Investigation of carbapenemase resistance genes in healthcare-associated infectious enterobacterales strains

Çalışmamızda, hastanemizde otomatize sistem ile meropeneme dirençli veya doza bağlı duyarlı saptanan Enterobacterales suşlarında fenotipik ve genotipik yöntemlerle karbapenemazların varlığının araştırılması amaçlandı. Karbapenemazlar, karbapenemler dahil olmak üzere çoğu β-laktamı hidrolize ederler. Bu enzmler üreten suşların saptanmasında brçok fenotpk ve genotpk yöntemler kullanılmaktadır. Genotipik yöntemlerden polimeraz zincir reaksiyonu zaman alıcı ve pahalı olmasına rağmen altın standart yöntemdir. Gram negatif bakterilerde artan direnç nedeniyle karbapenem direnç genlerinin profilinin belirlenmesi antibiyotik kullanım politikalarının belirlenmesinde yol gösterici olması açısından önem taşımaktadır. Çalışmamızda, Aralık 2019- Aralık 2020 tarihleri arasında bir yıllık süreçte otomatize sistem ile meropeneme dirençli veya doza bağlı duyarlı saptanan 79 Enterobacterales izolatı BD Phoenix CPO Detect paneli, karbapenem inaktivasyon yöntemi ve konvansiyonel PCR yöntemleri ile incelendi. Konvansiyonel PCR ile 42 izolat blaOXA-48 geni; 16 izolat blaNDM geni ve 7 izolat ise blaOXA-48 ile beraber blaNDM gen bölgesi pozitif olarak saptandı. İzolatların hiçbirinde blaIMP, blaVIM ve blaKPC genlerinde pozitiflik bulunmadı. PCR ile pozitif saptanan toplam 65 izolatın iki tanesi BD Phoenix CPO detect paneli ile negatif saptandı. mCIM testi ile ise 64 tanesi pozitif, yalnızca bir tanesi belirsiz olarak bulundu. Çalışmamız laboratuvarımıza gönderilmiş ardışık örneklerden üretilmiş karbapenem dirençli izolatlar ile planlanan ilk çalışma olduğu için verilerimiz hastanemiz ve bölgemiz açısından epidemiyolojik olarak önem taşımaktadır.In our study, it was aimed to investigate the presence of carbapenemases by phenotypic and genotypic methods in Enterobacterales strains that were found to be resistant to meropenem or susceptible to dose-related in our hospital. Carbapenemases hydrolyze most β-lactams, including carbapenems. Many phenotypic and genotypic methods are used to determine the strains producing these enzymes. PCR, which is one of the genotypic methods, is the gold standard method, although it is time consuming and expensive. Due to the increasing resistance in Gram-negative bacteria, the determination of the profile of carbapenem resistance genes is important in terms of being a guide in determining antibiotic use policies. In our study, 79 Enterobacterales isolates, which were determined to be resistant to meropenem or susceptible to dose-related, by the automated system between December 2019 and December 2020, were examined by the BD Phoenix CPO detection panel, mCIM and conventional PCR methods. Fourty-two isolates of blaOXA-48 genes by conventional PCR; 16 isolates of blaNDM gene and 7 isolates of blaOXA-48 and blaNDM gene region were positive. blaIMP, blaVIM and blaKPC genes were not positive in any of the isolates. Of the 65 isolates that were positive by PCR, two were found to be negative by the BD Phoenix CPO detection panel. With the mCIM test, 64 of them were positive and only one was indeterminate. Since our study is the first planned study with carbapenem resistant isolates produced from consecutive samples sent to our laboratory, our data are epidemiologically important for our hospital and region

Investigation of Carbapenemase Resistance Genes in Multidrug-Resistant Providencia rettgeri Strains

Objectives: Resistant bacterial pathogens are important causes of both community and healthcare associated infections. Providencia genus are Gram-negative bacilli in the Enterobacterales order, which mostly cause urinary tract infections. P.rettgeri is known to be a causative agent of catheter-related urinary system infections, especially in patients hospitalized in the intensive care unit recently. As with other resistant bacteria, the spread of hospital infections caused by Providencia species is mostly blamed on the failure of healthcare personnel to comply with infection control measures. Methods: In our study, a total of 22 multi-drug resistant P. rettgeri strains isolated from urine culture samples of 11 (50%) male and 11 (50%) female inpatients in our hospital between November 2017 and November 2021 were examined. Bacteria were evaluated for the presence of resistance genes by the mCIM, the BD Phoenix CPO detect panel, and conventional PCR. Results: By mCIM test, 18 (81.8%) strains were positive, three (13.6%) strains were negative, and one (4.6%) strain was indeterminate. All strains were identified as “class B carbapenemase producer” with the BD Phoenix CPO detection kit. With conventional PCR, OXA-48, IMP, VIM and KPC genes were not found to be positive in any of the strains, while all of the strains were found to be positive for the blaNDM gene. Conclusion:NDM is among class B carbapenemases and is common in the Enterobacteralesfamily. P. rettgeri has recently been recognized as the key organism in the spread of NDM-1. It is very important to control the spread of this bacteria, which has resistance genes that can be transferred with plasmids against many antibacterials in hospitals. Our study shows that it is necessary to follow these strains in our hospital and take necessary infection control measures to prevent their spread

