Research Article
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Pediatrik Kan Kültüründen İzole Edilen Gram Negatif Bakterilerin Prevalansı ve Antibiyotik Duyarlılık Paterni

Year 2024, Volume: 12 Issue: 1, 1 - 14, 02.05.2024
https://doi.org/10.24998/maeusabed.1392677

Abstract

Pediatrik hastalardan alınan kan örneklerinden izole edilen Gram negatif bakterilerin antibiyotik duyarlılıklarının değerlendirilmesi amaçlandı. Örnekler Bactec 9120 otomasyon sistemi ile değerlendirildi. AST N090 paneli ile gerçekleştirilen Vitek 2 Compact (Biomerieux Fransa) cihazı kullanılarak Gram-Negatif ID paneli ile bakteriler tanımlandı ve sonuçlar Klinik ve Laboratuvar Standartları Enstitüsü (CLSI) tavsiyelerine göre değerlendirildi. Antibiyotik direnci sonuçları: Seftriakson en dirençli antibiyotik (%71,4) oldu. Salmonella spp. çoğunlukla levofloksasin ve siprofloksasine (%100) dirençliydi. E. coli suşları tikarsilin ve piperasilin'e en dirençli (%71,4) iken, bu bakteriye karşı en etkili antibiyotikler imipenem ve meropenem (%100) oldu. Test edilen tüm antibiyotiklere karşı direnç oranları, ESBL üreten Klebsiella spp ve E coli suşlarında, ESBL üretmeyen suşlara göre anlamlı derecede yüksekti (p<0,05). Bu bilgiler göz önüne alındığında prematüre ve yenidoğan hastalarda ampirik tedavinin uygulanmasında mevcut direnç profillerinin değerlendirilmesi hayati önem taşımaktadır.

