Investigation of Molecular Mechanisms of Carbapenemase Producing Acinetobacter baumannii complex Isolates Isolated from Blood Cultures

INTRODUCTION: It was aimed to determine the presence of metallo-beta-lactamases (MBL) and oxacillinases (OXA) enzymes in Acinetobacter baumannii complex (ABC) isolates, which show decreased sensitivity to carbapenems isolated from blood cultures and to investigate the relationships of isolates among each other and with European clones (EU) I, II, III. METHODS: The study included ABC isolate which has reduced sensitivity to at least one of either imipenem or meropenem which was isolated from blood samples obtained from 74 patients who were admitted to the hospital between 2008 and 2009. Identification of isolates and their antimicrobial susceptibilities were performed using BD Phoenix Automated System (Becton-Dickinson, USA). OXA and MBL genes were investigated by polymerase chain reaction (PCR). The clonal relationship of the isolates was determined by pulsed-field gel electrophoresis (PFGE) method. RESULTS: MBL genes and blaOXA-24-like gene were not determined in any of the isolates. blaOXA-51-like was detected in all isolates, blaOXA-58-like gene in 32 isolates and blaOXA-23-like gene in 26 isolates. Using PFGE method, it was detected that fifty-five blood isolates carrying the blaOXA23-like and/or blaOXA-58-like gene were clustered under six clusters. The similarity of EU clones with clinical ABC isolates in the clusters was found to be over 90%. DISCUSSION AND CONCLUSION: ABC isolates producing oxacillinase in our hospital; The presence of association with EU clone III, which is reported very rarely in our country, and the detection of possible related isolates with EU clones I and II show the potential for the spread of these clones in our hospital and in our country

COMPARISON OF FUSIDIC ACID SUSCEPTIBILITY OF STAPHYLOCOCCI: A MULTICENTER STUDY

WOS: 000429278400017Introduction: The increasing antibiotic resistance of staphylococci, an important factor among societal and hospital-sourced infection factors, reduces the treatment choices available. Fusidic acid (FA), the use of which has recently come to the agenda again, is thought to form a new alternative treatment for staphylococci infections. The aim of our study is to identify the FA resistance situation at certain centers compared to generally increasing antibiotic resistance, to present epidemiological data on new antibiotherapy methods and to aid in treatment planning. Materials and methods: With this aim we determined and compared the susceptibility of 2018 Staphylococcus aureus and 5242 Coagulase negative Staphylococci strains obtained at 11 centers in different regions of our country against FA, oxacillin, penicillin, trimethoprim-sulfamethoxazole and ciprofloxacin. Results: The Coagulase negative Staphylococci strains were determined to be more resistant to all antibiotics compared to S. aureus strains. When the means of all centers are examined, FA resistance was found in 7.1% of S. aureus strains and 55.1% of Coagulase negative Staphylococci strains. Of all antibiotics for both S. aureus and Coagulase negative Staphylococci strains the antibiotic that strains were most susceptible to was trimethoprim-sulfamethoxazole, while the antibiotic that most were resistant to was penicillin. Conclusion: In light of these findings, with high susceptibility of 92.9% for S. aureus strains to FA, it appears to be a good alternative treatment choice for S. aureus infections. Due to high resistance rates of methicillin-resistant Coagulase negative Staphylococci sourced infections, before treatment it is necessary to perform an antibiotic susceptibility test. We believe that broader scale and more comprehensive studies will provide guidance in planning treatment

Distribution, Virulence Attributes and Antifungal Susceptibility Patterns of Candida Parapsilosis Complex Strains Isolated From Clinical Samples

It was recently proposed that Candida parapsilosis represents a complex composed of three closely related species, i.e., C. parapsilosis sensu stricto, C. orthopsilosis, and C. metapsilosis. The aim of this study was to describe the distribution of C. parapsilosis complex isolates among clinical samples. We also evaluated antifungal susceptibility profiles, in vitro presence of lipase and secreted aspartyl proteinase, as well as their ability to grow in total parenteral nutrition (TPN) solution, and biofilm production. A total of 413 non-C. albicans Candida isolates were obtained from various clinical samples between 2010 and 2011 in a Turkish Tertiary Care Hospital. Of them, 42 were identified as members of the C. parapsilosis complex. Among these, 38 (90.5%) were C. parapsilosis sensu stricto, 3 (7.1%) C. metapsilosis, and 1 (2.4%) C. orthopsilosis. All isolates recovered from blood were found to be C. parapsilosis sensu stricto and C. metapsilosis. In phenotypic tests, all 42 isolates grew in TPN solution and, although 26.2% of C. parapsilosis sensu stricto-isolates were capable of forming biofilms in vitro, neither C. orthopsilosis nor C. metapsilosis isolates were able to do so. Acid proteinase activity was detected in 31% of isolates and lipase activity in 33%. All isolates were sensitive to voriconazole, caspofungin, and anidulafungin, with only a single C. parapsilosis sensu stricto isolate showing dose-dependent susceptible to fluconazole. While the number of C. metapsilosis and C. orthopsilosis isolates remained low, there were no significant differences in antifungal MIC as compared to C. parapsilosis sensu stricto.WoSScopu

Echogenic lymph nodes in the differential diagnosis of pediatric sarcoidosis

We present a delayed diagnosis of sarcoidosis in an 11-year-old girl by demonstrating ultrasonographic imaging findings of granulomatous cervical and abdominal lymph node involvement. Pulmonary interstitial fibrosis in addition to multi-compartmental enlarged echogenic lymph nodes could be considered sarcoidosis. Punctate echogenic foci in the cervical lymph nodes should be considered in the differential diagnosis of sarcoidosis

Comparative Evaluation of In Vitro Activities of Carbapenemes Against Gram-Negative Pathogens: Turkish Data of COMPACT Study

WOS: 000291333900001PubMed ID: 21644063The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest (R) strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC(50) of doripenem against Pseudomonas spp. was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC(90) of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gram-negative pathogens, mostly Acinetobacter spp., MIC(50) was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance

Comparative Evaluation of In Vitro Activities of Carbapenemes Against Gram-Negative Pathogens: Turkish Data of COMPACT Study

The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest (R) strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC(50) of doripenem against Pseudomonas spp. was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC(90) of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gram-negative pathogens, mostly Acinetobacter spp., MIC(50) was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance

Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018

AbstractObjective To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines.Patients and methods This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test.Results In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively.Conclusions The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population