when evaluated according to Clinical & Laboratory Standards Institute guidelines. It has been observed that cefiderecol has a certain effect against carbapenem-resistant isolates. The association of bla OXA- 48-like and bla OXA-48-like +bla NDM , which are the most common in our country, and the presence of extended-spectrum (3- lactamase enzymes significantly reduce the effect of cefiderecol. Antibiotic susceptibility testing may be considered as an option in the treatment of infectious diseases caused by carbapenem-resistant E. coli and K. pneumoniae isolates, which are difficult to treat.

Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading pathogen in urinary tract infection. In recent years multidrug-resistant B2-ST131 E. coli clonal group has disseminated worldwide. The ST131 and its subclones H30 and H30-Rx have been identified only in a few studies from Turkey. The aim of this study is to investigate the presence of ST131 and its subclones and to analyze their adhesin virulence genes and antimicrobial resistance. A total of 250 urinary ExPEC isolates were included in the study. Resistance rates of 16 antimicrobial agents were determined by disk-diffusion. Multidrug-resistance and ESBL production were analyzed. Altogether 8 adhesin genes were investigated namely, papAH, fimH, sfa/focDE, focG, afa/draBC, iha, bmaE and gafD. A total of 39 ST131 isolate were determined and 33 (84.6%) were multidrug-resistant. ESBL production was detected in 34 (87.2%) ST131 and 61 (28.9%) of non-ST131 strains. In our study, we found a strong correlation between ST131 strains and fimH, iha, afa/draBC, papAH virulence determinants. Twenty-nine (85.3%) of 34 ST131-O25b-H30 isolates were identified as H30-Rx. All the papAH gene positive isolates were identified within ST131-O25b-H30-Rx lineage. Non-H30-Rx isolates within H30 isolates were identified as pattern 2. Almost 16% of the isolates were identified as ST131 regardless of clinical syndrome and approximately 34% of the multidrug-resistant isolates were H30-Rx subclone. We report H30-Rx as the dominant subclone of ST131 in our study. Imipenem, fosfomycin and nitrofurantoin proved to be the most effective agents according to antibiotic resistance patterns of both ST131 and non-ST131 E. coli strains.

Amaç: Çoklu ilaç dirençli Gram negatif bakterilerin tedavisi küresel anlamda önemli bir halk sağlığı sorunudur. Karbapenemlere dirençli Klebsiella pneumoniae bu grupta yer alan en önemli patojenlerden biridir. Bu çalışmada karbapenemlere dirençli ve duyarlı K. pneumoniae izolatlarının çeşitli antibiyotiklere direnç durumlarının karşılaştırılması ve tedaviye yol gösterici olunması amaçlanmıştır. Yöntem: Çeşitli klinik örneklerden izole edilmiş 709 karbapenem dirençli, 3029 karbapenem duyarlı 3738 K. pneumoniae izolatının direnç oranları retrospektif olarak incelenmiş, çeşitli antibiyotiklere direnç durumları karşılaştırılmıştır. İzole edilen mikroorganizmaların tanımlanmaları ve antibiyotik duyarlılık testleri VITEK 2 (bioMérieux, Fransa) otomatize sistemi ile yapılmış, sonuçlar European Committee on Antimicrobial Susceptibility Testing (EUCAST) standartlarına göre yorumlanmıştır. Karbapenemlere dirençli izolatlarda seftazidim/ avibaktam duyarlılığı ayrıca disk difüzyon yöntemi ile çalışılmıştır. Kolistin duyarlılığının saptanmasında sıvı mikrodilüsyon yöntemi kullanılmıştır. Antibiyogram sonucu orta derecede duyarlı olanlar, duyarlı olarak kabul edilmiş ve her hastadan birer izolat çalışma kapsamına alınmıştır. Bulgular: Karbapenemlere dirençli K. pneumoniae izolatlarında amikasin, amoksisilin/ klavulanat, aztreonam, sefazolin, sefepim, sefiksim, sefoksitin, seftazidim, seftriakson, sefuroksim, siprofloksasin, kolistin, fosfomisin, gentamisin, levofloksasin, netilmisin, nitrofurantoin, piperasilin/ tazobaktam, trimethoprim/ sulfametaksazol direnç oranları sırası ile %53,12; %99,78; %98,33: %100; %98,26; %97,90; %98,68; %98,57; %98,35; %98,77; %94,63; %16,74; %41,36; %59,32; %92,53; %79,9; %67,02; %99,45; %72.23’ tür ve karbapenemlere duyarlı K. pneumoniae izolatlarına göre anlamlı derecede yüksek bulunmuştur (p<0,001). Karbapenemlere dirençli izolatlarda seftazidim/ avibaktam direnci %22,5 saptanmıştır. Sonuç: Karbapenemlere dirençli K. pneumoniae izolatlarının karbapenem dışı antimikrobiyallere karbapenemlere duyarlı izolatlara göre daha dirençli olduğu gözlenmektedir. En etkili görünen kolistinin nefrotoksik etkileri nedeni ile son seçenek olarak saklanabileceği, uygun vakalarda seftazidim/ avibaktamın, kombinasyon tedavisinde de aminoglikozidlerin kullanılabileceği, üriner sistem enfeksiyonlarında fosfomisinin uygun bir seçenek olabileceği düşünülmektedir.

