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Author: search.filters.author.Kurt-Azap, Ozlemsearch.filters.applied.f.rights: search.filters.rights.info:eu-repo/semantics/closedAccess

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    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.
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    Antifungal Stewardship
    (2019) Kurt-Azap, Ozlem
    Invasive fungal infections are commonly detected because of increasing number of immunocompromised patients. Emerging antifungal resistance in addition to high mortality and costs are the triggers for the implementation of antifungal stewardship (AFS) programmes. The aim of stewardship programmes is the quality improvement in health care and better outcomes for the patients rather than the costs. Optimizing the use of antifungal drugs to achieve the best outcomes while minimizing adverse events and the emergence of resistance are the accompanying goals. AFS is less established than antibacterial stewardship because of a narrower and more complex evidence base along with only a few number of available drugs. Rapid diagnostic tools and therapeutic drug monitoring are the key components of the AFS programmes. Available data show that AFS programmes are feasible, sustainable and well accepted and favor the implementation of AFS programmes in routine care.