Background: Carbapenem-resistant Gram-negative bacteremia (CR-GNB) is seen with increasing frequency and result in high mortality. The aim of this study was to compare the risk factors and results of carbapenem-resistant and carbapenem-susceptible Gram-negative bacteremia and to determine the factors related to mortality. Methods: The study was conducted as a retrospective observational comparative case series between June 2016 and November 2017 in Şişli Hamidiye Etfal Training and Research Hospital. The patients were divided into two groups as carbapenem-susceptible and carbapenem-resistant according to antibiotic susceptibility data of blood cultures. The risk factors for the development of carbapenem resistance, length of hospital stay, mortality rates, and mortality related factors were investigated between these two groups. Results: Two hundred and eleven cases were included in the study. Of these cases, 54 were resistant to carbapenem and 157 were susceptible to carbapenem. Mortality occurred in 60 (28.4%) patients. The 14 and 28 day mortality rates of patients with carbapenem resistance were significantly higher than those without carbapenem resistance. There was no statistically significant difference between two groups in length of stay in the hospital after bacteremia. Pittsburgh bacteremia score, cardiovascular disease, urinary catheterization, and inappropriate empirical antibiotic therapy were the most significant risk factors for mortality. Conclusions: Carbapenem resistance is associated with increased mortality and inappropriate empirical antibiotic treatment increases mortality. Therefore, patients should be evaluated for risk factors in predicting CR-GNB and treatment for resistant pathogens should be applied in appropriate patients.

Objective: It has been shown in previous studies that inadequate empirical treatment is associated with mortality in a variety of infections caused by Gram-negative bacteria. In this study, the clinical effect of discordance in empirical treatment was investigated in patients with urinary tract infection (UTI) accompanied by bacteremia. Material and methods:We retrospectively reviewed the files of adult (>18 years old) patients who were diagnosed with UTI in our clinic between January 2014 and December 2015. Cases in which the same causative microorganism grew in both blood and urine cultures were included in the study. Patients using ceftriaxone and carbapenem as empirical antibiotic therapy (EAT) were compared as two different groups. In cases that the ethiologic agents were extended-spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli isolates, if the microorganism was resistant to initial antibiotic treatment the situation was defined as EAT discordance, and if it was sensitive it was defined as EAT concordance. Results:After the exclusion criteria were applied, 65 of the 266 cases examined were taken into the study. Clinical and laboratory features of cases of ceftriaxone and carbapenem groups were similar. There was no statistically significant difference between the two groups in terms of hospital stay and survival (p>0.05). Of 28 cases of ESBL-producing E. coli and K. pneumoniae, 18 were EAT discordant and 10 were EAT concordant. Clinical and laboratory features of EAT concordant and EAT discordant groups were similar. No statistically significant difference was found between the two groups in terms of hospital stay and survival (p>0.05). Conclusion:It was considered that ceftriaxone can still be a viable option in the EAT of UTI, which is accompanied by bacteremia without severe sepsis and septic shock findings. It was concluded that EAT discordance may not have a negative effect on the duration of hospital stay and survival rates in neither total cases nor ESBL positive ones.Keywords: Bacteremia; empirical antibiotic therapy; urinary tract infection.Cite this article as: Dökmetaş İ, Hamidi AA, Bulut ME, Çetin S, Öncül A, Uzun N. Clinical effect of discordance in empirical treatment of cases with urinary tract infection accompanied by bacteremia. Turk J Urol 2017; 43(4): 543-8.

Pyojenik karaciğer apsesi intraabdominal ve biliyer sistem infeksiyonlarının yaygın olmayan bir komplikasyonudur. İnfeksiyon komşuluk yoluyla direkt olarak ya da apandisit ve divertikülit gibi infeksiyon odaklarından hematojen yayılıma bağlı olarak gelişir (1-3). Pyojenik karaciğer apseleri gastrointestinal kanal yoluyla asandan olarak geliştiğinden genellikle polimikrobiktir (1). Ancak Tayvan ve bazı Doğu Asya ülkelerinden yapılan yayınlar-da, özellikle diyabetik hastalarda, intraabdominal ve biliyer sistemle ilgili predispozan faktörler olmaksızın Klebsiella pneumoniae'nin tek etken olarak saptandığı bir invazif karaciğer apsesi sendromu tanımlanmıştır (4-7). Bu olgularda %13 oranında metastatik infeksiyon olarak göz ve merkezi sinir sistemi tutulumu görülmüştür (7). K. pneumoniae'nin K1 ve K2 serotipinin özellikle diya- AbstractInvasive liver abscess syndrome caused by Klebsiella pneumoniae was first reported from Taiwan and related researches were generally conducted in Eastern Asian countries. However, in recent years similar cases are described all around the world. A minority of patients with primary liver abscess develop metastatic infection at other site of the body, but it is more prevalent when the etiologic agent is K. pneumoniae, especially K1 and K2 serotypes. The most common manifestations of metastatic infection are endophthalmitis, meningitis and brain abscess. A 49-year-old non-diabetic male who presented with primary liver abscess due to K. pneumoniae accompanied by endophthalmitis as a metastatic infection is reported to draw attention to this syndrome with high morbidity. Permanent complete vision loss occurred despite systemic and local antibiotic treatment and percutaneous drainage. Serologic subtyping and virulence analysis of the etiologic agent should be performed when this syndrome is suspected. Klimik Dergisi 2015; 28(3): 129-31.