1
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Isler B, Vatansever C, Özer B, Çınar G, Aslan AT, Falconer C, Bauer MJ, Forde B, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Can F, Paterson DL, Harris PNA. Higher rates of cefiderocol resistance among NDM producing Klebsiella bloodstream isolates applying EUCAST over CLSI breakpoints. Infect Dis (Lond) 2023; 55:607-613. [PMID: 37391868 DOI: 10.1080/23744235.2023.2226709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Cefiderocol is generally active against carbapenem-resistant Klebsiella spp. (CRK) with higher MICs against metallo-beta-lactamase producers. There is a variation in cefiderocol interpretive criteria determined by EUCAST and CLSI. Our objective was to test CRK isolates against cefiderocol and compare cefiderocol susceptibilities using EUCAST and CLSI interpretive criteria. METHODS A unique collection (n = 254) of mainly OXA-48-like- or NDM-producing CRK bloodstream isolates were tested against cefiderocol with disc diffusion (Mast Diagnostics, UK). Beta-lactam resistance genes and multilocus sequence types were identified using bioinformatics analyses on complete bacterial genomes. RESULTS Median cefiderocol inhibition zone diameter was 24 mm (interquartile range [IQR] 24-26 mm) for all isolates and 18 mm (IQR 15-21 mm) for NDM producers. We observed significant variability between cefiderocol susceptibilities using EUCAST and CLSI breakpoints, such that 26% and 2% of all isolates, and 81% and 12% of the NDM producers were resistant to cefiderocol using EUCAST and CLSI interpretive criteria, respectively. CONCLUSIONS Cefiderocol resistance rates among NDM producers are high using EUCAST criteria. Breakpoint variability may have significant implications on patient outcomes. Until more clinical outcome data are available, we suggest using EUCAST interpretive criteria for cefiderocol susceptibility testing.
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Affiliation(s)
- Burcu Isler
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Cansel Vatansever
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Berna Özer
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, School of Medicine, Ankara University Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Caitlin Falconer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Brian Forde
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Ankara Hospital, Başkent University, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, School of Medicine, Uludağ University, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Infectious Diseases, VKV American Hospital, Istanbul, Turkey
| | - Özlem Doğan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, School of Medicine, Ankara University Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Ankara Hospital, Başkent University, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Önder Ergönül
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Füsun Can
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - David L Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
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2
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Isler B, Falconer C, Vatansever C, Özer B, Çınar G, Aslan AT, Forde B, Harris P, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Can F, Paterson DL. High prevalence of ArmA-16S rRNA methyltransferase among aminoglycoside-resistant Klebsiella pneumoniae bloodstream isolates. J Med Microbiol 2022; 71. [PMID: 36748503 DOI: 10.1099/jmm.0.001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction. Aminoglycosides are used for the treatment of carbapenemase-producing Klebsiella pneumoniae (CPK) infections. 16S rRNA methyltransferases (RMTs) confer resistance to all aminoglycosides and are often cocarried with NDM.Hypothesis/Gap Statement. There is a dart of studies looking at the aminoglycoside resistance mechanisms for invasive CPK isolates, particularly in OXA-48 endemic settings.Aim. We aimed to determine the prevalence of RMTs and their association with beta lactamases and MLSTs amongst aminoglycoside-resistant CPK bloodstream isolates in an OXA-48 endemic setting.Methodology. CPK isolates (n=181), collected as part of a multicentre cohort study, were tested for amikacin, gentamicin and tobramycin susceptibility using custom-made sensititre plates (GN2XF, Thermo Fisher Scientific). All isolates were previously subjected to whole-genome sequencing. Carbapenemases, RMTs, MLSTs and plasmid incompatibility groups were detected on the assembled genomes.Results. Of the 181 isolates, 109(60 %) were resistant to all three aminoglycosides, and 96 of 109(88 %) aminoglycoside-resistant isolates carried an RMT (85 ArmA, 10 RmtC, 4 RmtF1; three isolates cocarried ArmA and RmtC). Main clonal types associated with ArmA were ST2096 (49/85, 58 %) and ST14 (24/85, 28 %), harbouring mainly OXA-232 and OXA-48 +NDM, respectively. RmtC was cocarried with NDM (5/10) on ST395, and NDM +OXA-48 or NDM +KPC (4/10) on ST14, ST15 and ST16. All RMT producers also carried CTX-M-15, and the majority cocarried SHV-106, TEM-150 and multiple other antibiotic resistance genes. The majority of the isolates harboured a combination of IncFIB, IncH and IncL/M type plasmids. Non-NDM producing isolates remained susceptible to ceftazidime-avibactam.Conclusion. Aminoglycoside resistance amongst CPK bloodstream isolates is extremely common and mainly driven by clonal spread of ArmA carried on ST2096 and ST14, associated with OXA-232 and OXA48 +NDM carriage, respectively.
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Affiliation(s)
- Burcu Isler
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Caitlin Falconer
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Cansel Vatansever
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Berna Özer
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brian Forde
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Patrick Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, School of Medicine, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases, VKV American Hospital, Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Özlem Doğan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, School of Medicine, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Önder Ergönül
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Füsun Can
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - David L Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,ADVANCE ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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3
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Isler B, Vatansever C, Özer B, Çınar G, Aslan AT, Stewart A, Simos P, Falconer C, Bauer MJ, Forde B, Harris P, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Paterson DL, Can F. Comparison of ceftazidime-avibactam susceptibility testing methods against OXA-48-like carrying Klebsiella blood stream isolates. Diagn Microbiol Infect Dis 2022; 104:115745. [DOI: 10.1016/j.diagmicrobio.2022.115745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/25/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
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4
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Isler B, Özer B, Çınar G, Aslan AT, Vatansever C, Falconer C, Dolapçı İ, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Chatfield MD, Forde B, Saltoğlu N, Azap A, Azap Ö, Akova M, Paterson DL, Can F, Ergönül Ö. Characteristics and outcomes of carbapenemase harbouring carbapenem-resistant Klebsiella spp. bloodstream infections: a multicentre prospective cohort study in an OXA-48 endemic setting. Eur J Clin Microbiol Infect Dis 2022; 41:841-847. [PMID: 35301623 DOI: 10.1007/s10096-022-04425-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam.
