Investigation of Macrolide- Lincosamide- Streptogramin B resistance in clinical staphylococ isolates by phenotypical and genotypical methods

Klinik örneklerden izole edilen stafilokoklarda, MLSB direnç fenotipinin ve dirençten sorumlu genlerin araştırılması amaçlanmıştır. Yöntem: Mikrobiyolojik yöntemler ve 16S rRNA sonuçlarına göre stafilokok olarak tanımlanan suşlar çalışmaya alınmıştır. MİK agar dilüsyon yöntemi ile eritromisin ve klindamisin yanı sıra vankomisin, linezolid, gentamisin, levofloksasin ve fusidik asit duyarlılıkları belirlenmiştir. MLSB direncini fenotipik olarak saptamak için D test yapılmış ve suşlar indüklenebilir MLSB, yapısal MLSB, MSB ve duyarlı olarak belirlenmiştir. Eritromisine dirençli olan suşlarda, direnç mekanizmalarının saptanması için PCR ile ermA, ermB, ermC ve msrA genleri araştırılmıştır. Bulgular: Elli dört S. aureus ve 28 KNS olmak üzere toplam 82 suş çalışmaya alınmıştır. Metisilin direncine göre 28 suş MRSA, 26 suş MSSA, 14 suş MRKNS ve 14 suş MSKNS olarak tanımlanmıştır. MİK agar dilüsyon testine göre direnç oranları eritromisin %54.9, linkozamid %35.4, gentamisin %45.1, fusidik asid %20.7 ve levofloksasin %53.7 olarak saptanmıştır. D test sonucunda en yüksek oranda yapısal MLSB direnci bulunmuştur. 25 suşta yapısal MLSB direnci (tüm suşların %30.5'i, makrolid dirençlilerin %55.5'i). 15 suşta indüklenebilir MLSB direnci (tüm suşların %18.3'ü. makrolid dirençlilerin %33.3'ü). 5 suşta MSB direnci saptanmıştır. MSB dirençlilerin tümünde PCR ile msrA geni bulunmuştur. Toplamda ermA geninin prevalansı %32.9. ermB %1.2, ermC % 7.3, msrA %6.1 saptanmıştır. Gen kombinasyonu olarak ermA+C %4.9. ermA+msrA %1.2 oranında bulunmuştur. Bir suşta direnç mekanizması belirlenememiştir. Sonuç: Rutin duyarlılık testleri ile belirlenemeyen indüklenebilir MLSB direnci D test ile kolaylıkla belirlenebilir. Bunun sonucunda stafilokokal infeksiyonlarda iyi bir seçenek olan klindamisin kullanımına daha doğru şekilde karar verilebilir. Direnç genlerinin saptanması için hızlı sonuç veren bir yöntem olan PCR kullanılabilir.The purpose of the present study was to determine the type and the responbible genes for the MLSB resistance in Staphylococci isolated from clinical samples. Methods: The isolates were identified to the species level using microbiological methods and 16S rRNA sequencing. Resistance rates for erythromycin, clindamycin, vancomycin, linezolid, gentamycin, levofloxacin, fusidic acid were determined with MIC agar dilution method. MLSB resistance phenotypes were investigated by the D test. PCR was used to detect the presence of ermA, ermB, ermC and msrA genes in erythromycin resistant isolates. Results: The study included 82 staphylococcal clinical isolates consisting of 54 S. aureus (28 MRSA and 26 MSSA) and 28 coagulase negative staphylococci. (14 MRCoNS and 14 MSCoNS) Resistance rates were as follows; clindamycin 35.4%, gentamycin 45.1%, fusidic acid 20.7% and levofloksasin 53.7%. The most frequently detected resistance phenotype among the total staphylococcal isolates was the constitutive type. Of 82 isolates, 54.9% were resistant to erythromycin; 30.5% (25 strains) of the isolates exhibited a constitutive phenotype (cMLSB) whereas 18.3% (15 strains) expressed an inducible resistance phenotype (iMLSB). Five strains showed MSB phenotype. All of the five isolates with MSB phenotype harboured msrA gene. The prevalence of resistance genes were as follows; ermA 32.9%, ermB 1.2%, ermC 7.3% and msrA 6.1%. Gene combinations of ermA-ermC was 4.9% and ermA-msrA was 1.2%. In one strain resistance mechanism could not determined. Conclusion: Inducible MLSB resistance which can not be determined with routine susceptibility tests can be determined easily by the D test. As a result the use of clindamycin which is a good option for staphylococcal infections can be decided more accurately. For detection of resistance genes a PCR method that provides rapid results can be also used