References

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  • Annavajhala, M. K., Gomez-Simmonds, A., Uhlemann, A. C., 2019. Multidrug-resistant Enterobacter cloacae complex emerging as a global, diversifying threat. Frontiers in Microbiology 10,44.
  • Arslan Gülen, T., İmre, A., Ödemiş, İ., and Kayabaş, Ü., 2020. Acinetobacter baumannii Infections and Antibiotic Resistance in Hospitalized Patients in an Education and Research Hospital: A Six-Year Analysis. Flora the Journal of Infectious Diseases and Clinical Microbiology 25, 563–571.
  • Atay, G., Kara, M., Sütçü, M., Aydın, Y. Ş., Torun, S. H., Karapınar, B. A., Kayacan, Z. Ç., Gürler, N., Çıtak, A., Nişli, K., Salman, N., Somer, A., 2019. Resistant gram-negative infections in a pediatric intensive care unit: A retrospective study in a tertiary care center. Turk Pediatri Arsivi 54, 105–112.
  • Behzadnia, S., Davoudi, A., Rezai, M. S., and Ahangarkani, F., 2014. Nosocomial infections in pediatric population and antibiotic resistance of the causative organisms in North of Iran. Iranian Red Crescent Medical Journal 16(2), e14562.
  • Boguniewicz, J., Revell, P.A., Scheurer, M.E., Hulten, K.G., Palazzi, D.L., 2021. Risk factors for microbiologic failure in children with Enterobacter species bacteremia _ Enhanced Reader. PLOSONE 7;16(10), e0258114.
  • Castanheira, M., Simner, P. J., and Bradford, P. A., 2021. Extended-spectrum β -lactamases: an update on their characteristics, epidemiology and detection. JAC-Antimicrobial Resistance 1-21.
  • Dhingra, S., Rahman, N. A. A., Peile, E., Rahman, M., Sartelli, M., Hassali, M. A., Islam, T., Islam, S., Haque, M., 2020. Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter. Frontiers in Public Health 8, 535668.
  • van Dijk, H. F. G., Verbrugh, H. A., Abee, T., Andriessen, J. W., van Dijk, H. F. G., ter Kuile, B. H., Mevius, D. J., Montforts, M. H. M. M., van Schaik, W., Schmitt, H., Smidt, H., Veening, J.-W., and Voss, A., 2022. Resisting disinfectants. Communications Medicine 2,6, 6265.
  • Dsouza, A., Mallepally, A. R., Marathe, N. A., Das, K., and Mohaptra, B., 2021. A Rare Case of Sphingomonas paucimobilis Spondylodiscitis Managed Surgically. Journal Of Orthopaedic Case Reports 11(4), 91–96.
  • Gajdács, M., Bátori, Z., Ábrók, M., Lázár, A., Burián, K., 2020. Characterization of resistance in gram-negative urinary isolates using existing and novel indicators of clinical relevance: a 10-year data analysis. Life 11;10(2),16.
  • Garnacho-Montero, J., Dimopoulos, G., Poulakou, G., Akova, M., Cisneros, J. M., de Waele, J., Petrosillo, N., Seifert, H., Timsit, J. F., Vila, J., Zahar, J. R., and Bassetti, M., 2015. Task force on management and prevention of Acinetobacter baumannii infections in the ICU. Intensive Care Medicine 41, 2057–2075.
  • Gazi, H., Tünger, Ö., Vural, Ş., Özbakkaloğlu, B., Sürücüoğlu, S., 2007. Çeşitli antibiyotik kombinasyonlarının çoğul dirençli Acinetobacter baumannii suşlarına in vitro etkileri. Türk Mikrobiyoloji Cemiyeti Dergisi 37 (1), 11-14
  • He, T., Wang, R., Liu, D., Walsh, T. R., Zhang, R., Lv, Y., Ke, Y., Ji, Q., Wei, R., Liu, Z., Shen, Y., Wang, G., Sun, L., Lei, L., Lv, Z., Li, Y., Pang, M., Wang, L., Sun, Q., Fu, Y., Song, H., Hao, Y., Shen, Z., Wang, S., Chen, G., Wu, C., Shen, J., and Wang, Y., 2019. Emergence of plasmid-mediated high-level tigecycline resistance genes in animals and humans. Nature Microbiology 4(9),1450-1456.
