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Öğe An outbreak of postoperative rapidly developing and multidrug-resistant klebsiella pneumoniae urosepsis due to a contaminated ureteroscope(Medical University of Plovdiv, 2022) Güler, Yavuz; Erbin, Akif; Gözdaş, Hasan TahsinIntroduction: Outbreaks caused by microorganisms contaminating the inside of rigid ureteroscopes are extremely rare. Some of these outbreaks, especially those caused by multidrug-resistant (MDR) infections, can cause serious problems, even death. Among these serious infections, we have no data about Klebsiella pneumoniae outbreaks caused by rigid ureteroscopes and their management and consequences. Aim: We aimed to report the outcomes of an outbreak of rapidly developing MDR K. pneumoniae urosepsis linked to rigid ureteroscopy (URS). Materials and methods: Data for 68 patients who had ureteroscopic lithotripsy (URS-L) operations using the same ureteroscope were retrospectively reviewed. Among them, 17 patients with postoperatively developing urosepsis were included in the study. Samples were taken from the operating room, camera heads, endoscopes, and ancillary instruments for culture workup. K. pneumoniae was produced in a swab culture obtained from the water inlet channel of the ureteroscope. Results: All patients had sepsis signs that developed within hours (2-7 hours). MDR K. pneumoniae was detected in the urine cultures of all patients. It was sensitive only to amikacin, tigecycline, colistin, and netilmicin. All patients were treated with tigecycline (100 mg intravenous daily). It was observed that K. pneumoniae growth continued without any symptoms in the first and fourth weeks of followup in 4 patients. These patients were accepted as colonization; no additional treatment was given. Conclusions: In the case of rapidly developing urosepsis after the URS procedure in a patient, instruments, devices, and endoscopes should be immediately checked for contamination to prevent the emergence of an outbreak. © 2022 Folia Medica. All rights reserved.Öğe Urosepsis caused by kluyvera ascorbata in a pregnant woman(Coll Physicians & Surgeons Pakistan, 2020) Erbin, Akif; Gözdaş, Hasan Tahsin; Güler, Yavuz; Canat, Halil LütfiAmong the Kluyvera species, K. ascorbafa has been isolated from only a few adult cases. Furthermore, there is little or no information in the literature as to whether the species of Kluyvera can cause a clinically significant infection in pregnant women. We report a case of urosepsis caused by K. ascorbata in a 23 year pregnant woman at 26 weeks of gestation who presented with left flank pain. Ultrasonography showed left grade 3 hydronephrosis, ureteral dilatation, and a 10 mm distal ureteral stone. The patient underwent laser lithotripsy and JJ placement. Ten days later, she was readmitted with urosepsis and empirical antibiotherapy and aggressive hydration were initiated. On the third day, K. ascorbafa growth was detected in the urine culture. Based on the clinical status of the patient and the antimicrobial susceptibility testing, the treatment was switched to ertapenem 1x1 g/day and was continued for 14 days. Among the Kluyvera species, K. ascorbata is the most frequent pathogen which may be isolated from pregnant women and can cause urosepsis. To the best of authors' knowledge, this is the first report showing the isolation of K. ascorbata in a pregnant woman which caused urosepsis.