Retrospective ınvestigation of ınpatients with urinary ınfection in an university medical center

Adnan Menderes Üniversitesi Tıp Fakültesi Arastırma ve Uygulama Hastanesi Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Klinigi'nde yatırılarak tedavi edilen üriner sistem infeksiyonlu hastalar geriye dönük olarak incelenerek tanı ve tedavi yaklasımlarınındegerlendirilmesi amaçlandı. Adnan Menderes Üniversitesi Tıp Fakültesi Arastırma ve Uygulama Hastanesi Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Klinigi'nde 01.01.200101.01.2009 tarihleri arasında yatırılarak tedavi edilen 73'ü kadın (%68,2), 34'ü erkek (%31,8) toplam 107 hasta geriye dönük olarak degerlendirildi. Hastalarda en sık rastlanılan belirtiler ates, dizüri ve kostavertebral açı hassasiyeti olarak saptandı. Alınan idrar kültürlerinde %68.2, kan kültürlerinde ise % 35.7 oranında üreme saptandı. Idrar ve kan kültürlerinde en sık üreyen mikroorganizma . Hastaların 79'unda (%74,7) tedaviye empirik olarak, diger hastalara ise (n=27 %25,3) kültür-antibiyogram sonucu ile baslanmıstı. Empirik tedavide birinci seçenek olarak seftriaksonun (n=65, %83) kullanıldıgı tespit edildi. Çalısmamızda tedaviye empirik olarak baslama oranının yüksek oldugu dikkatimizi çekmistir. Bu durumun düzeltilebilmesi için empirik tedavi baslama ölçütlerinin belirlenmesi önemlidir.It was aimed to evaluate the diagnostic and therapeutic approaches to urinary infections by retrospectively investigating the data belonged to inpatients with urinary infection treated in the clinic of Infectious Diseases and Clinical Microbiology ofAdnan Menderes University Medical Center. 107 patients (73 female and 34 male) treated in the Clinic of Infectious Diseases and Clinical Microbiology of Adnan Menderes University Medical Center between 01.01.2001 and 01.01.2009 were retrospectively investigated. The most commonly observed symptoms in the patients were fever, dysuria and costovertebral angle tenderness. Germinal reproduction was detected in the urinary and blood cultures in a ratio of 68.2% and 35.7%, respectively. was the most commonly detected microorganism in the blood and urine cultures. While 74.7 % of the patients (n=79) were treated by empiric antibiotics due to urgency, 25,3 % of the patients were treated based on culture and antibiogram results. Ceftriaxone was the first choice in the empiric treatment (n=65; 83%). We observed that the rate of starting to therapy empirically was higher. That's why it is important to determine the starting criteria of empiric treatment

Investigation of Clinical and Epidemiological Characteristics of Cases with a Diagnosis of Tularemia During Admission in Kastamonu

Introduction: In this study, it was aimed to evaluate cases with a probable diagnosis of tularemia for clinical and epidemiological characteristics during admission. Materials and Methods: Fifty cases with a probable diagnosis of tularemia were evaluated retrospectively for clinical and epidemiological characteristics during admission to a secondary hospital in Kastamonu in 2012-2013. The cases were classifi ed as “defi nitive tularemia” and “tularemia-like” cases according to their microagglutination test results. The two groups were compared regarding these characteristics. Results: A total of 17 (34.0%) cases were diagnosed as defi nitive tularemia. Glandular and oropharyngeal form (41.1%) was detected most frequently. The onset of complaints in 88.2% (n= 15) of defi nitive tularemia cases and in 51.5% (n= 17) of tularemia-like cases were between December and May. This ratio was higher in defi nitive tularemia cases (p 0.05). Living in rural areas was higher in defi nitive tularemia cases (100.0%), while the usage of central water supply was lower (29.4%) (p 0.05). Conclusion: In endemic regions, tularemia diagnosis should be considered primarily in cases clinically compatible with tularemia and in cases who live in rural areas, do not use central water supply and have similar patients around. Physicians in endemic areas should determine and take into consideration the annual and seasonal distribution characteristics of tularemia cases in their region