  • Horcajada, J. P., Montero, M., Oliver, A., Sorlí, L., Luque, S., Gómez-Zorrilla, S., Benito, N., and Grau, S., 2019. Epidemiology and treatment of multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa infections. Clinical Microbiology Reviews 28;32(4), e00031-19.
  • Iosifidis, E., Violaki, A., Michalopoulou, E., Volakli, E., Diamanti, E., Koliouskas, D., Antachopoulos, C., Drossou-Agakidou, V., Sdougka, M., and Roilides, E., 2017. Use of tigecycline in pediatric patients with infections predominantly due to extensively drug-resistant gram-negative bacteria. Journal of the Pediatric Infectious Diseases Society 6, 123–128.
  • Jain, N., Jansone, I., Obidenova, T., Simanis, R., Meisters, J., Straupmane, D., and Reinis, A., 2021. Antimicrobial resistance in nosocomial isolates of gram-negative bacteria: Public health implications in the latvian context. Antibiotics 10(7), 791.
  • Kashosi, T. M., Muhandule, A. B., Mwenebitu, D. L., Mihuhi, N., Mutendela, J. K., and Mubagwa, K., 2018. Antibio-résistance des souches de salmonella spp isolées d’hémocultures à Bukavu en RD Congo. Pan African Medical Journal 29: 42.
  • Kim, B., Jeon, Y. D., Kim, J. H., Kim, J. K., Ann, H. W., Choi, H., Kim, M. H., Song, J. E., Ahn, J. Y., Jeong, S. J., Ku, N. S., Han, S. H., Choi, J. Y., Song, Y. G., and Kim, J. M., 2015. Risk factors for mortality in patients with serratia marcescens bacteremia. Yonsei Medical Journal 56, 348–354.
  • Maugeri, G., Lychko, I., Sobral, R., and Roque, A. C. A., 2019. Identification and Antibiotic-Susceptibility Profiling of Infectious Bacterial Agents: A Review of Current and Future Trends. Biotechnology Journal 14, 1700750.
  • Meng, M., Li, Y., and Yao, H., 2022. Plasmid-Mediated Transfer of Antibiotic Resistance Genes in Soil. Antibiotics 11(4),525.
  • Nepal, R., Houtak, G., Karki, S., Dhungana, G., Vreugde, S., and Malla, R., 2022. Genomic characterization of three bacteriophages targeting multidrug resistant clinical isolates of Escherichia, Klebsiella and Salmonella. Archives of Microbiology 204,334.
  • de Oliveira Costa, P., Atta, E. H., and da Silva, A. R. A., (2015). Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: Risk factors and outcomes. Jornal de Pediatria 91, 435–441.
  • Oskouie, S. A., Ahangarzadeh Rezaee, M., Ghabili, K., and Firoozi, F., 2013. An Epidemiological Study of Nosocomial Infections in Tabriz Children’s Hospital Based on National Nosocomial Infection Surveillance System (NNIS). Life Science Journal 10(1),277-279.
  • Pachori, P., Gothalwal, R., and Gandhi, P., 2019. Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; a critical review. Genes & Diseases 6(2).
  • Prestinaci, F., Pezzotti, P., and Pantosti, A., 2015. Antimicrobial resistance: A global multifaceted phenomenon. Pathogens and Global Health 109(7),309-18.
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  • Siddiqui, M. K., Khatoon, N., and Roy, P. C., 2016. Untreated Liquid Hospital Waste: Potential Source of Multidrug Resistant Bacteria. Bangladesh Journal of Microbiology 182 (32), 21-24.
  • la Tela, I., Peruzy, M. F., D’Alessio, N., di Nocera, F., Casalinuovo, F., Carullo, M. R., Cardinale, D., Cristiano, D., and Capuano, F., 2021. Serotyping and evaluation of antimicrobial resistance of salmonella strains detected in wildlife and natural environments in southern Italy. Antibiotics 10, (4): 2079-6382.
  • European Committee on Antimicrobial Susceptibility Testing, Breakpoint Tables for Interpretation of MICs and Zone Diameters, European Society of Clinical Microbiology and Infectious Diseases Basel, Munich, Germany 2015.

Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture

Year 2024, Volume: 12 Issue: 1, 1 - 14, 02.05.2024
https://doi.org/10.24998/maeusabed.1392677

Abstract

It was aimed to evaluate the antibiotic susceptibilities of Gram-negative bacteria isolated from blood samples taken from pediatric patients. The samples were evaluated with the Bactec 9120 automation system bacteria were identified by the Gram-Negative ID panel using the Vitek 2 Compact (Biomerieux France) device performed with the AST N090 panel, and the results were evaluated according to The Clinical and Laboratory Standards Institute (CLSI) recommendations. Antibiotic resistance results: Ceftriaxone was the most resistant antibiotic (71.4%). Salmonella spp. it was mostly resistant to levofloxacin and ciprofloxacin (100%). While E. coli strains were the most resistant to ticarcillin and piperacillin (71.4%), the most effective antibiotics against this bacterium were imipenem and meropenem (100%). Resistance rates to all tested antibiotics were significantly higher in ESBL-producing Klebsiella spp and E coli strains than in non-ESBL-producing strains (p<0.05). Considering this information, it is vital to evaluate the current resistance profiles in the application of empirical treatment in premature and newborn patients.

References

  • Adegoke, A.A., Stenström, T.A., Okoh, A.I., 2017. Stenotrophomonas maltophilia as an emerging ubiquitous pathogen: Looking beyond contemporary antibiotic therapy. Frontiers in Microbiology 30 (8), 2276.
  • Alanazi, M. Q., Alqahtani, F. Y., Aleanizy, F. S., 2018. An evaluation of E. coli in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: Retrospective study. Annals of Clinical Microbiology and Antimicrobials 17(1), 3.
  • Al-Tamimi, M., Albalawi, H., Alkhawaldeh, M., Alazzam, A., Ramadan, H., Altalalwah, M., Alma’aitah, A., Al Balawi, D., Shalabi, S., Abu-Raideh, J., Khasawneh, A. I., Alhaj, F., Hijawi, K., 2022. Multidrug-Resistant Acinetobacter baumannii in Jordan. Microorganisms 10(5), 849.
  • Annavajhala, M. K., Gomez-Simmonds, A., Uhlemann, A. C., 2019. Multidrug-resistant Enterobacter cloacae complex emerging as a global, diversifying threat. Frontiers in Microbiology 10,44.
  • Arslan Gülen, T., İmre, A., Ödemiş, İ., and Kayabaş, Ü., 2020. Acinetobacter baumannii Infections and Antibiotic Resistance in Hospitalized Patients in an Education and Research Hospital: A Six-Year Analysis. Flora the Journal of Infectious Diseases and Clinical Microbiology 25, 563–571.
  • Atay, G., Kara, M., Sütçü, M., Aydın, Y. Ş., Torun, S. H., Karapınar, B. A., Kayacan, Z. Ç., Gürler, N., Çıtak, A., Nişli, K., Salman, N., Somer, A., 2019. Resistant gram-negative infections in a pediatric intensive care unit: A retrospective study in a tertiary care center. Turk Pediatri Arsivi 54, 105–112.
  • Behzadnia, S., Davoudi, A., Rezai, M. S., and Ahangarkani, F., 2014. Nosocomial infections in pediatric population and antibiotic resistance of the causative organisms in North of Iran. Iranian Red Crescent Medical Journal 16(2), e14562.
  • Boguniewicz, J., Revell, P.A., Scheurer, M.E., Hulten, K.G., Palazzi, D.L., 2021. Risk factors for microbiologic failure in children with Enterobacter species bacteremia _ Enhanced Reader. PLOSONE 7;16(10), e0258114.
  • Castanheira, M., Simner, P. J., and Bradford, P. A., 2021. Extended-spectrum β -lactamases: an update on their characteristics, epidemiology and detection. JAC-Antimicrobial Resistance 1-21.
  • Dhingra, S., Rahman, N. A. A., Peile, E., Rahman, M., Sartelli, M., Hassali, M. A., Islam, T., Islam, S., Haque, M., 2020. Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter. Frontiers in Public Health 8, 535668.
  • van Dijk, H. F. G., Verbrugh, H. A., Abee, T., Andriessen, J. W., van Dijk, H. F. G., ter Kuile, B. H., Mevius, D. J., Montforts, M. H. M. M., van Schaik, W., Schmitt, H., Smidt, H., Veening, J.-W., and Voss, A., 2022. Resisting disinfectants. Communications Medicine 2,6, 6265.
  • Dsouza, A., Mallepally, A. R., Marathe, N. A., Das, K., and Mohaptra, B., 2021. A Rare Case of Sphingomonas paucimobilis Spondylodiscitis Managed Surgically. Journal Of Orthopaedic Case Reports 11(4), 91–96.
  • Gajdács, M., Bátori, Z., Ábrók, M., Lázár, A., Burián, K., 2020. Characterization of resistance in gram-negative urinary isolates using existing and novel indicators of clinical relevance: a 10-year data analysis. Life 11;10(2),16.
  • Garnacho-Montero, J., Dimopoulos, G., Poulakou, G., Akova, M., Cisneros, J. M., de Waele, J., Petrosillo, N., Seifert, H., Timsit, J. F., Vila, J., Zahar, J. R., and Bassetti, M., 2015. Task force on management and prevention of Acinetobacter baumannii infections in the ICU. Intensive Care Medicine 41, 2057–2075.
