Association of SGLT-2 inhibitors with bacterial urinary tract infection in type 2 diabetes.

OBJECTIVE: We aimed to investigate the factors associated with UTI in patients with T2D whether being treated with SGLT-2i or not. METHODS: Adult patients with T2D, whose urine culture results were available, were analyzed retrospectively. Urine culture was obtained from mid-flow urine. Antibacterial treatment was given to the patients with UTI, which was defined by positive urine cultures and/or clinical findings. We grouped the patients as follows: Group A, those treated with SGLT-2i; and Group B, those not treated with SGLT-2i. RESULTS: A total of 101 patients were included. Median age was 56 (45-67), 56.4% (n = 57) of the patients were female. Urine culture was positive in 54.9% (n = 28) and 16% (n = 8) of Group A (n = 51) and Group B (n = 50), respectively. Of those for whom urine culture was positive, Escherichia coli was isolated in 83.3% (n = 30), and both Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) were isolated in 16.7% (n = 6). Klebsiella pneumoniae was isolated only from Group A. The need for and duration of hospitalization were higher in Group A (p < 0.001). UTI was detected in 60 patients. ROC analysis showed that a HbA1c of > 5.8% was associated with UTI with good accuracy (AUC: 0.835, p < 0.001). In multiple logistic regression analysis, SGLT-2i use and glucosuria were positive predictors for UTI (p = 0.004, Odds Ratio: 1984.013; and p = 0.028, and Odds Ratio: 12.480, respectively). CONCLUSION: Besides the association of HbA1c and BMI with UTI, SGLT-2i use and glucosuria predicted UTI. Urine culture is important with respect to the choice of antibacterial treatment, especially in those patients under SGLT-2i treatment. The effect of SGLT-2i on the development of UTI is independent of baseline BMI score or HbA1c.

In vitro activity of hyperthermia on swarming motility and antimicrobial susceptibility profiles of Proteus mirabilis isolates.

AIM: Swarming motility is a virulence factor for Proteus mirabilis and is a coordinated multicellular movement of bacteria. In this study, we investigated the inhibitory effect of hyperthermia on bacterial swarming motility and antimicrobial resistance. METHODS: Thirty-one P. mirabilis isolates were included in the study. Seven inoculated agar plates were incubated inside incubators with increasing temperature levels: at 36 °C (control) and 40-45 °C. On the next day, inhibition of swarming was evaluated and minimum paralyzing temperature (MPT) values were determined. An antimicrobial susceptibility test (antibiogram) is performed by exposing bacteria to increasing concentrations of antibiotics, in vitro. Thus, we used the Kirby-Bauer disk diffusion test as a screening method to analyze the antibiogram profiles of the isolates at 36 °C and 42 °C. Finally, a time-kill assay was performed to analyze the killing effect of hyperthermia (42 °C) on planktonic bacteria, in combination with the antibiotic meropenem at the first and third hours. A Wilcoxon signed-rank test was used to compare the killing effects of meropenem, hyperthermia and their combinations. RESULTS: The median MPT value was determined as 44 °C. In the disk diffusion assay, susceptibility development was observed in 94% of isolates for at least one antibiotic. In the time-kill assay, we observed a significant killing effect of hyperthermia in combination with meropenem. Under the microscope, we observed the formation of spherical cells by the effect of heat. CONCLUSION: We conclude that these findings might be useful when employing the hyperthermia method to treat infectious diseases caused by P. mirabilis in the future.

Quantitation of antibodies against SARS-CoV-2 spike protein after two doses of CoronaVac in healthcare workers.

Quantitation of antibodies to the spike protein of severe acute respiratory syndrome coronavirus 2  (SARS-CoV-2) was performed for the detection of adaptive immune response in healthcare workers (HCWs) vaccinated with CorovaVac. We prospectively recruited HCWs from a university hospital in Turkey. Serum samples from 1072 HCWs were obtained following 28 days of the first, and 21 days of the second dose. Detection and quantitation of SARS-CoV-2 antispike antibodies were performed by the chemiluminescent microparticle immunoassay (SARS-CoV-2 IgG II Quant; Abbott). Results greater than or equal to the cutoff value 50.0 AU/ml were reported as positive. After the first dose, antispike antibodies were detected in 834 of 1072 (77.8%) HCWs. Seropositivity was higher among females (84.6%) than males (70.6%) (p < 0.001) and was found to be highest in both women and men between the ages of 18-34. After the second dose, antibodies were detected in 1008 of 1012 (99.6%) HCWs. Antibody titers were significantly higher in those who had coronavirus disease-2019 before vaccination than those who did not (p < 0.001). Antibody positivity and median antibody titers were significantly less in HCWs with chronic diseases compared to those without (p < 0.05 and p < 0.001, respectively). In conclusion, our findings indicated that a relatively high frequency (99.6%) of humoral immunity was produced in HCWs aged 18-59 after two doses of CoronaVac. Quantitation of antibodies may help facilitate longitudinal monitoring of the antibody response, which will be especially useful in deciding the dose of the vaccine in vulnerable groups such as those over 60 years of age and those with chronic diseases.

