WoS İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/20.500.14627/6
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Article Investigation of the Susceptibility Rates to Ceftazidime-Avibactam and Colistin, Clonal Relationships, and Clinical Data of Patients with Carbapenem-Resistant Klebsiella Pneumoniae Isolates Detected in the ICUs of a Hospital in İstanbul(K Faisal Special Hospital Research Centre, 2026) Akkaya, Yuksel; Aydin, Irfan; Harmankaya, Sebile; Karakul, Mehmet; Aydin, Mehtap; Erdin, Begum Nalca; Kilic, Ibrahim Halil; Karakuş, MehmetBACKGROUND: The increase in carbapenem-resistant K. pneumoniae (CR-Kp) in intensive care units (ICUs) causes treatment difficulties and increases risk in mortality. OBJECTIVES: The aim of this study was to investigate the susceptibility rates of CR-Kp isolates obtained from ICUs to ceftazidime-avibactam (CAZ-AVI) and colistin, carbapenem resistance genes, clonal relationships and clinical characteristics of the patients. DESIGN: Retrospective cohort SETTING: Single-center, University of Health Sciences, & Uuml;mraniye Training and Research Hospital MATERIALS AND METHODS: This study was conducted between June 2023 and December 2024. Isolates were identified using VITEK MS v.3.2, and antibiotic susceptibility testing was performed using the VITEK 2 Compact system. CAZ-AVI susceptibility was determined using disk diffusion, and colistin susceptibility was determined using broth microdilution to determine minimum inhibitory concentration (MIC) values. Carbapenem resistance genes were determined using multiplex real-time polymerase chain reaction (RT-PCR) and clonal relationship arbitrarily primed-polymerase chain reaction (AP-PCR). MAIN OUTCOME MEASURES: Resistance genes of CR-Kp isolates, clonal relationships, CAZ-AVI and colistin resistance, and clinical characteristics of patients SAMPLE SIZE: Ninety-seven isolates from 76 patients RESULTS: Among patients with CR-Kp isolates, central venous catheter use was detected in 59 cases (78%), ventilator-associated pneumonia in 44 cases (58%), and bacteremia in 39 cases (51%), respectively. It was determined that 53 of the patients (70%) died. Using the AP-PCR method, 60 different genotypes were identified among 97 isolates, and clustering was determined in 42 of the isolates (46%). It was determined that 36 (37%) of the isolates were resistant to colistin and 42 (45%) were resistant to CAZ-AVI. NDM+OXA-48, OXA-48, KPC, KPC+NDM, and NDM genes were detected in 40 (43%), 32 (35%), 10 (11%), 2 (2%), and 3 (3%) isolates, respectively. It was determined that 30 (75%) of the isolates with NDM+OXA-48 and only 4 (12%) of the isolates with OXA-48 were resistant to CAZ-AVI. CONCLUSION: In addition to OXA-48, an increase in the frequency of CR-Kp isolates containing the NDM, NDM+OXA-48, KPC+NDM, and OXA-48+KPC genes were also detected. It was also determined that resistance to colistin and CAZ-AVI is increasing. The AP-PCR method can also be used to investigate infections. LIMITATIONS: Single center,Pulsed Field Gel Electrophoresis (PFGE) could not be performed together with AP-PCRArticle Investigation of the Synergic Effect of the Colistin/Sulbactam Combination in Carbapenem-Resistant <i>acinetobacter Baumannii</I> Complex Strains With Time-Kill and Checkerboard Methods(Bilimsel Tip Yayinevi, 2021) Kilbas, Imdat; Hatipoglu, Huseyin; Kilic, Umit; Kahraman Kilbas, Elmas Pinar; Koroglu, Mehmet; Altindis, Mustafa; Kılbaş, Elmas Pınar KahramanIntroduction: Infections caused by carbapenem-resistant Acinetobacter strains have become very common in recent years, and the most frequently used medicinal treatment is colistin. Combination treatments should also be applied to prevent development of resistance to colistin. This study examines the in vitro synergic effect of the colistin/sulbactam combination in carbapenem-resistant Acinetobacter strains with the time-kill and checkerboard methods. Materials and Methods: Twenty carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex strains, which were isolated from various clinical samples, were included in this study. Strains were identified with mass spectrometry, and antibiotic sensitivity results were determined with the VITEK 2 (R) system. The in vitro effect and synergic activity of the colistin, sulbactam, and colistin/sulbactam combination on the carbapenem-resistant strains were determined using the time-kill and checkerboard methods. Seventeen strains were examined with the time-kill method, and twenty strains were examined using the checkerboard method. The fractional inhibitory concentration index of strains was calculated for detection of synergic effect. Results: Using the time-kill method applied on the colistin/sulbactam combination showed that the combination had a synergic effect on all 17 strains, while sulbactam alone did not have a bactericidal effect in the studied concentrations. When applying the checkerboard method, it was determined that the colistin/sulbactam combination had a synergic effect on 17 of the strains (85%) and an additive effect on 3 strains (15%), sulbactam had a low effect alone (15%), and colistin was effective on all strains. Conclusion: Study results indicated that the colistin/sulbactam combination had a high level of synergic effect on all studied strains using both methods.