Murat Akova

Objective: This study examined 11-year trends in antimicrobial resistance and resistant organism isolation rates per 1000 patient-days among key Gram-positive and Gram-negative bacteria in a tertiary-care hospital in Türkiye. Materials and Methods: Microbiology data were obtained from the first isolate per patient per admission between January 2014 and December 2024. Organisms were identified using VITEK MS/matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility testing was performed using VITEK 2 or BD Phoenix, with disk diffusion used for selected agents. Clinical and Laboratory Standards Institute (CLSI) breakpoints were applied until 2015, and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints thereafter. Resistance rates (%) and resistant organism isolation rates per 1000 patient-days were calculated. Results: Enterococcus faecalis remained highly susceptible throughout the study period. In contrast, Enterococcus faecium showed progressive increases in ampicillin and vancomycin resistance, with the isolation rate of ampicillin-resistant bloodstream isolates approximately doubling from 0.405 per 1000 patient-days in 2014 to 0.773 in 2023. Methicillin-resistant Staphylococcus aureus isolation rates increased sharply, from 0.230 per 1000 patient-days in 2014 to 0.945 in 2022 among non-bloodstream isolates. Carbapenem resistance in Acinetobacter baumannii remained persistently high but broadly stable, except for a notable spike in 2021. Both resistance rates and resistant Klebsiella pneumoniae isolation rates increased for carbapenems and third-generation cephalosporins, with carbapenem resistance among bloodstream isolates increasing from 29% to 62% in 2023 and third-generation cephalosporin resistance increasing from 50% to 74%. Ceftazidime-avibactam resistance also emerged during the study period. Third-generation cephalosporin resistance in Escherichia coli initially increased but subsequently stabilized, whereas carbapenem resistance rates and isolation rates of carbapenem-resistant E. coli remained low and stable. Pseudomonas aeruginosa showed increasing resistance trends, with year-to-year fluctuations. Conclusion: Antimicrobial resistance patterns exhibited divergent trends across bacterial species. Increasing resistance rates and resistant organism isolation rates were observed in E. faecium, S. aureus, K. pneumoniae, E. coli, and P. aeruginosa, whereas E. faecalis and A. baumannii showed relatively stable patterns. Monitoring resistance rates helps update local empirical treatment guidelines, while resistant organism isolation rates per 1000 patient-days provide an additional measure for monitoring changes relevant to infection prevention and control programs.

Objective: Wound infections represent a major concern among earthquake survivors. Antibacterial prophylaxis is standard care for this population. However, there is no clear consensus guidelines regarding the choice of prophylactic agents. This study aimed to examine whether the spectrum of antibacterial prophylaxis affects wound infection rates in hospitalized survivors of the February 2023 earthquake in south-eastern Türkiye who were transferred to a tertiary care center outside the disaster zone. Materials and Methods: This retrospective study included patients with uninfected wounds upon hospital admission. Clinical characteristics, prophylaxis regimens, and microbiological data were analyzed to identify factors associated with subsequent infection. Results: The study included 83 patients. Post-admission wound infections developed in 13 patients (15.6%). These patients were more likely to require intensive care unit (ICU) admission, hemodialysis, and recurrent surgeries than those without infections. Notably, infected patients had received broader-spectrum prophylaxis (84.6% vs. 31.4%, p < 0.001), yet wound contamination with soil or debris was not significantly different between groups. Multivariable analysis identified ICU requirement as an independent risk factor for infection (adjusted odds ratio [aOR] 44.81; 95% confidence interval [CI] 6.55–306.51; p < 0.001), while prior antibiotic exposure before admission was associated with a lower risk of infection (aOR 0.10; 95% CI 0.01–0.69; p = 0.019). Among isolated bacteria, 76.5% were either extensively drug-resistant or multidrug-resistant, with Acinetobacter baumannii and Klebsiella pneumoniae being the predominant pathogens. Conclusion: The findings suggest that broad-spectrum prophylaxis alone is insufficient to prevent infections caused by highly resistant pathogens in disaster settings. The study highlights the critical need for strict adherence to infection prevention and control (IPC) measures. Overwhelming patient burden can diminish compliance with IPC practices and lead to prophylaxis failure. To manage difficult-to-treat infections, it is vital to implement additional protocols that ensure IPC integrity even under extreme workload conditions.

Delays in appropriate antimicrobial therapy can increase the risk of all-cause mortality (ACM) in hospital-acquired bloodstream infections (HA-BSIs) caused by Gram-negative bacteria (GNB). We aimed to evaluate the effectiveness of early appropriate antimicrobial therapy (EAAT) compared with late appropriate antimicrobial therapy (LAAT) in this population. This study used data from a multi-centre, prospective cohort including adult patients with HA-BSI caused by GNB across 22 Turkish hospitals. A hypothetical target trial allocating participants with HA-BSI caused by monobacterial GNB to either EAAT or LAAT was emulated using the weighting approach. The primary outcome was 14 day ACM; 28 day ACM was a secondary outcome. Cox proportional hazards models with inverse probability weighting were applied to account for confounding, with antibiotic treatment incorporated as a time-dependent variable. Among 680 patients, 14 day ACM occurred in 14.7% (40/272) of the EAAT group and 42.9% (175/408) of the LAAT group. EAAT was associated with a lower risk of 14 day ACM [adjusted hazard ratio (aHR) = 0.41; 95% CI: 0.28-0.61). Similarly, 26.1% (71/272) of the patients treated with EAAT and 49.5% (202/408) of those receiving LAAT died during 28 day follow-up (aHR = 0.66; 95% CI: 0.50-0.86). In the carbapenem-resistant GNB subset, EAAT reduced the hazard of 14 day ACM (aHR = 0.36; 95% CI: 0.21-0.60) and 28 day ACM (aHR = 0.60; 95% CI: 0.44-0.84). All prespecified and post hoc analyses consistently supported these findings. EAAT was associated with a survival benefit in individuals with HA-BSI due to GNB. Although these findings support early initiation of appropriate therapy, residual confounding cannot be excluded.