  • Gazi, H., Tünger, Ö., Vural, Ş., Özbakkaloğlu, B., Sürücüoğlu, S., 2007. Çeşitli antibiyotik kombinasyonlarının çoğul dirençli Acinetobacter baumannii suşlarına in vitro etkileri. Türk Mikrobiyoloji Cemiyeti Dergisi 37 (1), 11-14
  • He, T., Wang, R., Liu, D., Walsh, T. R., Zhang, R., Lv, Y., Ke, Y., Ji, Q., Wei, R., Liu, Z., Shen, Y., Wang, G., Sun, L., Lei, L., Lv, Z., Li, Y., Pang, M., Wang, L., Sun, Q., Fu, Y., Song, H., Hao, Y., Shen, Z., Wang, S., Chen, G., Wu, C., Shen, J., and Wang, Y., 2019. Emergence of plasmid-mediated high-level tigecycline resistance genes in animals and humans. Nature Microbiology 4(9),1450-1456.
  • Horcajada, J. P., Montero, M., Oliver, A., Sorlí, L., Luque, S., Gómez-Zorrilla, S., Benito, N., and Grau, S., 2019. Epidemiology and treatment of multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa infections. Clinical Microbiology Reviews 28;32(4), e00031-19.
  • Iosifidis, E., Violaki, A., Michalopoulou, E., Volakli, E., Diamanti, E., Koliouskas, D., Antachopoulos, C., Drossou-Agakidou, V., Sdougka, M., and Roilides, E., 2017. Use of tigecycline in pediatric patients with infections predominantly due to extensively drug-resistant gram-negative bacteria. Journal of the Pediatric Infectious Diseases Society 6, 123–128.
  • Jain, N., Jansone, I., Obidenova, T., Simanis, R., Meisters, J., Straupmane, D., and Reinis, A., 2021. Antimicrobial resistance in nosocomial isolates of gram-negative bacteria: Public health implications in the latvian context. Antibiotics 10(7), 791.
  • Kashosi, T. M., Muhandule, A. B., Mwenebitu, D. L., Mihuhi, N., Mutendela, J. K., and Mubagwa, K., 2018. Antibio-résistance des souches de salmonella spp isolées d’hémocultures à Bukavu en RD Congo. Pan African Medical Journal 29: 42.
  • Kim, B., Jeon, Y. D., Kim, J. H., Kim, J. K., Ann, H. W., Choi, H., Kim, M. H., Song, J. E., Ahn, J. Y., Jeong, S. J., Ku, N. S., Han, S. H., Choi, J. Y., Song, Y. G., and Kim, J. M., 2015. Risk factors for mortality in patients with serratia marcescens bacteremia. Yonsei Medical Journal 56, 348–354.
  • Maugeri, G., Lychko, I., Sobral, R., and Roque, A. C. A., 2019. Identification and Antibiotic-Susceptibility Profiling of Infectious Bacterial Agents: A Review of Current and Future Trends. Biotechnology Journal 14, 1700750.
  • Meng, M., Li, Y., and Yao, H., 2022. Plasmid-Mediated Transfer of Antibiotic Resistance Genes in Soil. Antibiotics 11(4),525.
  • Nepal, R., Houtak, G., Karki, S., Dhungana, G., Vreugde, S., and Malla, R., 2022. Genomic characterization of three bacteriophages targeting multidrug resistant clinical isolates of Escherichia, Klebsiella and Salmonella. Archives of Microbiology 204,334.
  • de Oliveira Costa, P., Atta, E. H., and da Silva, A. R. A., (2015). Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: Risk factors and outcomes. Jornal de Pediatria 91, 435–441.
  • Oskouie, S. A., Ahangarzadeh Rezaee, M., Ghabili, K., and Firoozi, F., 2013. An Epidemiological Study of Nosocomial Infections in Tabriz Children’s Hospital Based on National Nosocomial Infection Surveillance System (NNIS). Life Science Journal 10(1),277-279.
  • Pachori, P., Gothalwal, R., and Gandhi, P., 2019. Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; a critical review. Genes & Diseases 6(2).
  • Prestinaci, F., Pezzotti, P., and Pantosti, A., 2015. Antimicrobial resistance: A global multifaceted phenomenon. Pathogens and Global Health 109(7),309-18.
  • Rhomberg, P. R., Jones, R. N., Sader, H. S., Beavers-May, T., Steele-Moore, L., Della-Latta, P., Lee, L., Cavalieri, S., Wilson, M., Tierno, P., Peterson, L., Pankey, G., Bradley, J., Jacobs, M., Pfaller, M. A., Rolston, K., Carroll, K., Sewell, D., and Schoch, P., 2004. Results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme: Report of the 2001 data from 15 United States medical centres. International Journal of Antimicrobial Agents 23, 52–59.
  • Siddiqui, M. K., Khatoon, N., and Roy, P. C., 2016. Untreated Liquid Hospital Waste: Potential Source of Multidrug Resistant Bacteria. Bangladesh Journal of Microbiology 182 (32), 21-24.
  • la Tela, I., Peruzy, M. F., D’Alessio, N., di Nocera, F., Casalinuovo, F., Carullo, M. R., Cardinale, D., Cristiano, D., and Capuano, F., 2021. Serotyping and evaluation of antimicrobial resistance of salmonella strains detected in wildlife and natural environments in southern Italy. Antibiotics 10, (4): 2079-6382.
  • European Committee on Antimicrobial Susceptibility Testing, Breakpoint Tables for Interpretation of MICs and Zone Diameters, European Society of Clinical Microbiology and Infectious Diseases Basel, Munich, Germany 2015.
There are 32 citations in total.

