Aim: Infections of sterile body fluids (SBFs) require rapid and accurate diagnosis and treatment, since their morbidities and mortalities are high. To achieve this goal, definite epidemiologic data is absolutely required, since empiric and preemptive treatments are mainly based on this. The aim of this study was to evaluate infectious agents isolated from SBFs, susceptibility results and molecular analysis (PCR) data, retrospectively. Material and Method: Clinical samples of SBFs (Cerebrospinal, pleural, peritoneal, pericardial and synovial fluids) obtained from January 2017 to December 2020 in Atatürk City Hospital (tertiary center) were included. Identification of bacterial and fungal agents and antibiotic susceptibility were done by conventional and automated system (BD Phoenix™, Becton Dickinson Co., Sparks, MD, USA). Löwenstein-Jensen media and BACTEC Mycobacteria Growth Indicator Tube 960 (Becton Dickinson Co., Sparks, MD, USA) were used for mycobacterial analysis. Bosphore Viral Meningitis Panel Multiplex PCR Kit (Anatolia Geneworks, İstanbul, Turkey) were applied to detect HSV-1, HSV-2, VZV, Enterovirus and/or Parechovirus. Results: A total of 221 (9.74%) organisms were detected among 2269 samples. Particularly common gram negative bacterial agents covered the top of the list (Escherichia coli, Pseudomonas spp., Klebsiella spp. and Acinetobacter baumannii-Acinetobacter calcoaceticus complex). Staphylococcus aureus was the most frequent gram positive strain, followed by enteroccocci. Most of the A. baumannii isolates were multidrug resistant, Pseudomonas spp. showed over than 20% resistance rate to ceftazidime, cefepime and piperacillin-tazobactam. All enterococci were vancomycin-susceptible, one S. aureus strain was methicillin-resistant. All Mycobacterium tuberculosis complex isolates were found to be susceptible to first-line anti-tuberculosis drugs. Conclusions: Continuous laboratory surveillance even in local phase is important to guide clinicians. Even though our data did not show significant changes, improvements on laboratory capabilities and clinical awareness must be done. Isolation rates might be underestimated due to requirement of improvements in our laboratory, especially about sampling, anaerobe transportation and usage of blood culture vials.

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Objective: The aim of this study was to investigate clinical nonfermenting gram-negative isolates and their antibiotic resistance profile for a three-year period in a state (tertiary) hospital. Materials and Methods: A total of 3817 nonfermenting gram-negative strains isolated from various cultures of patients between January 2017 and December 2019 in XXX hospital were investigated retrospectively. Bacterial identification was performed using conventional methods and PhoenixTM 100 automated system (Becton Dickinson, MA, USA). Antibiotic susceptibilities were performed by PhoenixTM 100 automated system (Becton Dickinson, MA, USA). Results: A total of 2201 (57.7%) P.aeruginosa, 1283 (33.6%) A.baumannii-calcoaceticus complex, 202 (5.3%) S.maltophilia and 131 (3.4%) B.cepacia complex strains were identified. The majority of strains were isolated from intensive care units (54.5%), followed by internal medicine (33.4%) and surgical services (12.1%). Except co-trimoxazole and amikacin, all A.baumannii-calcoaceticus complex species showed over than 70% resistance to antibiotics. Significant alterations of resistance in amikacin were observed (29.1% to 66.6%). For P.aeruginosa, interestingly, an opposed significant decrease was found in amikacin (24% to 9.6%). In addition to β-lactam antibiotic resistance (generally over than 30%), resistance to fluoroquinolones (30.4%) seemed to have a particular importance. Co-trimoxazole showed promisingly below 10% resistance in S.maltophilia isolates. In B.cepacia complex isolates, ceftazidime resistance massively increased among years (2018, 22.2%; 2019, 67.0%), which was statistically significant. Similar pattern was also observed for co-trimoxazole. Conclusions: Despite recent increasing awareness worldwide, the conflict between humankind and resistant microorganisms is in the page of unfavorable side. As stated by many antimicrobial stewardship programs, this conflict cannot be won by just developing novel antimicrobials, but also by increasing efficiency of older ones. The first step of this approach is to “diagnose” the current condition, since surveillance studies indicate such data. It should be in mind that this contestation starts with local data.

Objective: Staphylococci cause community-acquired and hospital-acquired infections, and Staphylococcus aureus is one of leading agents. In the last decades methicillin-resistant S.aureus (MRSA), vancomycin-intermediate S.aureus (VISA) and vancomycin-resistant S.aureus (VRSA) became as major concerns. Resistance to other antibiotics is also another growing issue. The aim of this study was to investigate the prevalence of S.aureus species and to evaluate susceptibilities to antimicrobial agents in a state (tertiary) hospital. Methods: Clinical cultures from various samples (urinary tract, respiratory, wound, abscess, tissue, catheter and external auditory) obtained from January 2017 to December 2019 in XXX hospital were included in the study. Isolated S.aureus strains and their antibiotic susceptibilities were retrospectively evaluated. Results: A total of 765 S.aureus strains were isolated. 165 S.aureus strains were found as methicillin resistant (MRSA; 21.9%). There was not any statistically significant difference in MRSA rates among evaluated years (p=0.772). There was not any strain that was resistant to vancomycin, teicoplanin and/or linezolid. The highest rate was observed in penicillin resistance (n=646/728, 88.7%). There was not any statistically significant alteration in the resistance rates of all tested antibiotics during the three-year period. Conclusions: Despite dwindling MRSA rates in UAMDSS, CAESAR report indicates that Turkey seems to be in the beginning phase of this struggle. Local and/or national antimicrobial stewardship programs are in effect in Turkey, but further measures are required.

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