Influenza vaccination rates, knowledge, attitudes and behaviours of healthcare workers in Turkey: A multicentre study.

AIM: Influenza vaccination is the most effective method in prevention of influenza disease and its complications. Our study aimed to investigate the rates of vaccination and the behaviours and attitudes against the vaccine in healthcare workers in Turkey. METHODS: This multicentre national survey is a descriptive study in which 12 475 healthcare workers. Healthcare workers were asked to answer the questionnaire consisting of 12 questions via the survey. RESULTS: It was found that 6.7% of the healthcare workers regularly got vaccinated each year and that 55% had never had the influenza vaccine before. The biggest obstacle against getting vaccinated was determined as not believing in the necessity of the vaccine (53.1%). CONCLUSION: The rates of influenza vaccination in healthcare workers in Turkey are quite low. False knowledge and attitudes on the vaccine and disease are seen as the most important reasons to decline vaccination. It is important to detect reasons for anti-vaccination and set a course in order to increase the rates of vaccination.

[Investigation of hepatitis B and hepatitis C virus infections by serological and molecular methods in hemodialysis patients]. / Hemodiyaliz hastalarinda hepatit B ve hepatit C virus enfeksiyonlarinin serolojik ve moleküler yöntemlerle arastirilmasi

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are significant causes of morbidity and mortality in hemodialysis patients, since those patients are highly susceptible to infections due to immune suppression. The aims of this study were to investigate the presence of HBV and HCV infections in chronic hemodialysis patients by serological and molecular methods, and to determine the rate of occult HBV infection and the viral genotypes. A total of 201 patients who were under hemodialysis due to end-stage renal disease, were retrospectively evaluated. The study involved the patients at three different centers in Antalya, Turkey during 2006. HBV and HCV markers in the patients' sera were screened by ELISA method, viral nucleic acids were investigated by real-time polymerase chain reaction (PCR) in patients' plasma and viral genotypes were determined by DNA sequence analysis. Detection of at least one of the HBV markers HBsAg, anti-HBc total, and HBV DNA, was accepted as HBV infection, and detection of anti-HCV and/or HCV RNA was accepted as HCV infection. HBsAg positive patients with negative HBV DNA were considered as occult HBV infection. Of the patients 80 (40%) were female, 121 (60%) were male and the mean age was 51.16 ± 16.28 (range 17-93) years. In our study, sole anti-HBs positivity due to HBV vaccination, was detected in 89 (44.3%) patients. One hundred (50%) patients were found positive in terms of HBV infection and 40 (20%) were positive for HCV infection, while 24 (12%) patients had HBV and HCV co-infections. Eighty-five (42.3%) patients had no HBV and HCV infection. Among the 5 (2.5%) patients who were HBsAg positive, four were also HBV DNA positive. Occult HBV infection was detected in 1 (0.5%) patient. Anti-HCV and HCV RNA were found positive in 37 (18.4%) and in 24 (12%) patients, respectively. Among the HCV-RNA positive patients, 3 (12.5%) were anti-HCV negative. ALT and AST levels were found normal in all of the HBV DNA positive patients, and 62.5% (15/24) of HCV RNA positive patients. All of the HBV isolates were identified as genotype D and HCV isolates as genotype 1b. No statistically significant correlation was detected between the HBV infection and patients' age, duration of hemodialysis and elevation of serum transaminase levels (p> 0.05). On the other hand, HCV infection was seen to increase with age (p= 0.047). HCV infection showed a statistically significant increase with the duration of hemodialysis. HCV infection risk was increased in patients who were under hemodialysis for ≥ 25 months (p< 0.001, OR: 0224, 95% CI= 0089-0562). There was also a statistically significant correlation between the presence of HCV infection (anti-HCV and/or HCV RNA positive) and high levels of serum transaminases (p< 0.001). However, in two of the three cases who were anti-HCV negative and HCV RNA positive, serum transaminase levels were normal while the viral loads were high. Therefore to follow-up HCV infection in the hemodialysis patients, anti-HCV and serum transaminase levels may not be sufficient alone and these patients should be evaluated periodically for HCV RNA. In addition, the detection of occult HBV infection in one of the study patients, indicated that HBV DNA should also be investigated at regular intervals in the hemodialysis patients.

[Investigation of ESBL types in community acquired urinary Escherichia coli isolates by isoelectric focusing and polymerase chain reaction]. / Toplum kaynakli üriner sistem enfeksiyonu etkeni Escherichia coli suslarinda GSBL enzim tiplerinin izoelektrik odaklama ve polimeraz zincir reaksiyonu yöntemleri ile arastirilmasi