Details

Primary Language English
Subjects Clinical Microbiology
Journal Section Research Article
Authors

Engin Turan 0000-0001-6670-3217

Mehmet Bayraktar 0000-0003-2306-6531

Bashar Ibrahım 0000-0003-3086-0995

Publication Date May 2, 2024
Submission Date November 18, 2023
Acceptance Date January 31, 2024
Published in Issue Year 2024 Volume: 12 Issue: 1

Cite

APA Turan, E., Bayraktar, M., & Ibrahım, B. (2024). Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture. Mehmet Akif Ersoy University Journal of Health Sciences Institute, 12(1), 1-14. https://doi.org/10.24998/maeusabed.1392677
AMA Turan E, Bayraktar M, Ibrahım B. Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture. Mehmet Akif Ersoy University Journal of Health Sciences Institute. May 2024;12(1):1-14. doi:10.24998/maeusabed.1392677
Chicago Turan, Engin, Mehmet Bayraktar, and Bashar Ibrahım. “Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture”. Mehmet Akif Ersoy University Journal of Health Sciences Institute 12, no. 1 (May 2024): 1-14. https://doi.org/10.24998/maeusabed.1392677.
EndNote Turan E, Bayraktar M, Ibrahım B (May 1, 2024) Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture. Mehmet Akif Ersoy University Journal of Health Sciences Institute 12 1 1–14.
IEEE E. Turan, M. Bayraktar, and B. Ibrahım, “Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture”, Mehmet Akif Ersoy University Journal of Health Sciences Institute, vol. 12, no. 1, pp. 1–14, 2024, doi: 10.24998/maeusabed.1392677.
ISNAD Turan, Engin et al. “Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture”. Mehmet Akif Ersoy University Journal of Health Sciences Institute 12/1 (May 2024), 1-14. https://doi.org/10.24998/maeusabed.1392677.
JAMA Turan E, Bayraktar M, Ibrahım B. Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture. Mehmet Akif Ersoy University Journal of Health Sciences Institute. 2024;12:1–14.
MLA Turan, Engin et al. “Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture”. Mehmet Akif Ersoy University Journal of Health Sciences Institute, vol. 12, no. 1, 2024, pp. 1-14, doi:10.24998/maeusabed.1392677.
Vancouver Turan E, Bayraktar M, Ibrahım B. Prevalence and Pattern of Antibiotic Susceptibility of Gram-Negative Bacteria Isolated from Pediatric Blood Culture. Mehmet Akif Ersoy University Journal of Health Sciences Institute. 2024;12(1):1-14.