COVID-19 salgını tüm dünyada olduğu gibi Kocaeli Üniversitesi Tıp Fakültesinde de eğitim süreçlerini etkilemiştir. Üniversitemizin uzaktan eğitim altyapısının kullanılabilir olması eğitiminin aksamamasında temel güvencemiz olarak rol almıştır. Fakültemizde dersler senkronize Zoom programı kullanılarak tamamlanmıştır. Tıp eğitimi boyunca en çok uygulamanın yapıldığı, bu döneme kadar edinilmiş tüm bilgi beceri ve tutumun gerçek yaşantıya transfer edildiği bir zaman dilimi olan intörnlük dönemi sekteye uğramış, bu süreçte uzaktan erişimle sürdürülecek bir takım uygulamaları ve dersleri barındıran, içeriğinde Covid-19 programı, asenkron olgu çalışmaları, çevrimiçi olgu tartışmaları, sanal hasta uygulaması, kardiyoloji, halk sağlığı ve pediyatri senkronize dersleri ile kariyer günleri bulunan intörn modülü uygulanmıştır. Tıp Eğitimi AD, eğitim komisyonları ve yönetim aktif rol almış yazılı ve sözlü geri bildirimler alınarak öğrencilerle iletişim yakından sağlanmıştır. Yaşanan bu tecrübe sonunda, uzaktan eğitimin dersleri destekleyen bir uygulama olmaktan çıkıp tıp eğitiminin tamamını içermesi kabul edilebilir olmasa da e-öğrenme platformlarının kullanılması artık çok daha kabul edilebilir ve olağandır.

Amaç: El hijyeni, hastane enfeksiyonlarının önlenmesi açısından önemlidir. Çalışma, sağlık çalışanlarının ve hasta refakatçilerinin el hijyeni ile ilgili farkındalığının ve bilgilerinin artırılması, elde üreyebilecek patojenler için kanıt oluşturulması, el hijyeni uygulamalarının iyileştirilmesi amacıyla planlandı. Gereç ve Yöntemler: Çocuk hematoloji servisindeki sağlık çalışanları ve akut lösemili hastalarının refakatçileri çalışma grubunu oluşturdu. İlk 6 haftalık dönemde katılımcılardan mesai içinde farklı günlerde, önceden haber verilmeden sıvı besi yeri doldurulmuş büyük boy steril eldiven giymeleri istenerek el kültürleri alındı. Takip eden 4 hafta içinde, haftada 1 kez el yıkama ve alkollü el dezenfektanı kullanma konusunda tekrarlanan eğitimler verildi. Duvarlara; eldeki mikroorganizmaları, el yıkama tekniklerini ve el hijyeni gerektiren işlemleri gösteren posterler asıldı. Takip eden 6 hafta içinde çalışma grubundan el kültürleri tekrar alındı. Üremeler ve bakteri koloni sayımları açısından eğitim öncesi ve sonrası dönem karşılaştırıldı. Bulgular: Eğitim öncesi 200, sonrası 180 el kültürü alındı. Eğitim sonrası bazı bakterilerin üreme oranlarında anlamlı azalma saptandı. Acinetobacter (p<0,02), Bacillus (p<0,012), Methicillin-resistant Staphylococcus aureus (p<0,007), Methicillin-sensitive Staphylococcus aureus (p<0,001), Pseudomonas spp (Pseudomonas aeruginosa dışı) (p<0,043), Staphylococcus epidermidis (p<0,001), Staphylococcus haemolyticus (p<0,005). Eğitim sonrası alınan kültürlerdeki bakteri koloni sayımlarında da eğitim öncesine göre belirgin azalma görüldü (p<0,001). Meslek gruplarına göre karşılaştırma yapıldığında koloni sayımındaki azalmalar anlamlıydı (doktorlarda p<0,001, hemşirelerde p<0,001, temizlik personelinde p<0,002, refakatçilerde p<0,001). Enterobacter cloacae ve S. Epidermidis koloni sayımlarında anlamlı azalma görüldü (p<0,008, p<0,001). Sonuç: El hijyeni konusunda tekrarlanan eğitimler, bu konuda hazırlanan afişler ve el kültürü taramaları sağlık çalışanlarının ve refakatçilerin el hijyeninde iyileşme sağlamaktadır.