Association of SGLT-2 inhibitors with bacterial urinary tract infection in type 2 diabetes

Abstract Objective We aimed to investigate the factors associated with UTI in patients with T2D whether being treated with SGLT-2i or not. Methods Adult patients with T2D, whose urine culture results were available, were analyzed retrospectively. Urine culture was obtained from mid-flow urine. Antibacterial treatment was given to the patients with UTI, which was defined by positive urine cultures and/or clinical findings. We grouped the patients as follows: Group A, those treated with SGLT-2i; and Group B, those not treated with SGLT-2i. Results A total of 101 patients were included. Median age was 56 (45–67), 56.4% (n = 57) of the patients were female. Urine culture was positive in 54.9% (n = 28) and 16% (n = 8) of Group A (n = 51) and Group B (n = 50), respectively. Of those for whom urine culture was positive, Escherichia coli was isolated in 83.3% (n = 30), and both Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) were isolated in 16.7% (n = 6). Klebsiella pneumoniae was isolated only from Group A. The need for and duration of hospitalization were higher in Group A (p  5.8% was associated with UTI with good accuracy (AUC: 0.835, p < 0.001). In multiple logistic regression analysis, SGLT-2i use and glucosuria were positive predictors for UTI (p = 0.004, Odds Ratio: 1984.013; and p = 0.028, and Odds Ratio: 12.480, respectively). Conclusion Besides the association of HbA1c and BMI with UTI, SGLT-2i use and glucosuria predicted UTI. Urine culture is important with respect to the choice of antibacterial treatment, especially in those patients under SGLT-2i treatment. The effect of SGLT-2i on the development of UTI is independent of baseline BMI score or HbA1c

INVESTIGATION OF PLASMID-MEDIATED AmpC BETA-LACTAMASE TYPES IN KLEBSIELLA SPP. AND ESCHERICHIA COLI ISOLATES RESISTANT OR INTERMEDIATE TO CEFOXITIN

Plasmid mediated AmpC beta-lactamases are reported from Enterobacteriaceae with increasing frequency. There have been reports of treatment failures in patients infected with these organisms and given broad-spectrum cephalosporins. The aim of this study was to investigate the presence of plasmid mediated AmpC beta-lactamases in Escherichia coli and Klebsiella spp. A total of 41 strains of cefoxitin resistant or intermediate E.coli (n= 27) and Klebsiella spp. (n= 14) were collected from January 2005 to January 2006 at Akdeniz University Hospital Central Laboratory. Three-dimensional test was used as a phenotypic confirmatory test. Analytical isoelectric focusing electrophoresis was used to measure the pl values of the beta-lactamases. Plasmid mediated AmpC enzyme genes were amplified using multiplex polymerase chain reaction and sequenced by Beckman Coulter CEQ 8000. AmpC beta-lactamases were only detected in two isolates (7.4%) of E.coli. These isolates produced CMY-2 like enzymes and have either CTX-M or TEM enzyme. Transferable AmpC beta-lactamases are associated with multiple antibiotic resistance. Therefore detection of these enzymes in gram-negative bacteria has a clinical importance, since it can often provide valuable information to clinicians leading to more effective and appropriate use of antimicrobials

Influenza vaccination rates, knowledge, attitudes and behaviours of healthcare workers in Turkey: A multicentre study

PubMed: 32770856Aim: Influenza vaccination is the most effective method in prevention of influenza disease and its complications. Our study aimed to investigate the rates of vaccination and the behaviours and attitudes against the vaccine in healthcare workers in Turkey. Methods: This multicentre national survey is a descriptive study in which 12 475 healthcare workers. Healthcare workers were asked to answer the questionnaire consisting of 12 questions via the survey. Results: It was found that 6.7% of the healthcare workers regularly got vaccinated each year and that 55% had never had the influenza vaccine before. The biggest obstacle against getting vaccinated was determined as not believing in the necessity of the vaccine (53.1%). Conclusion: The rates of influenza vaccination in healthcare workers in Turkey are quite low. False knowledge and attitudes on the vaccine and disease are seen as the most important reasons to decline vaccination. It is important to detect reasons for anti-vaccination and set a course in order to increase the rates of vaccination. © 2020 John Wiley & Sons Lt