Browsing by Author "Can, Fusun"

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Characteristics And Outcomes Of Carbapenemase Harbouring Carbapenem-Resistant Klebsiella Spp. Bloodstream Infections: A Multicentre Prospective Cohort Study In An OXA-48 Endemic Setting
(2022) Isler, Burcu; Ozer, Berna; Cinar, Gule; Aslan, Abdullah Tarik; Vatansever, Cansel; Falconer, Caitlin; Dolapci, Istar; Simsek, Funda; Tulek, Necla; Demirkaya, Hamiyet; Menekse, Sirin; Akalin, Halis; Balkan, Ilker Inanc; Aydin, Mehtap; Tigen, Elif Tukenmez; Demir, Safiye Koculu; Kapmaz, Mahir; Keske, Siran; Dogan, Ozlem; Arabaci, Cigdem; Yagci, Serap; Hazirolan, Gulsen; Bakir, Veli Oguzalp; Gonen, Mehmet; Chatfield, Mark D.; Forde, Brian; Saltoglu, Nese; Azap, Alpay; Azap, Ozlem; Akova, Murat; Paterson, David L.; Can, Fusun; Ergonul, Onder; 35301623
A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam.
The Clinical Impact of ST131 H30-Rx Subclone in Urinary Tract Infections Due To Multidrug-Resistant Escherichia Coli
(2016) Can, Fusun; Kurt-Azap, Ozlem; Ispir, Pelin; Nurtop, Elif; Seref, Ceren; Loclar, Ilayda; Aktas, Ozge Nur; Orhan, Yelda Ceren; Ergonul, Onder; 27436393
In this study, risk factors for ST131 H30 and H30-Rx subclones among urinary tract infections (UTIs) caused by multidrug-resistant (MDR) Escherichia coli were described. Urine samples were collected from consecutive outpatients registered to the outpatient clinics of Bas, kent University Hospital (Ankara, Turkey) with complaints of acute cystitis in 2011. A total of 107 MDR E. coli isolates were included in the study. Of the 107 isolates studied, 26 (24.3%) were typed as ST131 clone. Extended-spectrum beta-lactamase (ESBL)-producers accounted for 59 (55.1%) of the 107 isolates. Among the 59 ESBL-positive isolates, 18 (31%) were found to belong to the ST131 clone. Of the 18 ESBL-positive ST131 isolates, 17 (94%) were defined as H30 subclone, among which 16 (94%) represented the H30-Rx subclone. Among the 48 ESBL-negative isolates, 8 (17%) ST131 isolates were detected, 7 (88%) of which belonged to H30 subclone; 5 (71%) of the H30 subclone isolates were classified under H30-Rx subclone. In multivariate analysis, hospitalisation within last year was the only host risk factor associated with MDR E. coli ST131 H30-Rx subclone UTI (OR = 3.5, 95% CI 1.04-12.17; P = 0.042). CTX-M-15 production was found to be highly associated with the presence of ST131 H30-Rx subclone (OR = 4.8, 95% CI 1.54-15.32; P = 0.007). In conclusion, urinary MDR E. coli ST131 H30-Rx subclone was found to be important in the dissemination of MDR UTIs in the community. Approximately 20% of the MDR isolates were H30-Rx subclone. Infection with this subclone was found to be healthcare-associated. (C) 2015 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.
