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Recently, an extended-spectrum beta-lactamase (PER-1) was found to be disseminated among Acinetobacter spp. and Pseudomonasaeruginosa isolates in Turkey. A population-based cohort study was conducted to elucidate predictive mortality factors in patients with nosocomial infections caused by Acinetobacter spp. and P. aeruginosa, with particular reference to PER-1-type extended-spectrum beta-lactamase (ESBL) production. The study group comprised 16 and 21 non-survivors and 82 and 126 survivors in cohorts infected with Acinetobacter and P. aeruginosa, respectively. In the Acinetobacter-infected cohort, nosocomial pneumonia, hypotension and infection with a PER-positive isolate were independent predictors of mortality. In the P. aeruginosa-infected cohort, impaired consciousness, a PER-positive isolate, male sex and (with a negative relative risk) urinary tract infection were independent predictors of death. This study demonstrated the relationship of PER-1-type ESBL-producing Acinetobacter spp. and P. aeruginosa with poor clinical outcome.

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A multicenter antimicrobial surveillance program was established in Turkey in 1995 to monitor the predominant Gram-negative pathogens from intensive care units (ICUs) and antimicrobial resistance patterns of these isolates. Sixteen hospitals participated in the study and a total of 1479 isolates from 1,100 patients were collected. The isolates were tested for their susceptibility against 13 antibiotics by E-test method. Minimum inhibitory concentrations (MICs) for each isolate were determined for imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin. The most common isolates were Pseudomonas spp. (28.2%), Escherichia coli (19.2%) and Klebsiella spp. (19.1%). We found very high resistance rates to all major antibiotics that are used to treat serious infections. Although imipenem is the most active agent, it had an overall susceptibility rate of 68%. Half of the tested Klebsiella spp. strains were found to produce ESBL. This is a very high rate when compared with the literature. Cross-resistance among species was also investigated. 52% of ciprofloxacin-resistant strains were also resistant to imipenem, 80% to ceftazidime, 97% to ceftriaxone, 86% to amikacin and 19% of imipenem-resistant strains were susceptible to ceftazidime and 18% to amikacin. When susceptibilities of the years 1995 and 1999 were compared, the most interesting finding was the decrease in resistance to 3rd generation cephalosporins. In conclusion, this national clinical isolate database shows that resistance rates are high, the change over years is not predictable and continuous surveillance is necessary to monitor antimicrobial resistance and to guide antibacterial therapy.

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Giriş:Hastane kökenli ya da sağlık bakımı ile ilişkili enfeksiyonların (HE) görülme sıklığı ülkeden ülkeye, hatta aynı hastanenin farklı birimlerine göre değişebilmektedir. Prevalans çalışmaları ile hastanelerdeki enfeksiyon sorunu daha geniş bir perspektifte tüm hastaneyi kapsayacak şekilde ortaya konulabilir ve kontrol önlemleri bu kapsamda değerlendirilebilir. Bu çalışmada bir üçüncü basamqk eğitim hastanesi olan hastanemizde 23 Aralık 2013 tarihinde yatan hastalardaki HE prevalansı irdelenmiştir. Gereç ve Yöntem: Bin sekiz yüz elli yatak kapasiteli hastanemizde (1,516'sı erişkin, 334'ü pediatrik ve toplam 328'i yoğun bakım yatağı), 23 Aralık 2013'de yatmakta olan hastalardan, ilgili bölüm enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültan hekimleri tarafından HE tanısı konulan hastalar altta yatan hastalıklar, risk faktörleri, uygulanan tıbbi girişimler, enfeksiyon odakları ve etken mikroorganizmalar açısından değerlendirilmiştir. Bulgular: Prevalans çalışmasının yapıldığı 23 Aralık 2013'de yatan hasta sayısı 1,470, HE prevalansı %7,21 olarak saptanmıştır. Hastalarda en sık görülen HE tipi pnömoni olup, diğer HE odakları sırasıyla idrar yolu enfeksiyonu, bakteriyemi, cerrahi alan enfeksiyonları ve intraabdominal enfeksiyonlar şeklinde sıralanmıştır. Sonuç: Hastanemiz gibi büyük hastanelerde tüm kliniklerde hastaya dayalı, aktif sürveyans yapılamadığı durumlarda, uygun aralıklarla tekrarlanan nokta prevalans çalışmalarının HE izleminde ve etkili enfeksiyon kontrol önlemleri alınmasında yararlı olacağını düşünüyoruz. Anahtar Kelimeler: Hastane enfeksiyonu, nokta prevelans, sürveyans, sağlık bakımı ilişkili enfeksiyonlar, nozokomiyal enfeksiyon Introduction: The prevalence of hospital-acquired or healthcare-associated infections (HAI) varies from country to country even between different units of the same hospital. By the help of prevalence studies, HAI rates can be demonstrated in a wider perspective and, based on these data; infection control measures may be reevaluated. In this study, we investigated the HAI prevalence in hospitalized patients on 23 December 2013 at our tertiary-care educational hospital. Materials and Methods: On 23 December 2013, patients diagnosed with HAI (by using Centers for Disease Control and Prevention criteria) by infectious diseases and clinical microbiology specialists in our 1850-bedded (including 1.516 adult, 334 pediatric and a total of 328 intensive care unit beds) tertiary-care hospital, were evaluated in terms of underlying disease, risk factors, implementation initiatives, focus of infection and causative microorganisms. Results: The number of patients hospitalized on 23 December 2014 was 1.470, the prevalence of HAI was found to be 7.21%. The most common type of HAI was pneumonia followed by urinary tract infection, bacteremia, surgical site infections and intra-abdominal infections. Conclusion: We conclude that repeated HAI prevalence studies at appropriate intervals are very useful for taking effective infection control measures and follow-up of HAI in large hospi...

Opportunistic infections due to Rhodococcus equi have been increasingly reported in the immunocompromised population, especially in patients with AIDS. In this report, we present an unusual case of purulent meningitis that developed in an immunocompetent six‐year‐old child through direct inoculation of R. equi.

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