Objective: In this study, we aimed to investigate the distribution of microorganisms isolated from febrile neutropenic patients in the adult hematology clinic and their antimicrobial susceptibilities for six years. Methods: The results of culture samples taken during 598 febrile episodes of 556 neutropenic patients admitted to the adult hematology clinic between January 2010 and December 2015 were retrospectively evaluated. Bactec (TM) 9120 (Becton Dickinson, Sparks, MD, USA) automated system for blood cultures from patients. Conventional diagnostic methods for identification and antibiogram, and VITEK (R) 2 (bioMerieux, Marcy l'Etoile, France) automated system was used if necessary. Results: During the six-year study period, 556 neutropenic patients were evaluated in 299 (53.7%) male patients. As the underlying diseases, 233 (42%) acute myeloid leukemia, 122 (22%) acute lymphoblastic leukemia, and 112 (20%) lymphoma were mostly seen. Gram-negative bacteria were the most frequent cause and their distribution were Escherichia coli, Klebsiella, Acinetobacter and Pseudomonas in order of frequency. Extended-spectrum beta-lactamase positivity in E. coli was 51%, while in Klebsiella spp. it was 55%. Coagulase-negative staphylococci (21%), E. coli (19%) and Klebsiella spp. (16%) were the most frequently isolated microorganisms. Enterococci were the most frequently isolated Gram-positive bacteria in 2012, exceptionally. Conclusions: In febrile neutropenia, a problem with frequent occurrence and fatality potential, we should closely monitor the resistance surveillance in isolated organisms, and review the antibacterial drugs frequently used for success of empirical therapy protocols.

Introduction: Vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) infections are among the most common Gram-positive nosocomial infections. These isolates are resistant to most antibiotics, limiting the antibiotic options that can be used in treatment and causing treatment failure. Linezolid is an important option in the treatment of resistant Gram-positive infections, and came into use in Turkey in 2006. Linezolid-resistant Enterococci and Staphylococcus strains are rarely reported worldwide. The aim of this study was to investigate whether there was an increase in linezolid minimum inhibitory concentration (MIC) values in VRE and MRSA isolates over time. Materials and Methods: Thirteen VRE and 20 MRSA isolates from 2005-2009 (group 1), 18 VRE and 20 MRSA isolates from 2013-2014 (group 2), and seven VRE and 27 MRSA isolates from 2017-2018 (group 3) obtained from various clinical samples at Kocaeli University Medical Faculty Hospital were included in the study. The linezolid MIC values of the isolates were determined by broth microdilution method. The results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing standards. Results: All of the VRE and MRSA isolates were susceptible to linezolid. Linezolid MIC50 and MIC90 values were 2 mg/l in VRE isolates in all three groups. In MRSA isolates, MIC50 was 2 mg/l in group 1, and 4 mg/l in groups 2 and 3, while MIC90 was 4 mg/l in all groups. Conclusion: Global rates of linezolid resistance has been reported to be <1% for S. aureus and VRE. There were no linezolid-resistant isolates in this study. However, we detected a significant increase in MIC50 and MIC90 values compared to most earlier studies performed in Turkey. This increase is expected due to the widespread use of linezolid over the years. The principles of rational antibiotic use should be applied to maintain the low resistance rates to linezolid, which is one of the few remaining options for the treatment of multidrug-resistant Gram-positive infections.

The aim of the study is to determine in-vitro effects of imipenem-tigecycline, imipenem-colistin and tigecycline-colistin against carbapenem-resistant Enterobacteriaceae (CRE) isolates. A total of 25 CRE isolates were included to the study. The minimum inhibition concentrations of imipenem, colistin-sulphate and tigecycline were determined with broth dilution method. Synergistic effects of imipenem-tigecycline, imipenem-colistin and tigecycline-colistin were investigated by microdilution checkerboard technique. All of the isolates were resistant to imipenem, whereas 25% of the isolates were resistant to colistin and tigecycline. Imipenem-colistin, imipenem-tigecycline and tigecycline-colistin combinations were synergistic against 40% (10/25), 24% (6/25), and 36% (9/25) of the isolates, respectively. Antagonism was observed in 8% (2/25) of the isolates in tigecycline-colistin combination. Tigecycline-colistin was the most effective (70% synergy) combination in Klebsiella spp. strains; whereas imipenem-colistin was the most effective (75% synergy) combination in Escherichia coli strains. Synergistic effect was variable and strain-depended against CRE isolates that have been tested.