Comparison Of Ceftazidime-Avibactam Susceptibility Testing Methods Against OXA-48-Like Carrying Klebsiella Blood Stream Isolates
(2022) Isler, Burcu; Vatansever, Cansel; Ozer, Berna; Cinar, Gule; Aslan, Abdullah Tarik; Stewart, Adam; Simos, Peter; Falconer, Caitlin; Bauer, Michelle J.; Forde, Brian; Harris, Patrick; Simsek, Funda; Tulek, Necla; Demirkaya, Hamiyet; Menekse, Sirin; Akalinj, Halis; Balkan, Ilker Inanc; Aydin, Mehtap; Tigen, Elif Tukenmez; Demir, Safiye Koculu; Kapmaz, Mahir; Keske, Siran; Dogan, Ozlem; Arabaci, Cigdem; Yagci, Serap; Hazirolan, Gulsen; Bakir, Veli Oguzalp; Gonen, Mehmet; Saltoglu, Nese; Azap, Alpay; Azap, Ozlem; Akova, Murat; Ergonul, Onder; Paterson, David L.; Can, Fusun; 35843111
Ceftazidime-avibactam exhibits good in vitro activity against carbapenem resistant Klebsiella carrying OXA-48-like enzymes. We tested two hundred unique carbapenem resistant Klebsiella blood stream isolates (71% with single OXA-48-like carbapenemases, including OXA-48, n = 62; OXA-232, n = 57; OXA-244, n = 17; OXA-181, n = 5) that were collected as part of a multicentre study against ceftazidime-avibactam using Etest (bioMerieux, Marcyl'Etoile, France), 10/4 mg disc (Thermo Fisher) and Sensititre Gram Negative EURGNCOL Plates (Lyophilized panels, Sensititre, Thermo Fisher) with the aim of comparing the performances of the Etest and disc to that of Sensititre. Ceftazidime-avibactam MIC50/90 was 2/> 16 mg/L for the entire collection and was 2/4 mg/L for single OXA-48-like producers. Categorical and essential agreements between the Etest and Sensititre were 100% and 97%, respectively. Categorical agreement between the disc and Sensititre was 100%. Etest and 10/4 mg discs are suitable alternatives to Sensititre for ceftazidime-avibactam sensitivity testing for OXA-48-like producers. (C) 2022 Elsevier Inc. All rights reserved.
Effect of initial antifungal therapy on mortality among patients with bloodstream infections with different Candida species and resistance to antifungal agents: A multicentre observational study by the Turkish Fungal Infections Study Group
(2020) Dogan, Ozlem; Yesilkaya, Aysegul; Menekse, Sirin; Guler, Ozlem; Karakoc, Cagla; Cinar, Gule; Kapmaz, Mahir; Aydin, Mehtap; Keske, Siran; Sahin, Suzan; Haciseyitoglu, Demet; Yalcin, Demet; Tekin, Suda; Atac, Nazli; Albayrak, Ozgur; Aksu, Ekin Deniz; Can, Fusun; Ergonul, Onder; 32335275
This study aimed to describe the effect of initial antifungal therapy on patient mortality and to detail the current distribution and resistance patterns of Candida spp. among patients with candidaemia. A prospective observational study was performed among consecutive patients with candidaemia from 10 Turkish medical centres between January 2015 and November 2018. The primary outcome was 10-day mortality. Species were identified using MALDI-TOF/MS. A total of 342 patients with candidaemia were included, of which 175 (51.2%) were male and 68 (19.9%) were aged <18 years. The most common species were Candida albicans (47.4%), Candida parapsilosis (26.6%), Candida tropicalis (9.6%) and Candida glabrata (7.6%). Among all Candida spp., the 10-day case fatality rate (CFR) was 32.2%. The CFR was highest in patients with C. albicans (57.3%) and lowest in patients with C. parapsilosis (21.8%). The resistance rate to fluconazole was 13% in C. parapsilosis, with no significant effect on mortality. No resistance to echinocandins was detected. In the multivariate analysis, being in the ICU [OR = 2.1 (95% CI 1.32-3.57); P = 0.002], renal failure [OR = 2.4 (1.41-3.97); P = 0.001], total parenteral nutrition [OR = 2 (1.22-3.47); P = 0.006], C. albicans infection [OR = 1.7 (1.06-2.82); P = 0.027] and echinocandin as primary agent [OR = 0.6 (0.360.99); P = 0.047] were significantly associated with mortality. Candidaemia is a deadly infection. Fluconazole resistance is emerging, although it was not significantly related to mortality. Using an echinocandin as the primary agent could be life-saving. (c) 2020 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Emerging Escherichia coli O25b/ST131 Clone Predicts Treatment Failure in Urinary Tract Infections
