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    Acinetobacter baumannii Infections and Antibiotic Resistance in Hospitalized Patients in an Education and Research Hospital: A Six-Year Analysis
    (Bilimsel Tip Yayinevi, 2020) Arslan Gulen, Tugba; Imre, Ayfer; Odemis, Ilker; Kayabas, Uner
    Introduction: Acinetobacter baumanii causes difficulties in the treatment of nosocomial infections due to increasing resistance worldwide. With an increase in resistant infections, the use of colistin has come to the fore. We aimed to investigate the antimicrobial resistance profile of A. baumanii strains isolated from clinical specimens as hospital-acquired colonizations and infection agents and to evaluate the clinical and microbiologic responses and adverse effects of antibiotic regimens used in patients who were isolated because of having infectious agents. Materials and Methods: A retrospective descriptive study of 326 adult patients with nosocomial A. baumannii colonizations and infections was conducted between January 2012 and December 2017 in Nigde Education and Research Hospital. In addition, a total of 212 adult patients who received at least 72 hours of antimicrobial therapy were evaluated. Standard and automated methods were used to identify isolated strains and antibiotic susceptibility. The antimicrobial susceptibility profile change over the 6-year period was evaluated. Adverse effects, and clinical and microbiologic response were evaluated in patients receiving antimicrobial therapy. Analysis of the variables was performed using SASS 22.0 (IBM Corporation, Armonk, New York, United States). Results: When antimicrobial resistance rates were examined, it was seen that imipenem (99.7%), ampicillin sulbactam (81.6%), cefoperazone sulbactam (60.3%), netilmicin (89.4%), tobramycin (88.4%), gentamicin (83.1%), amikacin (91.6%) and tigecycline (33.7%) had resistance rates; colistin resistance was not detected in the isolates. Resistance rate to other antibiotic groups was 100%. The resistance rates of ampicillin sulbactam, cefoperazone sulbactam, gentamicin, amikacin, and tigecycline were found to be statistically significant (p< 0.05). There were no significant differences in terms of nephrotoxicity, and clinical and microbiologic response among patients in whom colistin was used in combination with carbapenem, ampicillin/sulbactam, cefoperazone/sulbactam, and tigecycline (p> 0.05). Conclusion: In accordance with the global data, antimicrobial resistance rate in A. baumanii isolates was found to be high in our study. Treatment regimens in which colistin is used with other antimicrobial agents have no superiority in terms of efficacy and adverse effects. There is a clear need for new and effective antimicrobial agents in the treatment of resistant A. baumanii infections.
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    Deep Venous Thrombosis as a Complication of Brucellosis: A Case Report on Diagnosis and Treatment Management
    (Galenos Yayincilik, 2019) Arslan Gulen, Tugba; Serhatlioglu, Faruk; Imre, Ayfer; Kayabas, Uner
    [Abstract Not Available]
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    The Effect of Antibiotic Resistance and Inappropriate Empirical Antibiotic Therapy on 3-Day and 28-Day Mortality in Bacteremic Patients in the Intensive Care Unit: 5-Year Retrospective Analysis
    (Duzce Univ, Fac Medicine, 2022) Odemis, Ilker; Arslan Gulen, Tugba
    Aim: The aim of this study was to examine the effects of antibiotic resistance, empirical antibiotic therapy, and comorbid diseases on 3 -day and 28 -day mortality in patients with bloodstream infections. Material and Methods: Files of the patients with positive blood cultures results, between January 1(st), 2015, and January 1(st), 2020 were analyzed retrospectively. The primary outcome was 3 -day mortality and the secondary outcome was 28 -day mortality. Results: A total of 515 patients, 208 (40.4%) female and 307 (59.6%) male, were included in the study. The median age of the patients was 73 (range, 18-95) years. Vancomycin resistance was detected in 8 (3.4%) of 233 gram -positive bacteria. Third -generation cephalosporin, meropenem, and colistin resistance rates of the 282 gram -negative bacteria were found to be 72.7% (n=205), 53.2% (n=150), and 9.9% (n=28), respectively. The 3 -day and 28 -day mortality rates were 14.4% (n=74) and 64.3% (n=331), respectively. Charlson comorbidity index score (CCIS) (p=0.001) and acute physiology and chronic health evaluation (APACHE) II score (p=0.019) were found to be risk factors for 3 -day mortality. Risk factors for 28 -day mortality were; age (p<0.001), CCIS (p<0.001), APACHE II score (p=0.001), chronic obstructive pulmonary disease (p=0.007), hospital -acquired infection (p=0.033), and inappropriate antibiotic therapy (p<0.001). Conclusion: There was no association between antibiotic resistance and mortality, but inappropriate antibiotic treatment was found to increase the risk of 28 -day mortality. In addition, since high CCIS and APACHE II scores increase the risk of both 3 -day and 28 -day mortality, we think that considering these scoring systems will reduce the risk of mortality.