The aim of this study was to determine the extended-spectrum beta-lactamase (ESBL) types by isoelectric focusing (IEF) and polymerase chain reaction (PCR) methods in 56 Escherichia coli strains isolated from urine samples of patients with community-acquired urinary tract infection and determined as ESBL positive with the phenotypic screening tests (E test and combined disk method). IEF revealed that most of the strains produced 1 to 3 different bands, mostly at the isoelectric points 8.2 (n= 44, 79%) compatible with CTX-M. Twenty four (43%) isolates had CTX-M and TEM enzyme bands together, 16 (29%) isolates had only CTX-M enzyme bands, 3 (5%) isolates had CTX-M, TEM, SHV bands, one had CTX-M and SHV enzyme bands together, and one had only TEM band. Eleven E.coli strains did not yield any enzyme bands. PCR analysis revealed that 93% (n= 52) of the isolates had CTX-M, 64% (n= 36) had TEM and 11% (n= 6) had SHV, while 29 (52%) had CTX-M + TEM, three had CTX-M + SHV, and three had CTX-M + TEM + SHV genes together. PER-1 type beta-lactamases were not detected by PCR method. PCR analysis of the eleven strains that yielded no band in IEF showed that 5 strains had CTX-M + TEM, 3 had CTX-M and 3 had TEM enzyme genes. The consistency between IEF and PCR methods for the determination of CTX-M, TEM and SHV enzymes was 85%, 78% and 67%, respectively. Genes encoding ESBL's are usually located on transferrable plasmids that may also carry other resistance determinants. Thus detection of beta-lactamase enzyme types in ESBL positive bacteria is important for the choice of appropriate antimicrobial agents for treatment.

[Shall we report the carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii strains detected by BD Phoenix system?]. / Pseudomonas aeruginosa ve Acinetobacter baumannii suslarinda BD Phoenix sistemi ile saptanan karbapenem direncini raporlayalim mi?

Imipenem and meropenem are broad spectrum antimicrobial agents that are especially useful in the treatment of nosocomially acquired Pseudomonas aeruginosa and Acinetobacter spp. infections. Previous reports have noted that susceptibility tests could show false resistance to imipenem. For this reason, Centers for Disease Control and Prevention has recommended that all carbapenem resistant or intermediate resistant isolates should be tested with an additional method to verify the results. This study was aimed to evaluate the imipenem and meropenem susceptibilities by disk diffusion, E-test and broth microdilution in P. aeruginosa and Acinetobacter baumannii strains found to be resistant or intermediate to imipenem-meropenem by BD Phoenix automated susceptibility testing system. Between January 2006-January 2007, 85 non-duplicate isolates of A. baumannii and 51 non-duplicate isolates of P. aeruginosa which were determined as resistant or intermediate resistant to imipenem and/or meropenem by BD Phoenix automated identification and susceptibility system (Becton Dickinson, Sparks, MD, USA) were collected in Akdeniz University Hospital Central Laboratory. All strains were tested by E-test (AB Biodisk, Sweden), disk diffusion and reference broth microdilution (BMD) method following CLSI recommendations. All 51 isolates of P. aeruginosa determined as imipenem and/or meropenem resistant or intermediate resistant by BD Phoenix, were found to be imipenem and/or meropenem resistant or intermediate resistant by the reference BMD method. Minor error rates were same for all testing systems (1.9%) except for the meropenem results of BD Phoenix system (5.9%). No major errors were produced by any system. For A. baumannii, only one very major error was detected for meropenem by BD Phoenix system. Number of minor errors determined for meropenem by all testing systems compared to the reference test, ranged from 2 (2.4%) to 3 (3.5%). It was concluded that carbapenem susceptibility test results obtained by BD Phoenix system for P. aeruginosa and A. baumannii isolates, could be reported without an additional susceptibility testing method unless indicated on case basis.

[Investigation of plasmid-mediated AmpC beta-lactamase types in Klebsiella spp. and Escherichia coli isolates resistant or intermediate to cefoxitin]. / Sefoksitine dirençli ya da az duyarli saptanan Klebsiella spp. ve Escherichia coli izolatlarinda plazmid aracili AmpC beta-laktamaz enzim tiplerinin arastirilmasi.

Plasmid mediated AmpC beta-lactamases are reported from Enterobacteriaceae with increasing frequency. There have been reports of treatment failures in patients infected with these organisms and given broad-spectrum cephalosporins. The aim of this study was to investigate the presence of plasmid mediated AmpC beta-lactamases in Escherichia coli and Klebsiella spp. A total of 41 strains of cefoxitin resistant or intermediate E. coli (n= 27) and Klebsiella spp. (n= 14) were collected from january 2005 to January 2006 at Akdeniz University Hospital Central Laboratory. Three-dimensional test was used as a phenotypic confirmatory test. Analytical isoelectric focusing electrophoresis was used to measure the pl values of the beta-lactamases. Plasmid mediated AmpC enzyme genes were amplified using multiplex polymerase chain reaction and sequenced by Beckman Coulter CEQ 8000. AmpC beta-lactamases were only detected in two isolates (7.4%) of E. coli. These isolates produced CMY-2 like enzymes and have either CTX-M or TEM enzyme. Transferable AmpC beta-lactamases are associated with multiple antibiotic resistance. Therefore detection of these enzymes in gram-negative bacteria has a clinical importance, since it can often provide valuable information to clinicians leading to more effective and appropriate use of antimicrobials.