(2015) Can, Fusun; Azap, Ozlem Kurt; Seref, Ceren; Ispir, Pelin; Arslan, Hande; Ergonul, Onder; 25378460
Background. We described the clinical predictive role of emerging Escherichia coli O25b/sequence type 131 (ST131) in treatment failure of urinary tract infection. Methods. In this prospective observational cohort study, the outpatients with acute cystitis with isolation of E. coli in their urine cultures were assessed. All the patients were followed up for clinical cure after 10 days of treatment. Detection of the E. coli O25:H4/ST131 clone was performed by multiplex polymerase chain reaction (PCR) for phylogroup typing and using PCR with primers for O25b rfb and allele 3 of the pabB gene. Results. In a cohort of patients with diagnosis of acute urinary cystitis, 294 patients whose urine cultures were positive with a growth of >10(4) colony-forming units/mL of E. coli were included in the study. In empiric therapy, ciprofloxacin was the first choice of drug (27%), followed by phosphomycin (23%), trimethoprim-sulfamethoxazole (TMP-SMX) (9%), and cefuroxime (7%). The resistance rate was 39% against ciprofloxacin, 44% against TMP-SMX, and 25% against cefuroxime. Thirty-five of 294 (12%) isolates were typed under the O25/ST131 clone. The clinical cure rate was 85% after the treatment. In multivariate analysis, detection of the O25/ST131 clone (odds ratio [ OR], 4; 95% confidence interval [ CI], 1.51-10.93; P = .005) and diabetes mellitus (OR, 2.1; 95% CI,.99-4.79; P = .05) were found to be significant risk factors for the treatment failure. In another multivariate analysis performed among quinolone-resistant isolates, treatment failure was 3 times more common among the patients who were infected with ST131 E. coli (OR, 3; 95% CI, 1.27-7.4; P = .012). Conclusions. In urinary tract infections, the E. coli ST131 clone seems to be a consistent predictor of treatment failure.
In Memoriam: Prof. Dr. Kenan Midilli (1963-2022)
(2022) Aygun, Gokhan; Aygun, Pakize; Azap, Alpay; Benzonana, Nur; Can, Fusun; Ergonul, Onder; Kurt-Azap, Ozlem; Kuskucu, Mert Ahmet; Simsek-Yavuz, Serap; Turan, Ayfer; 0000-0002-3171-8926; AAK-4089-2021
Promoters of Colistin Resistance in Acinetobacter Baumannii Infections
(2019) Nurtop, Elif; Bilman, Fulya Bayindir; Menekse, Sirin; Azap, Ozlem Kurt; Gonen, Mehmet; Ergonul, Onder; Can, Fusun; https://orcid.org/0000-0002-3171-8926; 30964377; AAK-4089-2021
Objectives: We aimed to describe the mechanisms of colistin resistance in Acinetobacter baumannii. Materials and Methods: Twenty-nine patients diagnosed with colistin-resistant A. baumannii infection were included to the study. The mutations in pmrCAB, lpxA, lpxC, and lpxD genes, expression of pmrCAB, carbapenemases, and mcr-1 positivity were studied. Results: Twenty-seven (93%) of the patients received IV colistin therapy during their stay, and the case fatality rate was 45%. All mutations in pmrC and pmrB were found to be accompanied with a mutation in lpxD. The most common mutations were I42V and L150F in pmrC (65%), E117K in lpxD (65%), and A138T in pmrB (58.6%). The colistin minimum inhibitory concentrations (MICs) of the isolates having any of these four mutations were higher than the isolates with no mutations (p < 0.001). The two most common mutations in pmrC (I42V and L150F) were found to be associated with higher expressions of pmrA and pmrC and higher colistin MIC values (p = 0.010 and 0.031). All isolates were bla(OXA-23) positive. Conclusion: Coexistence of the lpxD mutation along with mutations in pmrCAB indicates synergistic function of these genes in development of colistin resistance in A. baumannii.