Mikrobiyol Bul
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Klebsiella pneumoniae is the cause of complicated and difficult-to-treat nosocomial infections such as sepsis, urinary tract infection, catheter related infections, pneumonia and surgical site infections in intensive care units. The biggest problem in infections with K.pneumoniae is that treatment options are limited due to multiple antibiotic resistance and consequently the increased morbidity and mortality. The widespread and improper use of carbapenems can lead to epidemics that are difficult to control, especially in intensive care units because of the acquired resistance to this group of antibiotics. ⋯ The 28-day mortality rates were 71.9% in the CRKP group (23/32) and 37.5% in the CSKP group (21/56). Presence of CRKP in terms of 28-day mortality (OR= 5.146; 95% CI= 1.839-14.398; p= 0.002) was an independent risk factor. The data obtained in this study will guide for conducting effective and continuous surveillance studies and implementing rational antibiotic programs to prevent the increase in CRKP.
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Streptococcus pneumoniae is a major cause of bacterial meningitis in children. It can progress and carries a serious risk of mortality and morbidity despite effective treatment. Cochlear implantation is a fairly successful procedure for restoring hearing in cases of sensorineural hearing loss. ⋯ To our knowledge, this is the first case of meningitis reported in our country associated with S.pneumoniae serotype 24B in a patient with a cochlear implant. While there has been a decrease in the prevalence of invasive pneumococcal disease with routine administration of the pneumococcal conjugate vaccine, a relative increase has been observed in its non-vaccine serotypes. This is relevant not only to patients with more risk factors, such as a cochlear implant, but also those who are at lower risk for pneumococcal infection.
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Malaria caused by Plasmodium species continues to affect the half of the world population. According to the World Health Organization 2017 data, 445.000 cases of malaria and 219 million cases of new clinical malaria cases were reported during the year. African continent is the geographical region where the disease is most frequent. ⋯ It is also known that it is difficult to distinguish a true recurrence in cases of relapses that can occur after a long time from primer infection. The best way to overcome this difficulty is to assume being in a malaria endemic area or not between primary infection and recurrence. We think that the applications that are carried out together with the microscope and molecular studies, especially in cases where there is relapses in which low parasitemia or travel story are insufficient, are extremely important both in terms of diagnosis and accurate identification of species and in the selection of treatment.
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Empiric treatment with broad-spectrum antibiotics exerts condensed pressure in intensive care units (ICUs) for the selection of multidrug-resistant bacteria. Multidrug-resistant gram-negative bacteria became the focus of interest owing to limited treatment options and negative effects on patient survival. Cumulative antibiograms can guide selection of correct empiric treatment, de-escalation treatment according to antibiogram results and development of policies in fight against antibiotic resistance. ⋯ Similarly colistin is the first choice in empiric treatment of infecitons due to non-enteric bacilli. However, the heterogeneity of the susceptibility profile observed in the hospitals, which are geographically close to each other, indicated the difference in the flora of the intensive care unit of hospitals. It would be appropriate to prepare cumulative antibiogram reports similar to those in the present study, to prevent complications, reduce costs and improve patient prognosis in the intensive care units of hospitals and these reports should become part of the infection control policies applied in hospitals.
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Letter Multicenter Study
[Results of a multicenter study investigating plasmid mediated colistin resistance genes (mcr-1 and mcr-2) in clinical Enterobacteriaceae ısolates from Turkey].
Colistin is a polymyxin antibiotic which is considered as one of the last line agents against infections due to multidrug resistant or carbapenem resistant gram-negative pathogens. Colistin resistance is associated with chromosomal alterations which can usually cause mutations in genes coding specific two component regulator systems. The first plasmid-mediated colistin resistance gene, mcr-1 was described in Escherichia coli and Klebsiella pneumoniae isolates in December 2015 and followed by another plasmid-mediated colistin resistance gene mcr-2 in 2016. ⋯ However, the presence of mcr-1/mcr-2 genes was not detected among the tested study isolates of Enterobacteriaceae. Although mcr-1/mcr-2 were not detected in our study isolates, it is highly important to understand the mechanism of resistance dissemination and determine the resistant isolates by considering that colistin is a last-line antibiotic against infections of multidrug or carbapenem resistant gram-negative bacteria. Thus, it is suggested that these mechanisms should be followed-up in both clinical and non-clinical (e.g. isolates from food animals, raw meats and environment) isolates of special populations.