The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.

Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. In this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. The results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates ( P = 0.007). There were significant differences in mortality ( P = 0.02), ANS ( P = 0.012), and HFT ( P = 0.007) among genotype clusters. The alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern.

Background Candida glabrata is the third leading cause of candidaemia in Turkey; however, the data regarding antifungal resistance mechanisms and genotypic diversity in association with their clinical implication are limited. Objectives To assess genotypic diversity, antifungal susceptibility and mechanisms of drug resistance of C glabrata blood isolates and their association with patients' outcome in a retrospective multicentre study. Patients/Methods Isolates from 107 patients were identified by ITS sequencing and analysed by multilocus microsatellite typing, antifungal susceptibility testing, and sequencing of PDR1 and FKS1/2 hotspots (HSs). Results Candida glabrata prevalence in Ege University Hospital was twofold higher in 2014‐2019 than in 2005‐2014. Six of the analysed isolates had fluconazole MICs ≥ 32 µg/mL; of them, five harboured unique PDR1 mutations. Although echinocandin resistance was not detected, three isolates had mutations in HS1‐Fks1 (S629T, n = 1) and HS1‐Fks2 (S663P, n = 2); one of the latter was also fluconazole‐resistant. All patients infected with isolates carrying HS‐FKS mutations and/or demonstrating fluconazole MIC ≥ 32 µg/mL (except one without clinical data) showed therapeutic failure (TF) with echinocandin and fluconazole; seven such isolates were collected in Ege (n = 4) and Gulhane (n = 3) hospitals and six detected recently. Among 34 identified genotypes, none were associated with mortality or enriched for fluconazole‐resistant isolates. Conclusion Antifungal susceptibility testing should be supplemented with HS‐FKS sequencing to predict TF for echinocandins, whereas fluconazole MIC ≥ 32 µg/mL may predict TF. Recent emergence of C glabrata isolates associated with antifungal TF warrants future comprehensive prospective studies in Turkey.

ÖZ Candida auris, yüksek virülansı, çoklu ilaç direnci, ciddi hastane enfeksiyonuna neden olması ve laboratuvar tanımlamasındaki zorluklar nedeniyle küresel bir tehdit oluşturmaktadır. İlk tanımlandığı 2009 yılından bu yana birçok ülkeden olgular rapor edilmiştir. Son zamanlarda ülkemizden de C. auris enfeksiyon olguları bildirilmektedir. Olgu, İzmir'den bildirilen ilk olgu olup ortopedi bölümünde yatan ileri diyabetik ayak enfeksiyonu olan 59 yaşındaki erkek hastadır. Dış merkezde bilateral femoropopliteal bypass operasyonu uygulanan hasta diyabetik ayak tanısını almıştır. İyileşmeyen nekrotik yaralar nedeniyle ortopedi bölümüne başvuran hastanın özgeçmişinde Tip 1 diyabet, hipertansiyon, hiperlipidemi ve koroner arter hastalığı mevcuttur. Hastaya uygulanan operasyonda sağ 2. metatars ve falanks çıkarılarak nekrotik doku debride edilmiştir. Yaradan alınan doku örneklerinin mikrobiyolojik değerlendirmelerinde maya ve gram negatif bakteri hücreleri görülmüş, kültür ve MALDI-TOF MS ile tanımlama yapılmıştır. Hastaya ampirik tazocin ve llinezolid tedavisi başlanmıştır. Ameliyat sonrası dönemde devam eden yara akıntısı ve nekroz görünümü nedeniyle hasta diz ekleminin yaklaşık 15 cm distalinden ampute edilmiştir. Kültürde üreyen maya ve bakteri kolonileri MALDI-TOF MS ile sırasıyla C. auris ve Klebsiella aerogenes ve Pseudomonas aureginosa olarak tanımlanmıştır. C. auris, ITS bölgesi sekans analizi sonucunda %99 homoloji ile doğrulanmıştır. Yapılan antifungal duyarlılık çalışmasında MİK değerleri flukonazol, amfoterisin B ve kaspofungin için sırasıyla >64 μg/ml, 2 μg/ml ve 0.25 μg/ml olarak saptanmıştır. İkinci amputasyondan sonra yara çevresindeki dokudan alınan sürüntü örnekleri ve nazal sürüntü örneğinde C. auris üremesi saptanmamıştır. Diz altı amputasyon ile bu hasta için muhtemel iyileşme olduğu düşünülmüştür. Ülkemizde artık C. auris enfeksiyonları akla getirilmelidir. C. auris'in doğru tanımlanması ve gerçek prevalansının belirlenmesinde MALDI-TOF MS büyük kolaylık sağlamaktadır. C. auris enfeksiyonunda diyabetin en önemli predispozan faktörlerden biri olması nedeniyle diyabetik ayak enfeksiyonlarında etken olarak akılda tutulmalıdır.

Objective: Tuberculosis retains its importance as the only infectious disease in the world that affects 10 million people and causes 1.5 million deaths per se. The major obstacle in the elimination and control of tuberculosis is the emergence and spread of resistant tuberculosis cases. It was aimed to determine the current Mycobacterium tuberculosis complex and its susceptibility to antituberculosis drugs at Dokuz Eylül University Hospital. Method: In our study, the results of all samples sent between January 2013 and November 2019 were examined retrospectively for the presence of M. tuberculosis complex and drug susceptibility results. The samples were cultured in Löwenstein Jensen media and BACTEC MGIT 960 system. Drug susceptibility testing was performed with the BACTEC MGIT 960 SIRE kit in accordance with the recommendations of the manufacturer. Results: In a total of 473 (2.2%) of 21620 specimens M. tuberculosis complex was reproduced. The samples were classified as pulmonary (n:300; 63.4%) and extrapulmonary (n:173; 36.6%), samples. When repeated samples of the same patient, were excluded, positive culture test results were determined in a total of 365 patients. Susceptibility to all primary antituberculosis drugs was shown in 275 of 321 (85.7%) patients, while total rates of resistance to streptomycin, isoniazid, rifampicin and ethambutol were found in respective number of patients as follows: (n:24 (7.5%), 22 (6.8%), (n:7; 2.2%) and (n:2; 0.6%). The rate of MDR was 0.6% in 2 patients. Conclusion: In our hospital, streptomycin is the first-line antituberculosis drug with the highest resistance rate. All susceptibility rates were seen lower than the data reported in Turkey Tuberculosis Control Report and other studies of Turkey. Implementing drug surveillance program plays an important role for maintaining these low rates and for the management of tuberculosis.