Background: Despite the vast growth of vaccine studies during the SARS-CoV-2 pandemic, clinical trials failed to adequately represent diverse societal groups, resulting in the underrepresentation of specific populations. Understanding the factors hampering participation in vaccine clinical trials is essential to better identify structural, ethical, and communication barriers and to improve inclusive strategies for broader and more equitable participation in future vaccine research. Objective: This study aimed to identify the perceived barriers to participation in vaccine trials among pregnant and lactating women, children aged younger than 18 years, and adults aged older than 65 years, as reported by professionals with expertise in vaccines or vaccine trials. Methods: An online questionnaire was developed to gather personal information, group-specific barriers to vaccine trial participation, and suggestions to overcome these barriers. Data are presented as absolute (n/N) and relative frequencies (%). Results: A total of 115 respondents, the majority (n=73, 63.5%) of whom were working in the scientific community, completed the online survey. Challenges in recruiting children were identified due to “safety or efficacy concerns,” “difficulties about ethics and regulatory issues,” and “lack of targeted information and communication.” Challenges in recruiting pregnant and lactating women were primarily “ethics and regulatory requirements,” “safety issues,” and “lack of prioritization or interest.” “Lack of information and communication channels adapted to the specific target group,” along with “lack of prioritization,” were the main challenges in recruiting older participants. Provision of health-related incentives, including but not limited to access to new treatments and receiving expert medical care, seems to be the top-rated motivation to participate in vaccine clinical trials. Conclusions: The main challenges in recruiting pregnant and lactating women and children in vaccine trials involve safety and efficacy concerns, as well as lengthy ethical and regulatory processes. For older adults, key issues include poor communication channels tailored to their needs, limited information, lack of prioritization, funding, infrastructure, and industry interest. Across all underrepresented groups, low awareness of and poor communication about research opportunities were major barriers. Additionally, mobility issues affected older adults, while lack of motivation and incentives affected children, and low health literacy and provider uncertainty impacted pregnant and lactating women. Improving communication infrastructure and enhancing communication strategies with clear, tailored messages to build trust and motivate participation are essential to improve inclusion in vaccine research.

(1) Background: Invasive fungal diseases (IFDs) represent significant challenges in clinical practice, particularly among immunocompromised individuals, leading to substantial morbidity and mortality. The present document aims to provide evidence-based consensus for the timely initiation of antifungal treatment, focusing on early empiric approaches among immunocompromised patients. (2) Methods: A multidisciplinary expert panel of nine healthcare professionals (HCPs) reviewed the literature, including guidelines and consensus reports (2013–2023; PubMed, Scopus). The panel defined appropriate empiric antifungal approaches for invasive candidiasis, aspergillosis, and mucormycosis among hematological and critically ill patients. Consensus was defined as ≥75% agreement. (3) Results: A total of 47 statements were included. The experts recommend that early targeted antifungal therapy is critical for high-risk patients with suspected IFDs. Empiric therapy may be initiated before definitive diagnosis, considering the local fungal prevalence and the patient’s risk category. Close monitoring is essential, and switching between antifungal classes may be necessary for patients who experience deterioration or side effects. The transition from intravenous to oral therapy depends on the specific infection, the availability of therapeutic drug monitoring, and the patient’s progress. (4) Conclusions: Implementing this targeted, early approach may improve the outcomes of vulnerable patients with IFDs.

Background: Anaerobic infections remain clinically significant yet underrecognized due to diagnostic challenges and limited routine susceptibility testing in clinical laboratories. Among these pathogens, Bacteroides fragilis is a clinically important anaerobe associated with bloodstream and deep‐seated infections. This study aimed to evaluate the epidemiology, clinical characteristics, and antimicrobial resistance patterns of Bacteroides fragilis bacteremia in a tertiary care hospital. Materials and Methods: This retrospective study included patients with blood cultures positive for Bacteroides fragilis between July 2018 and January 2023. Demographic characteristics, clinical features, infection sources, treatment regimens, and antimicrobial resistance patterns were analyzed. Results: Our analysis found a higher rate of Bacteroides fragilis bacteremia among cancer patients, likely linked to cancer treatments that compromise gastrointestinal defenses. Notably, both hospital‐acquired infection (OR: 4.99, 95% CI: 1.3–19.07, p = 0.019) and respiratory tract infection (OR: 8.19, 95% CI: 1.21–55.35, p = 0.031) were associated with an increased risk of death within 30 days, highlighting the importance of vigilance in healthcare environments. Resistance to clindamycin was substantial, while ampicillin resistance was expected because of the intrinsic resistance profile of Bacteroides species. While carbapenem resistance was uncommon, its presence signals a shifting resistance pattern. Metronidazole remained effective, supporting its continued use. Conclusion: Bacteroides fragilis bacteremia is associated with significant mortality, particularly in nosocomial settings. Continuous surveillance and appropriate antimicrobial stewardship are essential for effective management.