Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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; 27436393In 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.Item Renal Allograft With Calcium Oxalate Deposition: Association with Urinary Tract Infection and Development of Interstitial Fibrosis(2018) Ozdemir, B. Handan; Ayva, Sebnem; Ozdemir, Gokce; Atilgan, Alev Ok; Ozdemir, F. Nurhan; Haberal, Mehmet; 0000-0002-7528-3557; 0000-0002-2280-8778; 0000-0003-2545-0078; 0000-0001-8595-8880; 0000-0002-5682-0943; 0000-0002-3462-7632; 29528009; X-8540-2019; AAK-1967-2021; AAL-4282-2020; AAK-3333-2021; AAK-1697-2021; AAJ-8097-2021Objectives: The interaction between calcium oxalate deposition and urinary tract infection is not well established. We aimed to identify the association between these and to determine the role of calcium oxalate deposition on interstitial fibrosis development. Materials and Methods: Renal allograft biopsies of 967 patients were reviewed to identify those with calcium oxalate deposition in the renal allograft, with 27 (2.8%) identified. Follow-up biopsies were conducted to reevaluate for calcium oxalate presence and interstitial fibrosis development. At time of biopsy, presence of urinary tract infection and oxaluria was also examined from medical records. Results: Mean time for development of calcium oxalate deposition in renal allografts was 1.7 +/- 0.4 and 32.7 +/- 21.6 months in patients with primary and secondary oxalosis, respectively (P < .001). Of 27 patients with calcium oxalate deposition, 7 (25.9%) showed tubulointerstitial nephritis, with 2 also having urinary tract infection. Four patients (14.8%) had only urinary tract infection. Causes of tubulointerstitial nephritis were secondary to bacterial infection in 2 and secondary to viral infection in 5 patients (2 polyomaviruses, 2 cytomegaloviruses, 1 adenovirus). Time until development of interstitial fibrosis after calcium oxalate deposition was 3.5 +/- 2.1 and 10.3 +/- 4.1 months in patients with primary and secondary oxalosis, respectively (P = .01). Time until graft loss after calcium oxalate deposition was 9.3 +/- 7.8 and 21.8 +/- 12 months in those with primary and secondary oxalosis (P < .001), with 1-, 3-, and 5-year kidney graft survival of 43%, 28%, and 0% and 100%, 100%, and 67% in those with primary and secondary oxalosis, respectively. Conclusions: Calcium oxalate deposits increased the risk of urinary tract infection and tubulointerstitial nephritis, with bacteria inducing increased presence of calcium oxalate deposition in a renal allograft. Calcium oxalate deposition had a significant influence on interstitial fibrosis development, therefore negatively affecting graft survival.Item Evaluation of a Commercial Broth Microdilution Panel for Colistin Susceptibility Testing of Clinical Isolates of Escherichia coli and Klebsiella pneumoniae(2021) Mirza, Hasan C.; Bicakcigil, Asiye; Liste, Umran; Sancak, Banu; 0000-0002-8853-3893; 33978373; F-1232-2015Background: Colistin is among the last resort antibiotics for the treatment of infections caused by multidrug-resistant Gram-negative pathogens. Antimicrobial susceptibility testing of colistin is challenging due to its physicochemical properties. Broth microdilution (BMD) is the recommended method for colistin susceptibility testing. However BMD is not practical for clinical microbiology laboratories as manual preparation of BMD plates is time-consuming and labor intensive. Recently, some more user-friendly BMD products with commercial panels have become available. Our objective was to evaluate the performance of a commercial broth microdilution (BMD) product [Sensititre (Thermo Fisher Scientific)] for colistin MIC determination by comparison with reference BMD method using a collection of E. coli and K. pneumoniae isolates. Methods: A total of 323 unique patient isolates (102 E. coli, 221 K. pneumoniae) were included in the study. Isolates were stored at -70 degrees C and subcultured twice on sheep blood agar before testing. Colistin MICs of the isolates were determined using Sensititre (a premade BMD product with dried antibiotics) and an 'in-house prepared BMD panel prepared in accordance with CLSI guidelines' (reference method). MIC determination with Sensititre was performed according to manufacturer's instructions. The reference method was performed using untreated 96-well sterile polystyrene plates. Colistin MIC results were interpreted according to EUCAST breakpoints (susceptible, <= 2 mg/L; resistant, > 2 mg/L). Results: Overall susceptibility rate of isolates to colistin by reference BMD was 75.9%. Overall categorical agreement (CA), essential agreement (EA), very major error (VME), and major error (ME) rates for Sensititre were 98.5%, 72.5%, 3.8%, and 0.8%, respectively. The CA and EA between Sensititre and reference BMD for the isolates with reference colistin MICs close to the susceptibility breakpoint (2 - 8 mg/L) was 94.2% and 48.1%, respectively. Sensititre yielded a VME rate of 15% and ME rate of 0%, respectively, for this subset of isolates. Conclusions: In conclusion, Sensititre showed high CA but low EA with reference BMD for entire collection of isolates. The VME rate was just slightly above 3% and ME rate was acceptable. The rates of CA and EA were decreased and the rate of VME was increased when a subset consisting of more challenging isolates was used.Item Risk Factors for Urinary Tract Infection After Kidney Transplant: A Retrospective Analysis(2020) Tekkarimaz, Nihan; Ozelsancak, Ruya; Micozkadioglu, Hasan; Caliskan, Kenan; Demiroglu, Yusuf Ziya; Arslan, Ayse Hande; H, Mehmet; 0000-0001-5142-5672; 0000-0001-7631-7395; 