Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice.

PURPOSE: The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey. METHODS: A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report. RESULTS: Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetracycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respectively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 â€‹µg/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin. CONCLUSIONS: Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 â€‹µg/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.

Analysis of cytotoxic T lymphocyte antigen-4 (CTLA-4) exon 1 polymorphism in patients with type 1 diabetes mellitus in a Turkish population.

Recent studies have described linkage and association between cytotoxic T-lymphocyte antigen-4 (CTLA-4) gene polymorphism and type 1 diabetes mellitus (DM1) in some ethnic populations, but not others. This finding suggests that CTLA-4 gene association with DM1 may be influenced by the racial composition of the population. Thus, it is important to study the polymorphism of the CTLA-4 gene in different ethnic groups. In this case-control association study, the CTLA-4 gene exon 1 A/G polymorphism was analyzed in 48 children with DM1 and 80 healthy controls using polymerase chain reaction-restriction fragment length polymorphism analysis. The possible interaction of the CTLA-4 gene polymorphism with the presence of established genetic markers (HLA-DR genotyping) was also evaluated in 29 patients. The results of the present study do not suggest an association of the known polymorphism in exon 1 of the CTLA-4 gene with DM1 in this Turkish population, and G-allele containing CTLA-4 genotypes were not preferentially associated with age at clinical presentation or with presence of other genetic (HLA-DR3 or -DR4) markers of DM1.

The effects of once- or thrice-weekly mupirocin application on mupirocin resistance in patients on continuous ambulatory peritoneal dialysis--first 6 months' experience.

In the present study, we prospectively investigated the effects of once- or thrice-weekly prophylactic application of mupirocin to catheter exit sites on Staphylococcus aureus carriage, methicillin and mupirocin resistance, and catheter-related infections in continuous ambulatory peritoneal dialysis (CAPD) patients. We enrolled 36 CAPD patients (men/women: 21/ 15; mean age: 55.1 +/- 1.4 years) in the study. At the start of the study, patients had been on once-weekly mupirocin treatment for 3.1 +/- 2.0 years. They were then randomly assigned to use mupirocin either once weekly (group I; n = 18; men/women: 10/8; age: 55.3 +/- 1.8 years) or thrice weekly (group II; n = 18; men/women: 11/7; age: 55.0 +/- 2.3 years). During the study period, swabs were taken monthly from nares, axillae, the inguinal area, and the catheter exit site. We evaluated a total of 806 samples in the first 6 months of the study. The two study groups were similar in terms of age and sex. In group I, 5 isolations of S. aureus in 3 patients came from initial S. aureus carriers. During the first 6 months of the study, only 2 new S. aureus carriers were detected in group I, for a total of 7 isolations. Mupirocin resistance (MuR) was present in only 1 isolate and methicillin resistance (MeR) was not observed. In group II, no S. aureus carriers were present at the initial evaluation, and we encountered only 1 new S. aureus carrier during the first 6 months of the study. During the same period, MuR and MeR were absent in group II. During the 6 months, we observed 1 exit-site infection and 1 peritonitis episode attributable to coagulase-negative staphylococcus (CNS) in group I. In group II, we observed 1 exit-site infection attributable to CNS. During the first 6 months of the study, once- or thrice-weekly application of mupirocin to the catheter exit site has not led to any significant change in S. aureus carriage, MeR and MuR, or catheter-related infection in our CAPD patients.

Emergence of resistance in staphylococci after long-term mupirocin application in patients on continuous ambulatory peritoneal dialysis.

In the present study, we evaluated the effects of once-weekly mupirocin application to catheter exit sites on Staphylococcus aureus and coagulase-negative staphylococcus (CNS) colonization and investigated the resistance of those bacteria to methicillin (MeR) and mupirocin (MuR). We enrolled 36 continuous ambulatory peritoneal dialysis (CAPD) patients (mean age: 55.1 +/- 1.4 years) into the study. The patients (men/women: 21/15) had been applying mupirocin to the catheter exit site once weekly before the start of the study (mupirocin treatment duration: 3.1 +/- 2.0 years). During the study period, swabs were taken monthly from the nares, axillae, inguinal area, and catheter exit site. The swabs were inoculated on blood plates. Methicillin and mupirocin susceptibility were tested by disc diffusion according to the interpretative criteria of the National Committee for Clinical Laboratory Standards. We evaluated a total of 144 cultures. Among CNS isolates, the MuR was 66%, and the MeR was 38.8%. At the start of the study period, 3 patients were S. aureus nasal carriers. In nasal swabs, no MeR S. aureus was identified, and only 1 MuR S. aureus was found. Once-weekly application of mupirocin at the exit site in CAPD patients led to comparable rates of colonization by MuR S. aureus as did thrice-weekly or more frequent application. Clinical results showing high mupirocin and methicillin resistance in CNS are controversial.

[Comparison of routine sensitivity tests and mecA gene analysis for determination of methicillin resistance in Staphylococcus aureus isolates]. / Staphylococcus aureus izolatlarinin metisilin direncinin saptanmasinda rutin duyarlilik testleri ve mecA gen analizi sonuçlarinin karsilastirilmasi.

Currently, oxacillin disk diffusion test is the most frequently employed method to detect the methicillin resistance of Staphylococcus aureus isolates. However, due to some of the test conditions, errors may occur during the detection of heteroresistant bacteria. It is now widely accepted that lower incubation temperatures (< or = 35 degrees C) and media with a NaCl concentration of 2-4%, could facilitate detection. In our study, methicillin (oxacillin) susceptibilities of 125 S. aureus isolates were determined by the disk diffusion and microdilution tests as defined by National Committee for Clinical Laboratory Standards (NCCLS), and the results were compared with those of mecA gene analysis. In the routine susceptibility tests, 75 isolates were found to be methicillin resistant (MRSA), whereas 50 were found to be susceptible (MSSA). Various induction tests were performed to investigate the heterogeneous resistance among methicillin-susceptible isolates. These induction tests showed that the MIC values of seven isolates reached to the resistant levels, therefore these isolates should be accepted as "borderline oxacillin resistant S. aureus" isolates lacking the mecA gene. The susceptibility tests and mecA gene analysis of the remaining isolates yielded compatible results. In conclusion, susceptibility tests, when performed according to NCCLS recommendations, are found to be reliable and decisive, for the detection of methicillin resistance of S. aureus.