Ömrüm Uzun

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.

A 65-year-old woman with diabetes mellitus, hypertension, and relapsed acute myeloid leukemia previously treated with allogeneic hematopoietic stem cell transplantation (HSCT) was hospitalized for four months for chemotherapy, complicated by intermittent febrile (...)

Timely selection of appropriate empirical treatment for carbapenem-resistant Enterobacterales (CRE) bacteremia remains challenging, especially when prior antibiotic exposure data is unavailable. We found that intensive care unit stay duration predicts CRE bacteremia—with ≥8 days showing 81% sensitivity and 96% PPV—providing a practical clue for empirical therapy decisions.

Nocardia is a genus of aerobic, Gram-positive bacteria found in soil, decomposing organic matter, and water. It primarily causes infections in individuals with compromised immune systems. Pulmonary infections represent the most frequent manifestation of Nocardia-associated diseases, while extrapulmonary spread often involves

Candida auris is an emerging fungal pathogen that has become a critical global health concern due to its high antifungal resistance and potential to cause nosocomial outbreaks. Since its initial identification in Japan in 2009, C. auris has spread rapidly, posing significant treatment challenges across various healthcare settings worldwide. The biofilm formation ability of C. auris enhances its resilience against disinfectants and antifungal agents, complicating infection control in healthcare environments. This consensus report, developed with the collaboration of several Turkish medical specialty societies, including the Turkish Society of Infectious Diseases and Clinical Microbiology Specialty (EKMUD), the Turkish Society of Anesthesiology and Reanimation (TARD), the Turkish Intensive Care Society (TYBD), the Infectious Diseases – International Research Initiative (ID-IRI), the Clinical Microbiology Specialist Society (KLIMUD), the Turkish Microbiology Society (TMC), and the Public Health Institution of Türkiye (PHIT) under the Ministry of Health, provides a comprehensive overview of C. auris and its’ management. The report focuses on the epidemiology, antifungal resistance mechanisms, recommendations for diagnostic and therapeutic challenges, infection control and prevention measures and surveillance of C. auris. This consensus report aims to establish standardized diagnostic protocols, improve national surveillance systems, and promote effective infection control measures to mitigate C. auris related health risks in Türkiye. It also offers comprehensive national recommendations and addresses the need for inter-institutional collaboration, improve public health, and strengthen the healthcare response to this pathogens.

Purpose Posaconazole plasma levels can vary considerably among patients, underscoring the need for therapeutic drug monitoring (TDM). Nevertheless, access to TDM is limited in many clinical settings. This study aimed to investigate the impact of posaconazole TDM in daily practice at a tertiary care hospital. Methods We conducted a single-center retrospective study at a university hospital, reviewing patients who received posaconazole delayed-release tablets and underwent TDM between January 1, 2022, and December 18, 2023. Results A total of 35 patients with 74 posaconazole TDM were evaluated. Twenty-seven (77.1%) patients received posaconazole for prophylaxis. The median plasma concentration of posaconazole was 1.45 mg/L (interquartile range [IQR]: 1.74 mg/L). Overall, 74.3% of posaconazole concentrations were within the target range. Target attainment was achieved in 75.9% of prophylactic measurements (> 0.7 mg/L) and 68.7% of treatment measurements (> 1 mg/L). Subtherapeutic levels were identified in 19 samples from 12 patients. Among eight patients receiving prophylactic posaconazole with trough levels below 0.7 mg/L, two experienced breakthrough invasive fungal infections. Diarrhea, sampling before steady state, medication non-adherence, and poor oral intake were significantly more frequent in cases with subtherapeutic posaconazole levels (p = 0.022). Among six measurements with posaconazole concentrations exceeding 3.75 mg/L, an adverse effect attributable to posaconazole was observed in only one of the five patients with these elevated levels. Conclusion The findings of this real-world assessment suggest that posaconazole TDM may play a critical role in optimizing both prophylaxis and treatment, particularly among patients at risk for subtherapeutic exposure.

Introduction: Voriconazole (VCZ) serum concentrations may be affected by many factors, such as drug-drug interactions, liver dysfunction, genetic polymorphism, and inflammation. This study aimed to determine the relationship between VCZ measured trough plasma levels and C-reactive protein levels in patients with coronavirus disease 2019 (COVID-19)-associated aspergillosis (CAPA) and invasive pulmonary aspergillosis (IPA). Methodology: Patients who were > 18 years of age, received VCZ treatment for IPA or CAPA in our hospital between March 2020 and April 2021, and had their VCZ level monitored, were included in this retrospective study. Results: A total of 85 patients (35 diagnosed with CAPA) were included in this study. Forty-three patients (50.6%) had VCZ levels in the therapeutic range, 4 (4.7%) were sub-therapeutic, and 38 (44.7%) were supra-therapeutic. Inflammatory markers were significantly higher in patients with supra-therapeutic levels (p < 0.05). Supra-therapeutic levels and VCZ-related adverse effects were significantly more frequent in CAPA patients than in IPA patients (p = 0.011 and p = 0.002, respectively). Conclusions: Patients diagnosed with CAPA were more prone to adverse effects and supra-therapeutic VCZ levels. More frequent therapeutic drug monitoring is recommended in this patient population.

Objective: This study aims to assess the impact of hospital-specific guidelines on the optimal utilization of carbapenems and to examine their effects on patient outcomes. Design: Quasi-experimental study. Setting: Tertiary care hospital in Turkey where infectious diseases (IDs) consultation and antibiotic approval are mandatory for carbapenem use. Participants: All inpatients ≥18 years of age who received a carbapenem for at least 24 hours during the study periods were enrolled. Intervention: Hospital-specific treatment guidelines were introduced in April 2019. The control group was the year 2018, when there were no guidelines (pre-GP). The year 2020 was analyzed as the intervention period (post-GP). Results: A total of 678 patients were analyzed, 326 in the pre-GP period and 352 in the post-GP period. Following guideline implementation, there was a significant increase in appropriate carbapenem use (49.1% in pre-GP vs 71.9% in post-GP, P < .001). The duration of carbapenem use decreased significantly (P = .019). However, there was no significant change in the incidence of new infection episodes within the subsequent 30 days (27.6% in pre-GP vs 28.3% in post-GP), or in the length of hospitalization [median (25%–75%) = 28 (16–46) in pre-GP, 28 (15–47.5) in post-GP, P = .678]. Mortality rates were similar at day 7 post-GP (1.7%) compared to pre-GP (0.03%) (P = .125). Conclusions: The implementation of guidelines increased the appropriate utilization of carbapenems, without resulting in extended hospital stays or recurrent episodes. Despite an increased number of patients admitted to the ICU during the latter period, infection-related mortality rates remained comparable.