BackgroundThis study investigated risk factors of childhood urinary tract infection (UTI) associated with extended-spectrum -lactamase (ESBL)-producing bacteria (ESBL-positive UTI) and evaluated antimicrobial resistance as well as empiric treatment of childhood UTI.MethodsThe records of children with positive urine culture between 1 January 2008 and 31 December 2012 were evaluated. Patients with positive urine culture for ESBL-producing bacteria were defined as the ESBL-positive group, whereas patients of the same gender and similar age with positive urine culture for non-ESBL-producing bacteria were defined as the ESBL-negative group. Each ESBL-positive patient was matched with two ESBL-negative patients.ResultsThe ESBL-positive and negative groups consisted of 154 and 308 patients, respectively. Potential risk factors for ESBL-positive UTI were identified as presence of underlying disease, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months (P < 0.05). On logistic regression analysis, CIC, hospitalization and history of infection in the last 3 months were identified as independent risk factors. In the present study, 324 of 462 patients had empiric therapy. Empiric therapy was inappropriate in 90.3% of the ESBL-positive group and in 4.5% of the ESBL-negative group. Resistance to nitrofurantoin was similar between groups (5.1% vs 1.2%, P = 0.072); resistance to amikacin was low in the ESBL-positive group (2.6%) and there was no resistance in the ESBL-negative group.ConclusionsClean intermittent catheterization, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL-positive UTI. The combination of ampicillin plus amikacin should be taken into consideration for empiric therapy in patients with acute pyelonephritis who have the risk factors for ESBL-positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis.

Objective: This study aimed to evaluate infection-related mortality in patients with acute myeloid leukemia (AML) treated without preventive antibiotics and antifungals in a middle-income country. Materials and Methods: Infection-related mortality was evaluated retrospectively in 49 pediatric patients. Results: A total of 173 chemotherapy courses were administered as first-line chemotherapy. Four patients died during induction: one patient due to intracranial bleeding, two patients due to typhlitis, and one patient due to invasive fungal infection with pulmonary vascular invasion and massive bleeding. Another two patients died with resistant disease. During consolidation there were four infection-related deaths and one death due to cardiotoxicity. In first-line chemotherapy mortality was 22% (11/49); infection-related mortality was 14% (7/49). Event-free survival and overall survival at 6 years were 42.9% and 61.2% (95% CI: 44-76 and 66-99 months), respectively. Conclusion: Due to considerable infection-related deaths, antibacterial and mold-active antifungal prophylaxis may be tried during neutropenic periods in pediatric AML.

Background: This study aims to explore risk factors of childhood urinary tract infections (UTIs) associated with extended-spectrum β-lactamase (ESBL) producing bacteria (ESBL positive UTI) and to evaluate antimicrobial resistance as well as empiric treatment of childhood UTIs. Methods: The records of children who had positive urine culture results between 1 January 2008 and 31 December 2012 were evaluated. Patients having positive urine culture results for ESBL-producing bacteria were defined as ESBL positive group whereas patients of same gender and similar age having positive urine culture results for non-ESBL-producing bacteria were defined as ESBL negative group. Each patient from ESBL positive group was matched with two patients from ESBL negative group. Results: ESBL positive and negative groups consisted of 154 and 308 patients respectively. There were potential risk factors for ESBL positive UTI (p<0.05), namely presence of underlying diseases, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months. Logistic regression analysis revealed that CIC, hospitalization and history of infection in the last 3 months were risk factors. In our study, out of 462 patients, 324 patients had empiric therapy. Empiric therapies were inappropriate in 90.3% of the ESBL positive group and in 4.5% of the ESBL negative group. Resistance to nitrofurantoin was similar among groups (5.1% vs. 1.2%, p=0.072), resistance to amikacin was low in ESBL positive group (2.6%) and there was no resistance in ESBL negative group. Conclusions: CIC, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL positive UTI. Ampicillin plus amikacin combination should be taken into consideration for the empiric therapy of patients with acute pyelonephritis who have the risk factors for ESBL positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis. A cc ep te d A rt ic le This article is protected by copyright. All rights reserved.