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Affiliation(s)
- Burcu Isler
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Berna Özer
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cansel Vatansever
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Caitlin Falconer
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - İştar Dolapçı
- Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases, School of Medicine, Koç University, Rumelifeneri, 34450, Sarıyer, Istanbul, Turkey.,Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Özlem Doğan
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey.,Infectious Diseases, School of Medicine, Koç University, Rumelifeneri, 34450, Sarıyer, Istanbul, Turkey
| | - Mark D Chatfield
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Brian Forde
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - David L Paterson
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Füsun Can
- Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey.,Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Önder Ergönül
- Infectious Diseases, School of Medicine, Koç University, Rumelifeneri, 34450, Sarıyer, Istanbul, Turkey. .,Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.
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5
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Şahintürk F, Demirkaya H, Dere ÜA, Sönmez E, Altınörs N, Moray G, Haberal M. Intracranial Fungal Infection After Solid-Organ Transplant. EXP CLIN TRANSPLANT 2018. [PMID: 29528023 DOI: 10.6002/ect.tond-tdtd2017.p56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurologic complications after solid-organ transplant reveal a great spectrum of pathologies. Intracranial hemorrhages, cerebral ischemic lesions, infarctions, lymphoproliferative disorders, and infections, including aspergillosis, have been observed after liver transplant. Fungi constitute nearly 5% of all central nervous system infections, mainly occurring in immunocompromised patients. The most common causative agent is Aspergillus species. It presents either as maxillary sinusitis or pulmonary infection. Brain involvement of Aspergillus carries a high rate of mortality. Aspergillosis presents in the forms of meningitis, mycotic aneurysms, infarctions, and mass lesions. Aspergillosis does not have a specific radiologic appearance. Parenchymal aspergillosis has heterogenous signal intensity (hypointense on T1-weighted and hyperintense on T2-weighted images). Here, we present 3 patients who underwent solid-organ transplant and developed central nervous system aspergillosis. Different modalities of neurosurgical intervention were performed in combination with chemotherapy as part of their fungal therapy.
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Affiliation(s)
- Fikret Şahintürk
- Department of Neurosurgery, Baskent University Faculty of Medicine, Ankara, Turkey
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6
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Aydın M, Ergönül Ö, Azap A, Bilgin H, Aydın G, Çavuş SA, Demiroğlu YZ, Alışkan HE, Memikoğlu O, Menekşe Ş, Kaya Ş, Demir NA, Karaoğlan I, Başaran S, Hatipoğlu Ç, Erdinç Ş, Yılmaz E, Tümtürk A, Tezer Y, Demirkaya H, Çakar ŞE, Keske Ş, Tekin S, Yardımcı C, Karakoç Ç, Ergen P, Azap Ö, Mülazımoğlu L, Ural O, Can F, Akalın H. Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections. J Hosp Infect 2017; 98:260-263. [PMID: 29248504 DOI: 10.1016/j.jhin.2017.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.
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Affiliation(s)
- M Aydın
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Istanbul, Turkey.
| | - Ö Ergönül
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - A Azap
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara University, Ankara, Turkey
| | - H Bilgin
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Marmara University, Istanbul, Turkey
| | - G Aydın
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara University, Ankara, Turkey; Infectious Diseases and Clinical Microbiology Department, Afyonkarahisar Training and Research Hospital, Afyonkarahisar, Turkey
| | - S A Çavuş
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Y Z Demiroğlu
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Adana, Turkey
| | - H E Alışkan
- Clinical Microbiology Department, School of Medicine, Başkent University, Adana, Turkey
| | - O Memikoğlu
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara University, Ankara, Turkey
| | - Ş Menekşe
- Infectious Diseases and Clinical Microbiology Department, SBÜ Kartal Koşuyolu Yüksek İhtisas Hospital, Training and Research Hospital, Istanbul, Turkey
| | - Ş Kaya
- Infectious Diseases and Clinical Microbiology Department, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
| | - N A Demir
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Selçuk University, Konya, Turkey
| | - I Karaoğlan
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - S Başaran
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, İstanbul University, Istanbul, Turkey
| | - Ç Hatipoğlu
- Infectious Diseases and Clinical Microbiology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ş Erdinç
- Infectious Diseases and Clinical Microbiology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - E Yılmaz
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Uludağ University, Bursa, Turkey
| | - A Tümtürk
- Infectious Diseases and Clinical Microbiology Department, Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Y Tezer
- Infectious Diseases and Clinical Microbiology Department, Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - H Demirkaya
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Ankara, Turkey
| | - Ş E Çakar
- Infectious Diseases and Clinical Microbiology Department, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ş Keske
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - S Tekin
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - C Yardımcı
- Infectious Diseases and Clinical Microbiology Department, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Ç Karakoç
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, İstinye University, Istanbul, Turkey
| | - P Ergen
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ö Azap
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Ankara, Turkey
| | - L Mülazımoğlu
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Marmara University, Istanbul, Turkey
| | - O Ural
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Selçuk University, Konya, Turkey
| | - F Can
- Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - H Akalın
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Uludağ University, Bursa, Turkey
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