0000-0002-0788-8319; 0000-0002-8767-5021; 0000-0002-3462-7632; 31424358; AAE-7608-2021; AAD-9088-2021; AAD-5716-2021; AAJ-7201-2021; AAJ-8097-2021Objectives: Urinary tract infections are the most common type of infections in kidney transplant recipients. They are also important factors for increased morbidity and mortality. The aims of this study were to evaluate the number of urinary tract infections, to identify possible donor/receiver-based risk factors, and to evaluate the impact of these infections on graft function. Materials and Methods: Medical records of patients who had undergone kidney transplant between 2010 and 2017 were retrospectively analyzed. Results: Our study included 145 patients (49 women [33.8%] and 96 men [66.2%]), with mean age of 35.2 +/- 12.4 years. There were 105 episodes of urinary tract infections in 55 of 145 patients (37.9%) during the first year after transplant. Female sex (P = .001), glomerulonephritis as primary kidney disease (P = .04), pretransplant diabetes (P = .05), and presence of ureteral stent (P = .03) were significant risk factors for the development of urinary tract infections. The most frequent pathogens identified were Escherichia coli and Klebsiella pneumoniae. Mean glomerular filtration rate at 12 months was significantly lower in patients with urinary tract infection than in patients without infection (80 +/- 25 vs 68 +/- 28 mL/min; P = .006). Conclusions: In kidney transplant recipients, urinary tract infections are common complications and have negative outcomes on graft function. These infections remain an important disease that requires frequent investigations and new ways of approach for prevention.Item Comparison of Antimicrobial Susceptibilities of Escherichia coli Isolated From Urinary Cultures of Different Patient Groups: A University Hospital Experience(2020) Mirza, Hasan Cenk; Sancak, Banu; F-1232-2015Objective: Our objective was to investigate the antimicrobial susceptibilities of Escherichia coli isolated from urinary cultures in Central Laboratory of Hacettepe University Faculty of Medicine Hospital and to examine the differences between antimicrobial susceptibilities of E. coli isolated from different patient groups. Methods: E. coli isolated from urinary cultures between January 1, 2017 and April 30, 2018 were included in our study. Automated systems, i.e. VITEK (R) 2 Compact (bioMerieux, Marcy l'Etoile, France) and BD Phoenix (Becton Dickinson, Sparks, MD, USA) and disk diffusion test were used for the determination of antimicrobial susceptibilities. The patients from whom the bacteria were isolated were divided into groups according to age (<18 years, 18-64 years, and >64 years), gender and patient care (outpatients/inpatients). Results: The highest susceptibility rates were observed for carbapenems (>99%), fosfomycin (98.5%), nitrofurantoin (98.3%) and amikacin (94.2%), whereas the highest resistance rates were observed for ampicillin (61.3%) and amoxicillin-clavulanate (37.5-45.7%). Antimicrobial resistance rates of isolates from patients aged 65 years and over were higher than those of patients in other age groups, with the exception of piperacillintazobactam, amikacin and ertapenem. The resistance rates of isolates belonging to male patients were higher than those belonging to female patients for all antimicrobials. Also, the resistance rates of isolates belonging to inpatients were higher than those belonging to outpatients for all antimicrobials. When the rates of extended-spectrum beta-lactamase (ESBL)-producing E. coli from different age groups were compared, the highest rate (34.2%) was observed among the isolates from patients aged 65 years and over. The rates of ESBL-producing E. coli from males (33.9%) and inpatients (36.3%) were higher than those from females (23.8%) and outpatients (23.3%), respectively. Conclusions: Antimicrobial susceptibilities of E. coli isolates may vary among different patient groups. Demographic features of patients may guide for selecting the antimicrobials for empiric treatment of urinary tract infections.Item Arising Prevalence of OXA-48 producer Escherichia coli and OXA-48 with NDM co-producer Klebsiella pneumoniae Strains(2019) Uskudar-Guclu, Aylin; Guney, Mustafa; Sig, Ali Korhan; Kilic, Selcuk; Baysallar, Mehmet; AAU-6196-2020Background/aim: This prospective study aimed to determine the presence of the most common carbapenemase genes, blaOXA-48, blaKPC, blaIMP, blaVIM and blaNDM on carbapenem resistant clinical K.pneumoniae and E.coli isolates. Materials and methods: Isolates were selected according to EUCAST guideline; gradient test and disc diffusion with both meropenem and ertapenem discs. Resistance rates of these isolates to other antimicrobial agents were also examined by disc diffusion method. Carbapenem resistance gene were investigated by using Real-Time PCR. Results: A total of 3845 E. coli and 1689 K. pneumoniae isolates from clinical samples between January 2015 and April 2017 were evaluated. The 419 isolates were found as carbapenem resistant but only the first resistant isolate (n=155; 126 K. pneumoniae and 29 E.coli) of each patient were included. Carbapenem resistant isolates were most frequently isolated from intensive care units (48.8%). Colistin was the most effective antibiotic (91.0%). The 121 (78.1%) of the tested isolates were positive for OXA-48 (103 K. pneumoniae and 18 E. coli) and 9 K. pneumoniae carrying blaNDM were also positive for blaOXA-48. VIM, IMP and KPC type carbapenemases were not detected in any isolates. Conclusion: Carbapenem-resistant pathogens have been shown to be able to develop resistance mechanisms with more than one carbapenemase encoding gene.